Maternal/Fetal/Neonatal Interactions Kristine Falcon Chimento October 7, 2011

Infants affected by maternal disorders Infants affected by maternal medications Infants affected by maternal substance use ABP Content Specs

You are measuring serum electrolytes at 12 hours of age in a 4,500g infant delivered by cesarean section at 36 weeks' gestation. The infant is generally well- appearing, although he exhibits mild hypotonia. The laboratory results are: Sodium, 135 mEq/L Potassium, 4 mEq/L Chloride, 105 mEq/L Carbon dioxide, 18 mEq/L Calcium (total), 6.5 mg/dL Phosphorus, 5.5 mg/dL Magnesium, 1.6 mg/dL Serum glucose, 30 mg/dL

What is causing this infant’s abnormalities? Diabetic Mother What are some other findings you would look for in an IDM?

Infants of Diabetic Mothers

LGA is a baby > 90 th % for gestational age Macrosomia is a baby born > 4kg (90 th % for full term) SGA is a baby < 10 th % for gestational age (2.5kg at term) IUGR is a baby with reduction in expected fetal growth pattern *All SGA is IUGR, not all IUGR is SGA

Which of these babies was born to a diabetic mother?

LGA – Fetal hyperinsulinemia Increased maternal nutrients IUGR – Maternal microvascular disease – Placental Insufficiency Decreased fetal nutrients Both!

Macrosomia leads to … – Birth Asphyxia – Birth Trauma

Brachial Plexus Injury

Clavicular Fracture

Facial Palsy

Cephalohematoma