Altered transitional circulation in infants of diabetic mothers with strict antenatal obstetric management: a functional echocardiography study.

OBJECTIVE: Infants born to diabetic mothers (IDMs) even with good glycemic control are at risk for neonatal morbidity. Many of these problems occur during neonatal transition. We assessed (i) systemic and pulmonary blood flow in IDMs compared with controls and (ii) directional blood flow changes within fetal shunts during the first few days of life. STUDY
DESIGN: In this prospective observational cohort study, we evaluated right (RVO) and left ventricular output, superior vena cava flow, atrial and ductal shunts, and tricuspid regurgitation in 32 IDMs and 18 controls using serial echocardiography after birth and 48 h of life in both groups and at 24 and 72 h in IDMs only. RESULT: IDMs had lower RVO after birth and 48 h of life. IDMs also had less left to right atrial shunt and more right to left ductal shunt after birth compared with controls. In all, 15 of the 32 IDMs were admitted to the neonatal intensive care unit and 11 had respiratory symptoms.
CONCLUSION: Persistence of fetal shunts and decreased RVO in IDMs suggest that even those with good gestational control have impaired transitional hemodynamics.