TEAM C SURVIVAL GUIDE: Answer to Question #9

9. You are called to a delivery for a G2 P1 386 serology neg, GBS neg, HIV neg, class B 36 yo diabetic mother.  You are told that mom’s sugars have been relatively well controlled on insulin during pregnancy.  A large appearing female infant is delivered vaginally, cries spontaneously and is brought to the radiant warmer where you proceed with appropriate resuscitative efforts, following the NRP guidelines.  What needs to be done for this infant after the initial resuscitation is complete?  What scenarios should you be thinking about in this infant?

Infants of diabetic mothers (IDM) can be managed in the well baby nursery (GDM, Class A, A/B, B) provided the infant is well appearing without any obvious complications.  These infants should have their glucose levels monitored per the IDM protocol (p16 of blue book).  Management depends on glucose levels obtained (see protocol for details).  Infants of diabetic mothers can have a number of morbidities including, but not limited to, macrosomia (which can lead to birth injuries and asphyxia), respiratory distress syndrome (RDS), hypo-glycemia/calcemia/magnesemia, hyperbilirubinemia/polycythemia, and congenital anomalies.  These factors should be considered in the evaluation of an IDM.  (Please see IDM references for details.)