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Outcomes of Extremely Preterm Infants Born to Insulin-Dependent Diabetic Mothers
Nansi S Boghossian1, Nellie I Hansen2, Edward F Bell3
1Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina;
Insights
Infants born to mothers with diabetes using insulin before pregnancy faced higher risks for necrotizing enterocolitis and sepsis. However, neurodevelopmental outcomes were similar across groups.
Area of Science:
- Neonatal Research
- Perinatal Medicine
- Endocrinology
Background:
- Limited data exists on extremely preterm infants born to mothers with insulin-dependent diabetes mellitus (IDDM).
- Understanding in-hospital morbidities and neurodevelopmental outcomes is crucial for this vulnerable population.
Purpose of the Study:
- To examine mortality, in-hospital morbidities, and neurodevelopmental outcomes in extremely preterm infants.
- To compare outcomes based on maternal IDDM status and timing of insulin use (before pregnancy vs. during pregnancy).
Main Methods:
- A cohort study of infants born between 22 to 28 weeks' gestation (2006-2011).
- Utilized regression models to assess associations between maternal IDDM, insulin timing, and infant outcomes.
- Evaluated outcomes including mortality, morbidities, and neurodevelopment at 18-22 months' corrected age.
Main Results:
- Infants of mothers using insulin before pregnancy (IBP) showed increased risks of necrotizing enterocolitis and late-onset sepsis compared to those without IDDM.
- A trend towards higher in-hospital mortality risk was observed for infants of mothers with IBP versus those with insulin use starting during pregnancy (IDP).
- Survivors born to mothers with IBP had smaller head circumference z-scores, but no increased risk of neurodevelopmental impairment.
Conclusions:
- Infants born to mothers with IDDM and pre-pregnancy insulin use face elevated risks for specific morbidities.
- Necrotizing enterocolitis, sepsis, and smaller head circumference are key concerns for this group.
- While certain morbidities are higher, neurodevelopmental outcomes at 18-22 months appear comparable among survivors.
Background And Objective:
Little is known about in-hospital morbidities and neurodevelopmental outcomes among extremely preterm infants born to women with insulin-dependent diabetes mellitus (IDDM). We examined risks of mortality, in-hospital morbidities, and neurodevelopmental outcomes at 18 to 22 months' corrected age between extremely preterm infants of women with insulin use before pregnancy (IBP), with insulin use started during pregnancy (IDP), and without IDDM.
Methods:
Infants 22 to 28 weeks' gestation born or cared for at a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network center (2006-2011) were studied. Regression models compared the association between maternal IDDM and timing of insulin use and the outcomes of the 3 groups.
Results:
Of 10 781 infants, 536 (5%) were born to women with IDDM; 58% had IBP, and 36% had IDP. Infants of mothers with IBP had higher risks of necrotizing enterocolitis (adjusted relative risk [RR] = 1.55 [95% confidence interval (CI) 1.17-2.05]) and late-onset sepsis (adjusted RR = 1.26 [95% CI 1.07-1.48]) than infants of mothers without IDDM. There was some indication of higher in-hospital mortality risk among infants of mothers with IBP compared with those with IDP (adjusted RR = 1.33 [95% CI 1.00-1.79]). Among survivors evaluated at 18 to 22 months' corrected age, average head circumference z score was lower for infants of mothers with IBP compared with those without IDDM, but there were no differences in risk of neurodevelopmental impairment.
Conclusions:
In this cohort of extremely preterm infants, infants of mothers with IBP had higher risks of necrotizing enterocolitis, sepsis, and small head circumference.
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