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Rudolph's Pediatrics, 22e

Chapter 48. Infant of a Diabetic Mother

Respiratory Distress
Respiratory distress syndrome requiring admission to a neonatal intensive care unit occurs almost 6 times as frequently in IDMs as in infants of
nondiabetic mothers.23 IDMs are at increased risk for respiratory distress syndrome for several reasons. Surfactant deficiency due to a delayed
maturation of type II alveolar cells has been observed, but it is unclear whether the cause is hyperglycemia, hyperinsulinemia, or both.24

Glycogen levels in the lung normally decline with increasing gestational age. This decrease corresponds with increased surfactant production. Insulin
inhibits glycogen breakdown, decreasing available substrate for the synthesis of phosphatidylglycerol (PG), an important component of surfactant.
The presence of PG in the amniotic fluid is an indicator of lung maturity. There are several reports of delayed appearance of PG in diabetic
pregnancies.25,26 Even using amniotic fluid analysis to document maturation of the surfactant production system, there is still a 10% incidence of
respiratory distress syndrome in IDMs. Other causes of respiratory distress in the IDM include increased rates of premature birth, congenital heart
disease, and diaphragmatic paralysis from a brachial plexus injury.

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Respiratory Distress, Heather Morein French; Rebecca A. Simmons Page 1 / 1
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