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Abstract
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.
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.
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.
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.