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Delayed postnatal adaptation of pulmonary hemodynamics in infants of diabetic mothers
M P Seppänen1, O S Ojanperä, P O Kääpä
1Department of Pediatrics, University of Turku, Finland.
Insights
Infants of diabetic mothers show delayed closure of the ductus arteriosus and reduced pulmonary artery pressure decrease post-birth. Their left ventricular output remains comparable to healthy newborns.
Area of Science:
- Neonatal physiology
- Cardiovascular adaptation
- Pediatric cardiology
Background:
- Infants of diabetic mothers (IDMs) face risks due to fetal metabolic issues like hyperglycemia.
- Postnatal hemodynamic adaptation in IDMs, particularly concerning the pulmonary artery and ductus arteriosus, is not well understood.
- Respiratory distress is common in IDMs, necessitating further investigation into cardiovascular changes.
Purpose of the Study:
- To investigate the hypothesis that postnatal adaptation of pulmonary and ductal hemodynamics is disturbed in infants of diabetic mothers.
- To assess ductal shunting, pulmonary artery pressure, and left ventricular output in IDMs compared to controls.
- To utilize Doppler ultrasound for serial hemodynamic evaluations in the early neonatal period.
Main Methods:
- Doppler ultrasound was employed for serial evaluations.
- Study included 47 infants of diabetic mothers and 37 control neonates.
- Hemodynamic parameters assessed included ductal shunting, mean aortopulmonary pressure difference, and left ventricular output at 2, 12, 24, 48, and 72 hours of age.
Main Results:
- IDMs exhibited a higher incidence of patent ductus arteriosus at 12 and 48 hours.
- Bidirectional ductal shunting was more frequent in IDMs during the first day.
- Control infants had a significantly higher mean ductal aortopulmonary pressure difference in the first 24 hours; systemic pressures were higher in IDMs.
Conclusions:
- Postnatal closure of the ductus arteriosus and the decrease in pulmonary artery pressure are delayed in IDMs.
- Left ventricular output did not significantly differ between IDMs and control infants.
- These findings highlight altered cardiovascular adaptation in infants born to diabetic mothers.
Objective:
To test the hypothesis with Doppler ultrasound method that the postnatal adaptation of the pulmonary and ductal hemodynamics in infants of diabetic mothers is disturbed.
Study Design:
Infants of diabetic mothers are prone to respiratory distress caused by characteristic fetal metabolic abnormalities such as hyperglycemia and hyperinsulinemia with subsequent excess fetal growth. However, the postnatal course of the pulmonary and ductal hemodynamics is poorly known in these neonates. The presence of ductal shunting and the mean aortopulmonary pressure difference across the ductus arteriosus reflecting pulmonary artery pressure, as well as the left ventricular output, were serially evaluated with Doppler ultrasound method at 2, 12, 24, 48, and 72 hours of age in 47 infants of diabetic mothers and 37 control neonates of nondiabetic mothers.
Results:
The infants of diabetic mothers had a higher incidence of patent ductus arteriosus at 12 (p = 0.03) and 48 hours (p = 0.006) of life than control infants, but none of the infants of diabetic mothers needed ductal closure. Bidirectional ductal shunting was found more frequently in infants of diabetic mothers than control infants during the first day of life. The mean ductal aortopulmonary pressure difference was significantly higher in the control infants than in infants of diabetic mothers during the first 24 hours of life (p = 0.002). The mean systemic pressure values were higher in the infants of diabetic mothers than control infants (p = 0.002), but no significant differences in the left ventricular output were seen between the study groups during the first 3 days of life.
Conclusions:
The closure of the ductus arteriosus and postnatal decrease in pulmonary artery pressure are delayed in infants of diabetic mothers when compared with control infants during the first days of life. Left ventricular output values in infants of diabetic mothers do not differ from those of the control infants.