[Secundum atrial septal defect in newborns of diabetic mothers].

AIM

To evaluate in own material the incidence of secundum atrial septal defect type fossa ovalis (ASD II) with signs of cardio-respiratory maladaptation in infants of diabetic mothers (IDM) during the first 48 hours of life, and subsequent echocardiography follow-up of babies with ASD II during the first year of life.

MATERIAL AND METHODS

In the period from September 2002 to March 2003 a total of 502 neonates were born and 62 number them were from diabetic mothers. Echocardiography scanning was performed in a group of 49 neonates (42 IDM and 7 full-term infants of healthy mothers) with signs of cardio-respiratory maladaptation during the first 48 hours of life. Six neonates were born from pregestational diabetes mothers and 36 from gestational diabetes mothers (G1-17, G2-19), Birth weight of the newborns were in the range from 1370 to 4450 g, and gestational age was in the range between 30 to 41, mean 38.6 weeks. Apgar score was > 7 in 91.8% of neonates. In the whole study besides laboratory tests in direction of early onset infection, brain ultrasound and echocardiography scanning were performed. M-mode, 2-D presentation and Doppler blood flow velocity were done 4 times during the first year of life (in 2nd, 4th and 12th month).

RESULTS

ASD II with 2 to 9 mm diameter was diagnosed in 20 (40.8%) of the examined neonates. Among them 16 were IDM and 4 from healthy mothers. There was no statistically significant difference in the frequency of ASD II recognition in accordance with type of maternal diabetes. During subsequent echocardiography scanning, spontaneous closure of ASD II was found in 11 (55.0%) babies at the age of 12 months. In the remaining 9 (45.0%) infants a decrease in ASD II was notices in 6 (30.0%) cases and the same diameter of arterial defect was left in 3 (15.0%).

CONCLUSION

In 38.1% of neonates born to diabetic mothers, cardio-respiratory disturbances during the first 48 hours of life were accompanied by secundum atrial septal defect. During 12 months follow-up with echocardiography evaluation, decrease in diameter or spontaneous closure o ASD II occurred in most of our patients.