[Secundum atrial septal defect in newborns of diabetic mothers]
Grazyna Dawid1, Maria Beata Czeszynska, Anita Horodnicka-Jozwa
1Klinika Neonatologii, Pomorska Akademia Medyczna, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland.
Insights
Secundum atrial septal defect (ASD II) was found in 40.8% of neonates with cardio-respiratory issues, particularly in infants of diabetic mothers (IDM). Most cases showed spontaneous closure or reduction in ASD II diameter within the first year.
Area of Science:
- Neonatal Cardiology
- Pediatric Echocardiography
- Maternal-Fetal Medicine
Background:
- Infants of diabetic mothers (IDM) are at increased risk for congenital heart defects.
- Cardio-respiratory maladaptation in neonates necessitates thorough cardiac evaluation.
Purpose of the Study:
- To determine the incidence of secundum atrial septal defect (ASD II) in neonates with cardio-respiratory issues, especially IDMs.
- To assess the natural progression of ASD II through echocardiography during the first year of life.
Main Methods:
- Echocardiography performed on 49 neonates (42 IDM, 7 controls) with cardio-respiratory symptoms within 48 hours of birth.
- Follow-up echocardiography at 2, 4, and 12 months to evaluate ASD II changes.
- M-mode, 2-D, and Doppler assessments were utilized.
Main Results:
- ASD II (2-9 mm) was diagnosed in 20 neonates (40.8%), with 16 being IDMs.
- No significant difference in ASD II frequency based on maternal diabetes type.
- Spontaneous closure occurred in 55% of ASD II cases by 12 months; 30% showed decreased diameter.
Conclusions:
- Cardio-respiratory disturbances in 38.1% of IDMs were associated with ASD II.
- Most neonates with ASD II experienced spontaneous closure or reduction in defect size within the first year.
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.
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