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Fluid status changes during the transition in infants of diabetic mothers

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Abstract

In animal and human neonates, expansion of the extracellular fluid volume is associated with “wet” lung and poor respiratory outcomes. To define fluid status changes during the transition from fetal to neonatal life in infants of diabetic mothers (IDM), we conducted a single-centre (Policlinico Abano Terme, Abano Terme, Italy) study of 66 IDM and a 1:2 matched control group from January 1 to September 30, 2020. Fluid status changes were assessed by computing Δ Hct from umbilical cord blood at birth and capillary heel Hct at 48 h, accounting for body weight decrease. IDM presented with significantly lower cord blood Hct levels in comparison to controls (47.33 ± 4.52 vs 50.03 ± 3.51%, p < 0.001), mainly if delivered by elective cesarean Sect. (45.01 ± 3.77 vs 48.43 ± 3.50%, p = 0.001). Hct levels at 48 h were comparable (55.18 ± 5.42 vs 54.62 ± 7.41%, p = 0.703), concurrently with similar body weight decrease (− 217.21 ± 113.34 vs − 217.51 ± 67.28 g, p = 0.614). This supports significantly higher ∆ Hct in IDM (5.13 ± 5.24 vs 7.29 ± 6.48, p < 0.01) and extra circulating fluid loss of 2–3%.

Conclusion: Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung.

What is Known:

• In neonates, evidence suggests that expansion of the extracellular fluid volume prior to the postnatal diuresis is associated with poor respiratory outcomes.

What is New:

• Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung.

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Availability of data and material

The data supporting our findings can be found in the Archives of the Policlinico Abano Terme, stored in electronic format.

Abbreviations

IDM:

Infants of gestational diabetes mothers

TTN:

Tachypnea of the newborn

RDS:

Respiratory distress syndrome

PPHN:

Persistent pulmonary hypertension of the newborn

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Author information

Authors and Affiliations

  1. Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy

    Vincenzo Zanardo, lorenzo Severino, Pietro Guerrini & Gianluca Straface

  2. IRS, Istituto Giannina Gaslini, Genova, Italy

    Domenico Tortora

  3. Institute of Anesthesiology, Toronto University, Toronto, Canada

    Matteo Parotto

Authors
  1. Vincenzo Zanardo
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  2. Domenico Tortora
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  3. Matteo Parotto
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  4. lorenzo Severino
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  5. Pietro Guerrini
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  6. Gianluca Straface
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Contributions

VZ carried out the study. DT and MP participated in study design. LS participated in study design and coordination. PG and GS helped draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vincenzo Zanardo.

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Ethics approval

Study protocol approved by the Scientific Committee for the Policlinico Abano Terme (SC-PAT), Abano Terme, Italy.

Consent to participate

The Scientific Committee for the Policlinico Abano Terme deemed this study to be of minimal risk with no interaction and no intervention with human subjects and thus, was exempt from consent.

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The Scientific Committee for the Policlinico Abano Terme consented the publication.

Conflicts of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Zanardo, V., Tortora, D., Parotto, M. et al. Fluid status changes during the transition in infants of diabetic mothers. Eur J Pediatr 181, 245–252 (2022). https://doi.org/10.1007/s00431-021-04197-7

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  • DOI: https://doi.org/10.1007/s00431-021-04197-7

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