Maayan-Metzger Ayala, Lubin Daniel, Kuint Jacob
Department of Neonatology, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Ramat Gan and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Neonatology. 2009;96(2):80-5. doi: 10.1159/000203337. Epub 2009 Feb 19.
To discover the risk factors for developing hypoglycemia in newborns born to diabetic mothers and to characterize the rates of glucose concentrations in the first two days of life.
Retrospective recordings of medical charts of 576 healthy term infants of diabetic mothers during an 18-month period. We determined the following pre-feeding glucose concentrations: 'normoglycemia' (> or =47 mg/dl = 2.6 mmol/l), 'mild hypoglycemia' (40-46 mg/dl = 2.2- 2.5 mmol/l), 'moderate hypoglycemia' (30-39 mg/dl = 1.7-2.1 mmol/l) and 'severe hypoglycemia' (<30 mg/dl = 1.7 mmol/l).
Glucose concentrations below 'normoglycemia' and 'severe hypoglycemia' were observed in 280 (48.6%) and 23 (4%) of the infants, respectively. The main risk factors for developing glucose concentrations below 'normoglycemia' in the first day of life were large size for gestational age and maternal insulin-dependent diabetes mellitus. 'Severe hypoglycemia' was more common among infants born to mothers who needed insulin (either type A2 or insulin-dependent diabetes mellitus). Infants born to mothers with insulin-dependent diabetes mellitus were less mature, heavier, large for their gestational age and exhibited more 'severe and moderate hypoglycemia' in the first day of life as compared to infants born to diabetes type A1 and A2 mothers. In addition, infants who were large for gestational age tended to have more 'moderate hypoglycemia' when born to diabetes type A1 mothers compared to small and appropriate-for-gestational-age infants. Thirty infants (5%) still had hypoglycemia on the second day of life. This subgroup of infants did not differ with regard to maternal-type diabetes.
Infants born to diabetic mothers tend to have a high rate of hypoglycemia on the first day of life when a relatively high cut-off point (> or =47 mg/dl = 2.6 mmol/l) is used. Infants born large for gestational age as well as those born to mothers with juvenile diabetes mellitus are at higher risk and should be closely monitored.
探究糖尿病母亲所生新生儿发生低血糖的危险因素，并描述其出生后前两天的血糖浓度变化情况。
回顾性记录576例糖尿病母亲的健康足月儿在18个月期间的病历。我们测定了以下喂养前血糖浓度：“血糖正常”（≥47mg/dl = 2.6mmol/l）、“轻度低血糖”（40 - 46mg/dl = 2.2 - 2.5mmol/l）、“中度低血糖”（30 - 39mg/dl = 1.7 - 2.1mmol/l）和“重度低血糖”（<30mg/dl = 1.7mmol/l）。
分别在280例（48.6%）和23例（4%）婴儿中观察到血糖浓度低于“血糖正常”和“重度低血糖”的情况。出生第一天血糖浓度低于“血糖正常”的主要危险因素是大于胎龄儿和母亲胰岛素依赖型糖尿病。“重度低血糖”在需要胰岛素治疗的母亲（A2型或胰岛素依赖型糖尿病）所生婴儿中更为常见。与A1型和A2型糖尿病母亲所生婴儿相比，胰岛素依赖型糖尿病母亲所生婴儿在出生第一天不太成熟、体重更重、大于胎龄，且表现出更多的“重度和中度低血糖”。此外，与小于胎龄儿和适于胎龄儿相比，A1型糖尿病母亲所生大于胎龄儿往往有更多的“中度低血糖”。30例（5%）婴儿在出生第二天仍有低血糖。该亚组婴儿在母亲糖尿病类型方面无差异。
当采用相对较高的血糖切点（≥47mg/dl = 2.6mmol/l）时，糖尿病母亲所生婴儿在出生第一天低血糖发生率较高。大于胎龄儿以及青少年糖尿病母亲所生婴儿风险更高，应密切监测。
