METABOLIC EVENTS IN INFANTS OF DIABETIC MOTHERS DURING FIRST 24 HOURS AFTER BIRTH III.

ABSTRACT. Plasma amino acid concentrations (AAC) were studied in 31 diabetic mothers (10 of White class A, 10 of B-C and 11 of D-F) and their 32 infants during the first 24 hours after birth. Only minor differences between the 3 groups were found at birth and 2 hours, and none at 12 and 24 hours after birth. The individual AAC in umbilical vein plasma did not correlate with birthweight. All AAC except aspartic acid, aspargine, cystine and glutamic acid were higher in umbilical venous plasma than in maternal plasma. Umbilical venousarterial differences of amino acids did not correlate with maternal or umbilical vein insulin concentrations except for threonine and valine. In general essential amino acids decreased after birth. In 8 infants with hypoglycemia and hyperinsulinism at 2 hours of age several plasma amino acids were lower than in the normoglycemic infants.     

METABOLIC EVENTS IN INFANTS OF DIABETIC MOTHERS DURING FIRST 24 HOURS AFTER BIRTH II.

ABSTRACT. Changes in plasma glycerol (FG), free fatty acids (FFA) and triglyceride (TG) were studied in 24 normo- and 8 hypoglycemic infants of diabetic mothers (IDM). In both groups a normal rise in plasma FG 2 hours after birth was found indicating unimpaired lipolysis. The rise in plasma FFA, however, was only about 50% of normal in normoglycemic IDM and about 25% of normal in hypoglycemic IDM. The rise in plasma TG was normal in normoglycemic and about 70% of normal in hypoglycemic IDM. The 2 hour rise in plasma FFA correlated with the 2 hour concentration of insulin and glucose, whereas the rise in plasma FG and TG did not. Maternal plasma FFA correlated with fetal FFA retention (unbilical vein minus artery (V-A) FFA concentrations). No correlations were found between maternal plasma FFA values and birth-weights nor between umbilical V-A FFA concentrations and birth-weights.     

PLASMA NORADRENALINE AND ADRENALINE IN INFANTS OF DIABETIC MOTHERS AT BIRTH AND AT TWO HOURS OF AGE

ABSTRACT. Plasma noradrenaline and adrenaline in the umbllical artery were very high in many infants of both diabetic mothers (IDM) and non-diabetic mothers (controls) compared to values obtained in adults. Blood pH was slightly but significantly lower in IDM than in controls at delivery. There was a significant negative correlation between plasma noradrenaline and blood pH in IDM at birth, but no correlation between plasma noradrenaline and blood glucose, birth weight and Apgar scores. Plasma noradrenaline decreased significantly from birth to two hours of age both in IDM and controls. At two hours of age plasma noradrenaline and adrenaline were significantly greater in IDM compared to controls whereas blood glucose concentration was lower in the former group. There was a close inverse correlation between plasma noradrenaline and adrenaline, respectively, and blood glucose in IDM at two hours of age but not in controls. The elevated plasma noradrenaline at delivery in IDM may be explained by clinically undetectable acidosis whereas elevated plasma catecholamines at two hours are probably due to hypoglycaemia.     

METABOLIC OBSERVATIONS IN INFANTS OF STRICTLY CONTROLLED DIABETIC MOTHERS

Abstract. Thirty-five infants of strictly controlled diabetic mothers (IDM), 12 infants of gestational diabetic mothers (IGDM) and 29 control infants were studied to assess the influence of maternal blood glucose level during pregnancy on infant metabolic measurements. At 2 hours after birth the disapperance rate k_t of intravenously injected glucose was determined. Plasma concentration of glucose, insulin, FFA, glycerol and β-hydroxybutyrate were followed in umbilical arterial blood. The 2 hour mean k_t value of IDMs (1.27) was higher (p<0.05) than in IGDMs (1.14) and controls (0.80), but the group mean values were no different at 3 to 5 days although the k_t values were higher. In 10 IDms, k_t values were determined both at 2 hours (1.24) and at 3 days (1.39) without significant differences. Pretest FFA but not glycerol values correlated inversely to k_t values in IDMs and IGDMs. A late insulin peak at 60 min was found in both controls and IGDMs. Insulin responses were unrelated to k_t values. No relation was found between pregnancy glucose value (5 daily determinations during 4 and 2 weeks prior to delivery in DM and GDM respectively) or maternal glucose at delivery and k_t values of IDMs and IGDMs. According to the FFA and glycerol values at 2 hours after birth, 3 sub-groups of IDMs and IGDMs were arbitrarily formed. IDMs and IGDMs of group 1 had glucose, k_ts, FFA, glycerol and β-hydroxybutyrate values no different from controls, whereas sub-groups 2 and 3 showed increasing metabolic deviations. Clinical data and pregnancy glucose levels could not separate the 3 sub-groups. However, the day-to-day variation in maternal glucose was greater in sub-group 3. Mean values of daily maternal blood glucose differences at 10 o'clock correlated to 2-hour k_ts in IDMs. We conclude that strict metabolic control during pregnancy will normalize metabolic adjustment of the infant, thus supporting the maternal hyperglycemia-fetal hyper-insulinism theory.     

EFFECT OF GLUCAGON ON BLOOD GLUCOSE HOMEOSTASIS IN INFANTS OF DIABETIC MOTHERS

ABSTRACT: Wu, P. Y. K., Modanlou, H. and Karelitz, M. (Department of Pediatrics, University of Southern California School of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, USA). Effect of glucagon on blood glucose homeostasis in infants of diabetic mothers. Acta Paediatr Scand, 64:441, 1975.–Thirty infants of diabetic mothers (IDM) were randomly selected and divided into 3 groups of 10 babies each. Group A were used as controls. Group B received glucagon 300Uµg/kg i.m. and Group C received glucagon 300µg/kg i.v. at birth. Hypoglycemia developed in 6 infants in Group A and 4 infants in Group B. None of the infants in Group C had hypoglycemia. Mean blood glucose was higher in Group C in the first 3 hours than Group A, and higher in Group B in the first 1/2-1 hour. I.v. glucagon, 300µg/kg when given in the first IS minutes after birth prevented hypoglycemia in IDM in the first hours of life.     

THE TRANSCAPILLARY ESCAPE RATE OF T-1824 IN NEWBORN INFANTS OF DIABETIC MOTHERS AND NEWBORN INFANTS WITH RESPIRATORY DISTRESS OR BIRTH ASPHYXIA

ABSTRACT. Ingomar, C. Joh. and Klebe, J. G. (Diabetes Center of the Royal Maternity Hospital and the University Department for Newborn Infants, Rigshospitalet, Copenhagen, Denmark). The transcapillary escape rate of T-1824 in newborn infants of diabetic mothers and newborn infants with respiratory distress or birth asphyxia. Acta Paediatr Scand, 63: 565, 1974.—The influence of certain clinical conditions (idiopathic respiratory distress, birth asphyxia and diabetic embryopathy) on the transcapillary escape rate of human albumin, was investigated in 52 newborn infants. The dyestuff T-1824 (Evan's blue) was used for the labelling of plasma albumin in vivo, and its plasma concentration was determined spectrophotometrically using a micro-method. From serial measurements carried out during the first hour following the injection of T-1824, the escape rate (%/hour) was calculated. Among healthy newborn infants the escape rate was found to increase proportional to the magnitude of the placental transfusion. The same applied to infants with respiratory distress and infants of diabetic mothers, the escape rate of whom did not differ from that of healthy infants. By contrast, the escape rate of albumin was, among some cases of birth asphyxia, found to be increased out of proportion to the placental transfusion, which the infants had received. It is discussed whether the increased escape rate found in these cases is caused by an increased capillary permeability or an increased capillary surface area.     

EFFECT ON SERUM CALCIUM OF lα-HYDROXY-VITAMIN D3 SUPPLEMENTATION IN INFANTS OF LOW BIRTH WEIGHT, INFANTS WITH PERINATAL ASPHYXIA, AND INFANTS OF DIABETIC MOTHERS

Abstract. Petersen, S., Christensen, N. Chr. and Fogh-Andersen, N. (Department of Neonatology and Department of Clinical Chemistry, Rigshospitalet, Copenhagen, Denmark). Effect on serum calcium of lα-hydroxy-vitamin D₃ supplementation in infants of low birth weight, infants with perinatal asphyxia, and infants of diabetic mothers. Acta Paediatr Scand, 70: 897, 1981.-Thirty infants of low birth weight, 34 infants with perinatal asphyxia, and 16 infants of diabetic mothers were investigated for early neonatal hypocalcaemia. The infants were randomized into a group prophylactically given lα-hydroxy-vitamin D₃, 0.05 or 0.10 μ/kg i.v. on the first 3 days of life, and an untreated control group. In infants of low birth weight and infants of diabetic mothers there were no differences in serum ion-Ca concentrations on days 2, 3, 5, and 7 between the treated and untreated groups. In infants with perinatal asphyxia, however, serum ion-Ca concentrations on days 5 and 7 were significantly higher in the treated than in the untreated group, while on days 2 and 3 the differences were not statistically significant. The hypocalcaemia in asphyctic infants was not correlated to bicarbonate treatment, but infarits with severe signs of asphyxia had lower serum ion-Ca concentrations than infants with only mild or no signs. Hypocalcaemia in asphyctic infants might be explained by a decreased concentration of 1 α, 25-dihydroxy-vitamin D₃ following reduced lα-hydroxylation in the kidney as a consequence of anoxia during perinatal asphyxia.     

CIRCULATORY ADAPTATION IN NEWBORN INFANTS OF STRICTLY CONTROLLED DIABETIC MOTHERS

ABSTRACT. Possible relations between neonatal circulatory function and maternal diabetic control were investigated in 22 infants of strictly controlled diabetic mothers during the first 2 days after birth. Eleven infants were delivered vaginally (V) and 11 infants by elective cesarean section (S). Maternal diabetes was more severe in the latter group. Half of the infants had one or more episodes of neonatal morbidity although none presented symptomatic hypoglycemia. Plasma glucose FFA and C-peptide were measured at birth and 3-6 hours later together with skinfold thickness; heart size was determined by X-ray at 24-28 hours; stroke volume and cardiac output were repeatedly determined by transthoracic impedance and ECG. C-peptide at birth was higher in group S than in V. C-peptide in both groups were neither related to glucose or FFA nor to birthweight or skinfold thickness. Infants with neonatal complications including cardiomegaly had the highest C-peptide values. Skinfold was positively correlated to maternal pregnancy glucose level, birthweight percentile and infant heart volume. Mean values for stroke volume and cardiac output were similar in both groups and not different from normal controls when related to body weight. Heart volume and stroke volume were significantly related. ECG abnormalities were seen in 6 infants who showed cardiomegaly on X-ray. We suggest that the present finding of an association between elevated C-peptide concentration at birth and the occurrence of neonatal complications including cardiomegaly and ECG abnormalities could be the consequence of functional hyperinsulinism and that the cardiomegaly is of adaptive type.     

METABOLIC OBSERVATIONS IN INFANTS OF STRICTLY CONTROLLED DIABETIC MOTHERS Plasma Levels of Glucose, FFA, Glycerol and D-β-hydroxybutyrate during the First Two Hours after Brith

Arterial concentrations of FFA, glycerol, glucose and D-β-hydroxybutyrate were serially measured during the first 2 hours after birth in IDMs, IGDMs and in control infants. All diabetic mothers were subjected to a well defined program of control during pregnancy. IDMs had only a slight increase in mean plasma FFA concentrations and the values were significantly lower than those of the IGDM and control groups at all times. In contrast the rise in mean plasma glycerol values was significant and similar in all groups, suggesting a comparable increase in lipolysis. Following birth IDMs showed a more pronounced decrease in mean plasma glucose values than the other groups. Mean plasma values of D-β-hydroxybutyrate showed a significant drop during the first 60 minutes and thereafter the values remained low and were not significantly different between the groups. The pattern of changes in FFA, glycerol and glucose was not influenced by type of delivery, duration of diabetes and/or presence of retinopathy in the mothers, nor was there any apparent relationship to the degree of maternal metabolic control during pregEancy. It is suggested that the low mean FFA levels despite of increasing mean glycerol concentrations in IDMs are explained by an increased rate of re-esterification of FFA withi!i adipose tissue. Thcse findings can only partly be explained by postnatal functional hyper-insulinism. The recent demonstration af higher than normal glycogen concentrations within adipose tissue in IDMs cffers a more plausible explanation for the increased rate of re-esterification during the first hours after birth. The p;esent data do not allow of conclusions as to thc relative importance of increased glycogen stores as compared with that of hyperinsulin-ism during the first 2 hours after birth in IDMs.     

ACID-BASE AND ELECTROLYTE BALANCE IN NEWBORN INFANTS OF DIABETIC MOTHERS

The acid-base and electrolyte balance was studied in 8 diabetic and 8 healthy mothers and their infants at caesarean section near term. Microliter methods were used for determination of pH, total CO₂, potassium, sodium, chloride, calcium, total protein, inorganic phosphorus, glucose and lactate. The acid-base and electrolyte balance of the newborn infant of a well-controlled diabetic mother did not differ significantly from that of a newborn infant of a healthy mother. The infant of a diabetic mother seemed to be able to correct for an excess load of glucose and to maintain a “normal” level in the blood in the umbilical artery. Earlier observations that intense maternal hyperventilation is associated with a changed uterine and placental circulation and results in fetal acidosis were not confirmed in the present study.     

HYPOCALCEMIA IN INFANTS OF DIABETIC MOTHERS

ABSTRACT. Twenty-two infants of diabetic mothers (IDM) were studied and were divided into two groups: a first group of 14 IDM did not receive vitamin D3 and was studied at birth and at 2, 24, 48 and 120 hours; a second group was given daily dosage of 60 μg of vitamin D3 from 3 hours to 120 hours and was studied at 2 hours and 120 hours.
In the first group, serum calcium levels decreased markedly during the first 24 hours of life (mean ± SD: 1.77±0.3 mmol/1, p <0.01) and remained low at 5 days. Serum phosphorus levels remained normal but serum magnesium levels decreased significantly at 24 hours (mean ± SD: 0.64±0.108 mmol/1, p <0.01) and returned to normal at 5 days. Serum immunoreactive parathormone levels increased consistently to high levels at 24 hours and remained elevated at 120 hours ( p <0.001). Serum immunoreactive calcitonin levels increased at 24 hours ( p <0.001) and decreased at 120 hours to low or undetectable values in all infants.
In group II, serum 25O-HD levels and 1.25 OH₂ D levels increased significantly ( p <0.001) respectively to 27.2±2.7 ng/ml and 114±20 pg/ml at 5 days. The results of this study show hypocalcemia to be a common event in IDM during the first days of life and furthermore hypophosphatemia, hypoparathyroidism, hypomagnesemia or defect of vitamine D metabolism would not seem to be the main etiological factors.     

IMMUNOELECTROPHORETIC DETERMINATION OF SERUM GLOBULINS 1N NEWBORN INFANTS OF DIABETIC MOTHERS

ABSTRACT. Davidsen, Otto (Diabetes Centre, Royal Maternity Department B, Rigshospitalet and Department of Clinical Chemistry, Sundby Hospital, Copenhagen, Denmark) Immunoelectrophoretic Determination of Serum Globulins in Newborn Infants of Diabetic Mothers. Acta Paediatr Scand, 63: 833, 1974.—Serum globulins were investigated by means of crossed immunoelectrophoresis in the cord blood from 40 infants of diabetic mothers and 92 infants with non-diabetic mothers. In infants of non-diabetic mothers the concentration of most globulins was lower than in adults and positively correlated to the gestational age of the infant. For α₂-HS-glycoprotein and an unidentified α₂-glob-uEn, however, a negative correlation to the gestational age was observed. Infants of diabetic mothers had a higher Concentration of transferrin and lower concentrations of α₂-macroglohulin and α₁-lipoprotein as compared with infants of the reference group. In the diabetes group the globulin concentrations were correlated neither to the gestational age nor to their increased birth weight, but the ratio α₂,-macroglobulin/α₂-HS-glycoprotein, which was expected to be independent of variations in the degree of hydremia of the infants, was significantly correlated to the gestational age. As judged from this parameter, infants of diabetic mothers are comparable to infants of non-diabetic mothers of about 4 weeks lower gestational age.     

PLACENTAL TRANSFUSION IN INFANTS OF DIABETIC MOTHERS ELUCIDATED BY PLACENTAL RESIDUAL BLOOD VOLUME

The influence of the method of delivery and the clamping technique on the placental transfusion is investigated by measurement of the placental residual blood volume in 58 infants of diabetic mothers and in 65 infants of nondiabetic mothers. It is shown that infants of diabetic mothers delivered vaginally compared with infants of diabetic mothers delivered by caesarean section, have a larger placental residual blood volume, if early clamping is employed. This relation suggests that also in infants of diabetic mothers, a temporary deposition of the distribution of the foeto-placental blood volume between the infant and the placenta occurs during vaginal delivery, because of the impaired venous backflow to the infant. The difference in the placental residual blood volume is more pronounced for infants of diabetic mothers than for infants of non-diabetic mothers. Further, it is shown that the placental residual blood volume is significant larger in infants of diabetic mothers but only after vaginal delivery with early clamping, compared with the same group of infants of non-diabetic mothers.     

METABOLIC EFFECTS OF OBSTETRIC REGIONAL ANALGESIA AND OF ASPHYXIA IN THE NEWBORN INFANT DURING THE FIRST TWO HOURS AFTER BIRTH: I. Arterial Blood Glucose Concentrations

Abstract. Swanstrom, S. and Bratteby, L.-E. (Perinatal Research Unit of the Department of Paediatrics and the Unit of Paediatric Physiology of the Department of Clinical Physiology, University Hospital, Uppsala, Sweden). Metabolic effects of regional analgesia and of asphyxia in the newborn infant during the first two hours after birth. I. Arterial blood glucose concentration. Acta Paediatr Scand, 70: 791, 1981. Effects of obstetric regional analgesia and of asphyxia on the arterial blood glucose concentrations were inestigated in 83 newborn infants divided into a control group, an asphyxia group, a continuous epidural, and a paracervical + pudendal block group. Lidocaine was used in the analgesia groups. All infants except those of the asphyxia group had 1-minute Apgar scores ≥7. 1) In the asphyxiated infants high blood glucose values and strong correlations between blood glucose concentrations and different signs of asphyxia (Apgar score, base deficit and lactate) were found. 2) In infants whose mothers were given regional analgesia the results were: (a) high glucose values in 20 % of the infants and an association between increased glucose concentrations in these infants and signs of fetal distress, (b) low blood glucose values (< 1.67 mmol/1) in 27 % of the infants. It is recommended that the blood glucose is checked in the newborns after obstetric regional analgesia.     

FREE FATTY ACIDS, GLYCEROL AND TRIGLYCERIDES DURING THE FIRST 24 HOURS IN INFANTS WITH A BIRTH WEIGHT ≤2 700 GRAMS

ABSTRACT. Christensen, N. C. (Departments of Obstetrics and Paediatrics, Odense University Hospital, Odense, Denmark). Free fatty acids, glycerol and triglycerides during the first 24 hours in infants with a birth weight <2 700 grams. Acta Paediatr Scand 70:485,.–The influence of birth weight and gestational age on the concentrations of free fatty acids, glycerol and triglycerides during the first 24 hours of life were studied in 86 healthy newborn infants with BW ≤2700 g. Very low FFA values were found in the first 6 hours in infants with GA ≤34 weeks, whereas FFA increased from the second hour in infants with higher GA. All infants had peak values at 12 h. Significant correlations were found between FFA and GA, most pronounced in the second hour after birth. No differences were seen between AGA and SGA infants of similar GA. High glycerol concentrations were found from the second hour in all infants irrespective of GA and BW. Triglyceride concentrations 24 hours after birth were not influenced by GA or BW. The finding of intact lipolysis but low FFA releases in the first hours in infants with GA ≤34 weeks could not be explained by differences in rectal temperature, blood glucose or caloric intake.     

PLASMA INSULIN AND K VALUES DURING INTRAVENOUS GLUCOSE TOLERANCE TEST IN NEWBORN INFANTS WITH ERYTHROBLASTOSIS FOETALIS

Plasma insulin was determined during i.v. glucose tolerance test (GTT) performed 3 hours after birth in the fasting state in 18 infants with erythroblastosis foetalis (e.f.) and in 11 control infants. Mean fasting plasma insulin concentration as well as the insulin concentration at each time during the i.v. GTT and the disap pearance rate of glucose (K value) were significantly higher in the e.f. infants than in the control group. E.f. infants—as a group—exhibit hyperinsulinism at birth. Between birth weight and fasting insulin concentration and between birth weight and K value significant positive correlations were found. The plasma insulin concentration after the i.v. glucose load showed an even increase, reaching a maximum in 40–60 min in the e.f. group, fundamentally the same pattern that was observed in the normal group, but different from that in infants of diabetic mothers. It is stressed that the hyperinsulinism in e.f. infants is probably of a genesis different from that in infants of diabetic mothers.     

THE INFLUENCE OF THE METHOD OF DELIVERY AND THE CLAMPING TECHNIQUE ON THE RED CELL VOLUME IN INFANTS OF DIABETIC AND NON-DIABETIC MOTHERS

The red cell volume has been investigated in 35 infants of diabetic mothers and in 18 infants of non-diabetic mothers. It is shown that not only the clamping technique but also, the method of delivery has an influence on the red cell volume of the infant. Thus the red cell volume is less in infants delivered vaginally with early clamping, compared with infants delivered by caesarean section with early clamping. These findings support the theory that during vaginal delivery a temporary change in It is suggested that IDM during vaginal delivery with early clamping deposit more blood in the placenta than do the non-IDM, since we found a smaller red cell volume per kg the distrfbution of. the foeto-placental blood volume between placenta and child occurs.     

CHYMOTRYPTIC ACTIVITY IN STOOL OF LOW BIRTH WEIGHT INFANTS IN THE FIRST WEEK OF LIFE

ABSTRACT: Jodl, J., Kornfalt, R. and Svenningsen, N. YV. (The Motol Paediatric Clinic, University of Prague, Prague, Czechoslovakia, and the Department of Paediatrics, University Hospital, Lund, Sweden). Chymotryptic activity in stool of low birth weight infants in the first week of life. Acta Paediatr Scand, 64:619, 1975.–Pancreatic enzyme activity in low birth weight (LBW) infants during the first postnatal week has been evaluated by analysing the chymotrypsin content of 198 stool specimens from 42 LBW infants with birth weights ranging between 750 and 2570 g. A wide variation in chymotryptic activity yet with a tendency to initially low values with a peak on the third day after birth was found. Small-for-gestational age (SGA) infants had significantly lower values than appropriate-for-gestational age (AGA) infants. This is considered due to intra-uterine malnutrition with secondary pancreatic dysfunction in SGA infants. In screening program for cystic fibrosis or other defects of exocrine pancreatic activity, low stool chymotrypsin values cannot be considered pathological until after the fourth day of life.