Infant of Diabetic Mother (IDM) 

Overview: 

An infant of a diabetic mother is a baby who is born to a mother with diabetes. The baby’s mother had high blood sugar (glucose) levels throughout pregnancy. 

1. Treatment: 

All infants who are born to mothers with diabetes should be tested for low blood sugar (hypoglycemia), even if they have no symptoms.If an infant had one episode of low blood sugar, tests to check blood sugar level will be done over several days. Testing will be continued until the infant's blood sugar remains stable with normal feedings. Feeding soon after birth may prevent low blood sugar in mild cases. Low blood sugar that does not go away is treated with sugar (glucose) and water given through a vein. 

Rarely, the infant may need breathing support or medicines to treat other effects of diabetes. High bilirubin levels are treated with light therapy (phototherapy). Rarely, the baby's blood will be replaced with blood from a donor (exchange transfusion) for this problem. 

2. Effects to Neonate: 

Infants of diabetic mothers (IDM) may have congenital heart disease (CHD) possibly due to the increase in insulin that stimulates fetal growth increasing heart size. Increase in insulin production is in response to the mother’s high blood sugar. Preexisting maternal diabetes can cause more issues due to the presence of high blood sugars during the first trimester when the heart is developing. IDM patients suffer increased incidents of large for gestational age (LGA), CHD, cardiomyopathy, persistent pulmonary hypertension of the newborn (PPHN), and respiratory distress syndrome (RDS). 

3. Prognosis: 

The prognosis for an infant of a diabetic mother (IDM) depends on several factors, including the severity of maternal diabetes, the control of blood sugar levels during pregnancy, and the presence of any associated complications. IDM babies are at higher risk for preterm birth, macrosomia (large size for gestational age), hypoglycemia (low blood sugar), respiratory distress syndrome (RDS), and congenital anomalies, particularly heart and neural tube defects. Early recognition and management of these conditions, such as blood sugar stabilization and respiratory support, can improve outcomes. However, IDM babies are also at increased risk for long-term health issues, including developmental delays, obesity, and type 2 diabetes later in life, particularly if maternal blood glucose levels were poorly controlled. With appropriate neonatal care, many IDM babies can have a good short-term prognosis, though lifelong monitoring for metabolic and developmental issues may be necessary. Often, an infant’s symptoms go away within a few weeks. However, an enlarged heart may take several months to get better. 

4. Complications 

a. Hypertrophic Cardiomyopathy: 

This occurs secondary to the effects of hyperinsulinemia, including increased myocardial fiber size and number

causing cardiomegaly and CHF. This condition usually resolves over the first few months of life but may take as

long as 12 months to resolve. 

b. Congenital Heart Disease: 

The most common cardiac defects include: 

• Transposition of the Great Arteries (TGA) 

• Ventricular Septal Defect (VSD) 

• Coarctation of the Aorta (COA) 

 c. Persistent Pulmonary Hypertension of the Newborn (PPHN): 

There is an increased incidence of PPHN secondary to concurrent conditions in the IDM that contributes to the increased pulmonary vascular resistance. These factors include: 

• Perinatal asphyxia  

• Respiratory distress 

• Polycythemia 

• Hypoglycemia 

What must RT’s be ready for with IDM baby?  

• Respiratory Distress Management: IDM babies are at increased risk of respiratory distress due to factors like maternal diabetes. NICU RTs should be prepared to provide immediate respiratory support, including interventions like oxygen therapy and neonatal ventilation, to address potential respiratory complications. 

• Glucose Monitoring and Support: IDM babies may experience fluctuations in blood glucose levels. NICU RTs should be ready to monitor blood glucose levels and, if necessary, administer glucose or collaborate with the medical team to ensure optimal glucose management. 

• Neonatal Intubation: In severe cases or instances of respiratory distress syndrome (RDS), NICU RTs may need to perform neonatal intubation to assist with breathing. They should be skilled in this procedure and ready to act promptly. 

• Monitoring for Complications: IDM babies may be at risk of various complications, including respiratory issues, hypoglycemia, and other metabolic disturbances. NICU RTs should be vigilant in monitoring for these complications and providing appropriate interventions when necessary. 

• Emergency Situations and Cesarean Sections: In emergency situations, such as the need for an emergency cesarean section, NICU RTs must be prepared for sudden changes in the birthing plan. This may involve rapid response to provide respiratory support for both the mother and the baby.