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RISKS for Infants of Diabetic Mother: HYPOGLYCEMIA and what else???!! — Transcript

by Tala Talks NICU · 4,841 words · 741 segments · language en · Watch on YouTube

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0:02[Music]
0:04a lot of hospitals and news stations
0:06like to discuss the largest baby ever
0:08born in a hospital anywhere and then
0:10they show this beautiful footage of this
0:13absolutely adorable chunky little baby
0:16who looks so healthy and happy and my
0:18first thought is always i wonder what
0:21the mother's blood sugar average was
0:22during the pregnancy
0:27hello and welcome to tala talks nicu
0:30where we take medical concepts and
0:32simplify them so that you learn them and
0:35hopefully retain them forever so you
0:37asked and now we're delivering this
0:39entire video is on infant of diabetic
0:42mothers so before you watch on remember
0:44to like and to subscribe and let us know
0:47below what you would like to watch next
0:50so like i said today we're going to be
0:52talking about infants of diabetic
0:54mothers or as you know we love our
0:57three-letter acronyms and the nicu
0:58that's also shortened to idms so the
1:01topics that we're going to be going over
1:03today are one general information about
1:06diabetes during pregnancy two the
1:08difference between gestational and
1:10pre-gestational diabetes on the babies
1:13three congenital malformations in ibms
1:16four the way diabetes affects the
1:19infant's weight and size
1:20five the size of the infant and the
1:22effect on perinatal trauma and
1:24depression
1:25six metabolic disorders and idms seven
1:28hematological issues and idms and eight
1:32cardiorespiratory issues and idms so
1:35stick around and you will learn
1:36everything you need to know so let's
1:38start with some general information
1:40about diabetes during pregnancy
1:42about one to two percent of all pregnant
1:45women will have either type 1 or type 2
1:48diabetes and a further 6 to 9 percent of
1:52pregnant women are diagnosed with
1:54gestational diabetes during the
1:56pregnancy so as many of you have pointed
1:58out this is really an extremely common
2:00occurrence for all babies especially for
2:03the babies in the nicu
2:04there are different ways that the obese
2:07test mothers to see whether they have
2:10gestational diabetes or not but
2:12generally the tests are performed
2:14somewhere between 24 and 28 weeks and
2:17the first test that's done is generally
2:19which is pretty much done on everybody
2:21is an oral glucose challenge test where
2:24the mother is given like a 50 gram
2:26syrupy drink to drink
2:28and then her blood sugar is tested an
2:30hour later if it's above 140 then she is
2:34at increased risk of diabetes and she
2:36has to do another test then the mothers
2:39come back and have to drink this 100
2:41grams of glucose which is an incredibly
2:45very very sickly syrupy drink and then
2:48their blood sugars are tested one two
2:50and three hours after they've drunk the
2:52drink and if two of those results are
2:54abnormal then the mothers are diagnosed
2:56with gestational diabetes again note
3:00that they are being diagnosed between 24
3:03and 28 weeks as you all know or as you
3:06will learn infants of diabetic mothers
3:08are at increased risk of many different
3:10abnormalities and disorders but the good
3:13news is is that the better that the
3:15mother's sugars are under control the
3:17less likely that the infants will suffer
3:20from those disorders so really good
3:22glucose control is really important for
3:24the mothers apart from measuring mothers
3:27fasting blood sugars or just general
3:29blood sugars during pregnancy to kind of
3:31have an idea of how well her blood sugar
3:34is under control the other test that can
3:36be followed is the hba1c in the mother's
3:39blood
3:40hba1c is a measure of glycated
3:43hemoglobin and it kind of measures the
3:45average amount of blood sugar that the
3:49mother experienced over the last three
3:51to four months ideally in pregnant
3:53mothers with diabetes that number is
3:55somewhere between six and six point five
3:58percent less than that and that would be
4:00considered normal
4:01so for example you can use this
4:03clinically so for example you have a
4:05mother that comes in and she's about to
4:07deliver and her admission blood sugar is
4:0995 and you know that she's diabetic but
4:12you still feel that okay the baby's
4:14probably gonna kind of be okay and then
4:16you find out that her hba1c is like 9.5
4:20percent at that point you have to assume
4:23that actually her blood sugars have been
4:24pretty out of control and you need to be
4:27more concerned about the baby after it's
4:29born
4:30so number two what is the difference
4:32between pre-gestational and gestational
4:34diabetes
4:36obviously this is pretty straightforward
4:38pre-gestational diabetes means that the
4:40mother was diagnosed as having elevated
4:43sugars before she got pregnant whereas
4:45gestational diabetes like we already
4:47said is normally diagnosed somewhere
4:49between 24 and 28 weeks
4:51different classifications have been put
4:54forward for how we should name mothers
4:57that had diabetes before pregnancy and
5:00also how long they've had it for
5:03one of the earliest classifications for
5:05diabetes during pregnancy was developed
5:07by dr priscilla white in 1949 and it's
5:10called the white's classification and
5:13the white's classification is a list of
5:15letters starting from a going further
5:17and further down the alphabet and the
5:19further down the alphabet the letters go
5:22then the longer the mothers have the
5:24disease and the higher the chance that
5:27the mother has vascular disease
5:29dr white developed this to kind of
5:31estimate what are the chances that this
5:34was going to affect the baby so
5:36logically the further down the alphabet
5:39or the worse the diabetes is then the
5:42higher the chance there is a vascular
5:44disease and so the higher the likelihood
5:46that the placenta is going to have
5:48vascular disease as well and that the
5:50baby would be affected and therefore
5:52have increased risk of preterm labor and
5:53stillbirths and everything else under
5:55that classification gestational diabetes
5:59is a if it's a1 it means that the mother
6:02does indeed have high sugars but it's
6:04being controlled by diet if it's a2 then
6:08it means that the mother is being given
6:10medications for her gestational diabetes
6:12so again
6:13a means that the mother was diagnosed
6:15with diabetes between 24 to 28 weeks if
6:19the mother was diagnosed with diabetes
6:21after the age of 20 and has had diabetes
6:24for less than 10 years then she's
6:26classified as a type b diabetic you can
6:29look at the chart i'm not going to go
6:31through all of these but basically as i
6:32said the lower down the alphabet the
6:35letters go the worse the diabetes is so
6:37for example type f means that the
6:40mother's now got nephropathy if she's
6:42diagnosed with type r diabetes then this
6:45is pretty much the worst and at that
6:47point she's got malignant retinopathy so
6:50really bad vascular disease i'm going to
6:52emphasize this point again the one of
6:55the biggest differences between
6:56gestational and pre-gestational diabetes
6:59is that gestational diabetes doesn't
7:01really get out of control until about 24
7:04to 28 weeks
7:05why is this so important
7:08this is so important because as you all
7:10know all of the organs are formed during
7:13the first trimester
7:15and having high circulating levels of
7:18sugar so if that developing embryo is
7:21exposed to high levels of sugar
7:24continuously then the organs are much
7:27more likely to develop abnormally that's
7:29what embryopathic means in fact infants
7:33born to mothers with pre-gestational
7:34diabetes so diabetes diagnosed before
7:37they got pregnant are eight times more
7:40likely to have infants born with
7:42congenital malformations as opposed to
7:45infants born to
7:47non-diabetic mothers mothers with
7:49gestational diabetes have a slightly
7:52increased risk of having congenital
7:55malformations in their infants but
7:57nowhere near the eight times that
8:00pre-gestational diabetics do and in fact
8:02a lot of people postulate that that
8:04slightly increased risk is probably
8:06really just mothers that really were um
8:09pre-gestational diabetic but weren't
8:11actually diagnosed until the 24th to the
8:1428th week of gestation so again just to
8:17emphasize one more time the reason why
8:20true gestational diabetics don't have an
8:23increased risk of abnormal malformations
8:26is that it really doesn't kick in until
8:28way after the organs have already been
8:30formed organs are formed in the first
8:32trimester true gestational diabetes
8:34doesn't really kick in until the end of
8:36the second beginning of the third
8:37trimester there is some very good news
8:40about pre-gestational diabetic mothers
8:43and that is that numerous studies have
8:45shown that if mothers that have diabetes
8:49have really good sugar control even
8:52before that they get pregnant especially
8:54before they get pregnant then the chance
8:57of them having an infant with
8:59malformation absolutely plummets to
9:01really very close to the general
9:03population so excellent sugar control in
9:07diabetic women who are trying to get
9:09pregnant is super super important for
9:11the health of their babies number three
9:13let's go over some of the major
9:15congenital malformations that infants of
9:18mothers with pre-gestational diabetes
9:21are increased risk of having so a
9:24neurological abnormalities and that
9:26includes an increased risk of neural
9:28tube defects also called spina bifida
9:31and that is where there is like an
9:33abnormally made spinal cord whether the
9:36spinal cord and its coverings are kind
9:38of open to the outside world so a baby
9:41is born and you can literally see the
9:42spinal cord or where there is a tract
9:44going towards the juror or the meninges
9:48or whatever or whether it's a tethered
9:50cord anencephaly can also occur more
9:52commonly and that's really where large
9:55areas of the brain are just not formed
9:57properly babies are also increased risk
9:59of having hydrocephalus or more fluid on
10:01the brain a lot of that is associated
10:03with the neural tube defects
10:06and a really really bizarre malformation
10:09that infants of diabetic mothers are
10:11also predisposed to is something called
10:13caudal regression syndrome and that's
10:15really where the whole lower half of the
10:17body kind of from the lower spine
10:19downwards can be formed extremely
10:22abnormally and their legs and the whole
10:25pelvic area can be really almost
10:28non-existent in these infants another
10:30big set of malformations that can occur
10:33is b cardiac malformations so
10:37in fact these can be common enough that
10:40a lot of obs would want to get a fetal
10:42echo on these mothers just to make sure
10:44that their heart is developing normally
10:47but common heart defects include a
10:50truncus a transposition of the great
10:53arteries or a tga remember that one tga
10:56and lga babies that's a big exam
10:58question tricuspid atresias also infants
11:01of diabetic mothers are increased risk
11:03of having situs and versus where just
11:04like all the organs are shifted to the
11:06other side as well as just smaller
11:08malformations like vsds and asds but
11:11altogether much higher risk of having
11:13cardiac issues and c the third big
11:16category is gut anomalies and so really
11:20probably the most common here is
11:21atresias especially anal atresias
11:25the other kind of fairly common
11:28occurrence that happens in the gut is
11:29something called small left colon
11:32syndrome and really this is where kind
11:34of the descending colon is just much
11:37much skinnier than it should be in
11:39infants of diabetic mothers so for
11:41example say you haven't had a say you
11:43have a baby that hasn't stalled in a day
11:46or a day and a half then look back and
11:49check to see if the mother was diabetic
11:51or not because if she really was a
11:53poorly controlled diabetic then that
11:55could kind of guide you in one direction
11:56number four now let's discuss the way
11:59that diabetes affects the baby's size
12:02and weight
12:04i'm sure that you all know this but
12:06infants of mothers with both gestational
12:09as well as pre-gestational diabetes uh
12:12much more likely to be macrosomic or
12:14just really large or what we call
12:17medically large for gestational age
12:19which means that for whatever age they
12:20were born at they are larger than 90
12:23percent of the other babies so they're
12:25above the 90th percentile
12:27as an aside here a lot of hospitals and
12:30news stations like to discuss the
12:32largest baby ever born in a hospital
12:34anywhere and then they show this
12:36beautiful footage of this absolutely
12:39adorable chunky little baby who looks so
12:42healthy and happy and my first thought
12:44is always i wonder what the mother's
12:46blood sugar average was during the
12:48pregnancy what her hba1c was because i
12:51bet that in just about every single one
12:53of these babies the mother probably had
12:55some level of diabetes many factors are
12:58implicated in why these babies get so
13:00large one of them is insulin growth
13:03factor and what's interesting is that
13:06these babies get really large bodies so
13:09their trunk and their legs and their
13:10arms their length and their weight is
13:12generally really large but it doesn't
13:14seem to affect their brain and head
13:16growth as much so normally the head
13:19circumference is a normal size even in a
13:22baby that's lga and i'll explain why
13:24this is so important in a bit
13:26the other important thing that you need
13:28to understand about weight in these
13:31infants of diabetic mothers is even
13:33though the vast majority of them are at
13:35increased risk of being macrosomic or
13:38large there is a smaller percentage that
13:41is actually at increased risk of being
13:44small for gestational age and going back
13:46to the white's classification system
13:48those are generally the babies of
13:51mothers who have advanced and pretty
13:54uncontrolled diabetes so according to
13:57the white classification system that is
13:59for mothers with
14:01type d
14:02diabetes onwards so the ones that you'd
14:05have would you'd expect to have pretty
14:07bad vascular disease and so you would
14:09expect that to also affect the
14:11vascularity of the placenta so these
14:13babies are at increased risk of having
14:16of being iugr and ending up being sga
14:19even though the vast majority of babies
14:22before that so a b and c are much more
14:25likely to be large for gestational age
14:27now number five let's talk about the
14:30effect that the size of the infant has
14:34on the actual delivery course now it's
14:37pretty easy to imagine that if you're
14:40trying to deliver a really really big
14:42baby then that baby is much more likely
14:44to get stuck especially if the baby is
14:47being delivered vaginally
14:48what makes that even worse in infants of
14:51diabetic mothers is like we already said
14:54the head circumference is normally a
14:56pretty proportionate size so it's not
14:59necessarily much larger like the rest of
15:01the body is so what can happen is that
15:04the head can come out it's not so
15:06massive that it can't come out so the
15:07head comes out
15:09and then the shoulders and the rest of
15:11the body gets stuck because it's so much
15:14larger and this is what's called
15:16shoulder dystocia obviously this puts
15:19the babies at much increased risk of
15:21perinatal depression as well as of
15:24traumas so logically these babies would
15:26be at increased risk of having a
15:28brachial plexi injury so like an herb's
15:31paralysis or a clump keys paralysis also
15:34that increased risk of having fractures
15:36so for example a clavicular fracture or
15:38a fracture of the humerus but the thing
15:40that we really worry about is the infant
15:43suffering from perinatal asphyxia or
15:45hypoxia or ischemia where the baby while
15:48it's being delivered where if the head
15:50is stuck and the cord is stuck the baby
15:52is literally not getting enough blood to
15:54its brain and these babies can have
15:56severe perinatal depression and suffer
15:58from hypoxic ischemic injuries so
16:01because of all these reasons if the
16:04mother is known to be carrying a
16:06macrosomic infant so an infant that is
16:09large for gestational age then that
16:11mother is much more likely to be induced
16:13earlier at say 37 weeks or taken for
16:15c-section so in fact infants of diabetic
16:18mothers are at increased risk of having
16:20c-section and by the way all the other
16:23issues that can be more associated with
16:25the c-section most notably ttn or
16:27transient to kidney or the newborn
16:29number six let's talk about metabolic
16:32disorders in idms and the one that
16:35everybody knows and automatically thinks
16:37about is the infants getting
16:39hypoglycemia and let me just explain why
16:42this happens if a mother has high
16:45circulating blood sugar in her
16:47bloodstream
16:48then that that high blood sugar will
16:50cross through the placenta and go into
16:53the baby's bloodstream through a process
16:56called diffusion or facilitator
16:58diffusion if you're doing your neo
16:59boards which as you all know is movement
17:02of a substance from a higher to a lower
17:04concentration so all that sugar will
17:06just kind of carry on going through to
17:08the baby
17:09the mother may have an high insulin
17:11level but insulin does not cross through
17:13the placenta so when the baby's body
17:16sees that high sugar then the baby's
17:19pancreas will start making more and more
17:21insulin this is completely appropriate
17:24during the pregnancy itself when the
17:26fetus's body is actually seeing this
17:28high sugar and we need the insulin to
17:30take the sugar away and put it into the
17:32cells so what happens after the baby is
17:34born
17:35the infant's pancreas is really revved
17:38up and producing a lot of insulin
17:40because the infant has been exposed to
17:42this high sugar concentration throughout
17:45pregnancy so the pancreas is still
17:47really wrapped up but now that the baby
17:49is delivered it's cut off from that
17:51constant source of glucose and now the
17:54baby is responsible for itself to get
17:57glucose into the bloodstream and most
18:00likely the baby won't be able to get
18:02that same sort of substrate won't be
18:04able to get enough sugar into the
18:06bloodstream as had been given to the
18:09baby during pregnancy and the job of
18:11insulin is to take that
18:14blood glucose out of the blood and kind
18:16of pull it into cells and build up the
18:18glycogen and the fat stores and
18:20everything and so the combination of the
18:23higher insulin and not having the same
18:26amount of glucose being given means the
18:28the amount of blood sugar in the blood
18:31vessels of the baby is going to go down
18:34a lot couple that to the fact that a lot
18:36of these babies are large for
18:38gestational age and anyway need more
18:40sugar than the average for gestational
18:42age baby then it's kind of like a double
18:45whammy for why these babies are going to
18:47end up with lower sugars they're lga and
18:49they've got high insulin levels
18:52the risk is such that really all infant
18:55of diabetic mothers should be screened
18:56for low sugars after birth and whether
18:59that's for 12 hours or 24 hours
19:02depending on your hospital's protocol
19:04these sugars should be followed pretty
19:05carefully if the sugar is somewhere
19:07below 40 to 45 mix per deciliter then an
19:11intervention is probably needed again
19:13i'm going to go over a whole other video
19:15on hypoglycemia but for now realize that
19:18idms are definitely an increased risk of
19:20hypoglycemia and in fact even though
19:22they are increased risk of many other
19:24things that i'm also going to talk about
19:26today the low sugar is the only thing
19:29that they actually have to be tested for
19:31so all idms should have a sugar check at
19:34some point one more thing that can
19:36contribute to low sugars and idms is
19:39potential feeding issues in infants of
19:42diabetic mothers and nobody really knows
19:45why but idms especially the really large
19:47ones can have the potential to have very
19:50poor coordination and strength and
19:52stamina for their feeds so here we're
19:55talking about even late pre-term and
19:57turn babies they can take a lot of time
20:00even after they get over their
20:01hypoglycemia issues just kind of
20:03learning how to feed their full feeds in
20:06fact they may be in the hospital for
20:07several days or several weeks just
20:09trying to learn how to feed again nobody
20:12knows exactly why maybe it was related
20:15to the fact that they got the sugar so
20:16easily during pregnancy maybe it's
20:18something to do with just neurological
20:21latent development or something but a
20:24lot of these babies can take a lot
20:25longer than expected just learning how
20:27to feed their full feeds
20:29infants are at increased risk for other
20:32metabolic disorders for example
20:33hypocalcemia or a low calcium which is
20:36generally considered a serum calcium
20:38level below about seven
20:40this is important to remember if you
20:42have like a really jittery infant and
20:45who is an idm and you check the sugar
20:47and the sugar is like 17 you're like
20:49well it's not hypoglycemia remember it
20:51could be hypocalcemia the low calcium is
20:55thought to be secondary to the
20:56interruption of the parathyroid hormone
20:59pathway and normally it is transient but
21:02if it seems to be affecting the babies
21:04anyway especially if they're jittery
21:06then the baby may need to have treatment
21:08whether it's actually giving um extra
21:10calcium or even giving vitamin d and
21:12stuff so that the calcium is better
21:14absorbed for the future idms can also
21:17have
21:18hypomagnesemia i said it or a low
21:20magnesium level and honestly this is
21:24thought to be because the mothers of
21:27diabetic mothers generally do have a
21:28lower magnesium level maybe because they
21:30urinate out more again this is transient
21:33as well and unless it's a cardiac
21:35patient where you really want to have
21:37that magnesium and calcium exactly where
21:39you want it to make sure that you're not
21:41making the heart any more unstable
21:43generally babies that have kind of
21:45slightly low magnesium are going to be
21:47asymptomatic it is important for you to
21:50realize it though because if you do have
21:53low calcium and you also have low
21:55magnesium the calcium will not get
21:57corrected unless you also correct the
21:59magnesium so if you ever have
22:01hypercalcemia in an idm also check the
22:04magnesium level number seven
22:06hematological issues in idms
22:09idms are much more likely to have
22:11polycythemia or a high hematocrit so
22:15polycythemia is defined as a hematocrit
22:18above 65 percent this is thought to be
22:21secondary to some level of placental
22:23insufficiency so basically these babies
22:26are really really large but their
22:28placentas aren't as proportionally large
22:31so they're kind of being exposed to a
22:33constant level of a little bit of
22:35hypoxia this relative chronic hypoxia
22:38will increase the erythropoietin level
22:40in the babies and therefore cause a
22:43higher hermatocrit most of the time this
22:45really isn't an issue the babies are
22:47just nice and ruddy but as that
22:49hematocrit gets higher and higher
22:51especially as it gets closer to about 70
22:54it can make the blood really really
22:56sticky and end up with something called
22:59hyper viscosity syndrome this can result
23:02in sludging or like the little clots or
23:04thrombosis happening in the different
23:06blood vessels so depending where this
23:08happens the most you're going to end up
23:10with different signs and symptoms so
23:12these babies are at increased risk of
23:14having a stroke they are increased of
23:16having respiratory distress if more of
23:18that sludging is happening in like the
23:20capillaries of the lungs or these babies
23:23are also at increased risk of having a
23:24renal vein thrombosis so an idm is a
23:28greatly increased risk of having renal
23:30vein thrombosis compared to the general
23:32population just to emphasize though
23:34again unless the baby is having some
23:36symptoms then we don't really routinely
23:38check the hematocrit in these babies
23:41logically if a baby has a high
23:43hematocrit then they are also increased
23:45risk of having jaundice or
23:46hyperbilirubinemia
23:48as that hematocrit slowly kind of breaks
23:50down and releases the bilirubin in fact
23:53for reasons not entirely known even idms
23:57that don't have a really high hematocrit
23:59have a slight increased risk of having
24:01jaundice most babies in the u.s at least
24:04check for jaundice at some point anyway
24:06so this is pretty much a routine test
24:08checked in both idms as well as as in
24:11non-idms now eight cardiorespiratory
24:14issues and idms like we already said in
24:18infants of mothers with pre-gestational
24:19diabetes um are at increased risk of
24:23having structural anomalies of the heart
24:25for example a tga or transposition of
24:27the great arteries so it is recommended
24:30that these infants especially the ones
24:33with the with the mothers with the
24:34poorly controlled sugars should get a
24:37fetal echo even obviously before the
24:39mothers deliver just to check the
24:41anatomy of the heart
24:43but even in infants of mothers with
24:45gestational diabetes are at an increased
24:48risk of the high sugars affecting their
24:51hearts and the way that it can do that
24:53is causing a type of cardiomyopathy it
24:56is always transient but sometimes the
25:00infant and the heart has to be supported
25:02until the heart kind of remodels itself
25:04and goes back to normal this type of
25:07cardiomyopathy happens when the
25:09interventricular septum so basically the
25:12wall between the left ventricle and the
25:14right ventricle gets really really
25:17hypertrophied or muscular or much more
25:20thickened
25:21if that intraventricular wall is really
25:24thickened so say this is my lv wall and
25:27this is the intraventricular wall then
25:30during systole
25:31when the whole heart is being squeezed
25:34it may get to a point that it actually
25:37blocks off the
25:39blood from going out of the aorta
25:41because the whole heart is much thicker
25:43than it should than it should be and so
25:45you end up with like an outflow track
25:47obstruction because the blood literally
25:49cannot get out from the aorta because
25:52it's being pushed together the muscles
25:54of the opposite side of the wall are
25:55being pushed together
25:57this can result with decreased blood
25:59going to the body as well as just kind
26:01of back up and respiratory distress so
26:04sometimes we do have to treat this very
26:06aggressively and the way that we treat
26:08it is kind of twofold the first thing
26:10that we have to do is try to make sure
26:12it's one of kind of the rare disease of
26:14the heart where we really want to keep
26:16the fluid level up because we want there
26:19to be lots of blood in the heart so that
26:21that left ventricle is full and it's
26:23less likely to become obstructed when
26:26it's squeezing together during systole
26:28the second thing that we want to do
26:30which we often don't do as well in heart
26:32disease is we want to give a better
26:34blocker or we want to slow down the rate
26:37of the heart beating because if we do
26:39that then there'll be more time in
26:41diastole where the blood can fill the
26:43left ventricle and so again with more
26:45blood in the ventricle they're less
26:47likely to squeeze together and cause
26:49that outlet obstruction
26:51often we don't have to do anything we
26:53may hear a little murmur and we'll get
26:55an echo and see that that
26:57intraventricular wall is slightly
26:59thickened
27:00but really the baby is doing fine
27:02eventually even in the ones that are
27:04really symptomatic eventually the heart
27:06just kind of remodels itself and the
27:08heart will end up being completely
27:10functionally as well as structurally
27:12normal whether that takes a few months
27:14or a few years
27:16finally and this shouldn't really be
27:17finally because honestly i think it's
27:19one of the things that we see the most
27:20after the hyperglycemia is that idms are
27:23at increased risk of rds or respiratory
27:26distress syndrome or surfactant
27:28deficiency this is thought to be
27:30secondary to
27:32high levels of sugar maybe delaying the
27:34production of surfactant in the babies
27:37and practically though what that means
27:40is is that we may see worsened rds in
27:43the smaller babies but even in like a 37
27:47week or maybe even a 38 weeker who's
27:49technically term
27:51these the babies that may present like
27:52they've got rds and you can't really
27:55figure out why they've got their air
27:56bronchograms and their chest x-rays are
27:58hazy and then you just kind of put it
28:00together that the mother had like really
28:02bad uncontrolled diabetes and so these
28:04babies even though they are term are
28:06actually lacking surfactant and then the
28:09other thing that we see a lot in idms is
28:11an increased risk of ttn or transient
28:14tachypnea of the newborn which you will
28:16know if you saw the ttn video
28:18and
28:19really that is kind of twofold as well
28:22the high sugar is somehow thought to
28:24delay the fluid absorption from the
28:26lungs but also like we said earlier if
28:29the babies are large for gestational age
28:31they're much more likely to be taken for
28:33an elective c-section which means that
28:35they're much more likely to have ttn
28:37anyway so definitely ttn is a much
28:40higher risk in idms okay that was a lot
28:43today i uh tried not to go too much into
28:46detail and i left a lot of stuff out so
28:48i hope that it was helpful for you um
28:50please do like the video and remember to
28:53subscribe if you haven't already thank
28:55you if you have and please let us know
28:57below what you'd like us to talk about
28:59next thank you so much for being here
29:03[Music]
29:21you

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