NEWBORN WITH ERRORS IN METABOLISM (DM)

Introduction
Diabetes is a group of metabolic disease characterized by high blood sugar (glucose) levels that results from defects in insulin secretion, or action or both. In type 1 diabetes, the pancreas doesn't produce insulin. In type 2 diabetes, the pancreas produces insulin but the body's cells aren't able to absorb it. In both cases, glucose builds up in the blood, overflows into the urine, and passes out of the body which means it doesn't get used for energy.

Diabetes mellitus is uncommon in infancy and newborn period. The two common forms seen are the Transient and Permanent forms of diabetes mellitus of the newborn. They have to be differentiated from the transient hyperglycemic states (Blood sugar > 125 mg/dl) seen in newborns who receive parenteral glucose infusions and in those with septicemia and CNS disorders. Transient diabetes mellitus of the newborn (TDNB) is defined as hyperglycemia occurring within the first month of life lasting at least 2 weeks and requiring insulin therapy. Compared to transient form, permanent diabetes mellitus is uncommon. It is usually due to pancreatic dysgenesis often associated with other malformations and rarely due to type 1 diabetes mellitus. The diagnosis is based on the demonstration of both exocrine and endocrine pancreatic dysfunction. These children are managed as type 1 diabetes mellitus. They are prone to develop the vascular complications of diabetes at an earlier date.

Pathophysiology of Diabetes Mellitus in Newborns

NEONATAL DIABETES MELLITUS

Nursing Management

Treatment for infants of diabetic mothers:

Treatment of a baby born to a diabetic mother often depends upon the control of diabetes during the last part of pregnancy and during labor. Specific treatment will be determined by your baby's physician based on: your baby's gestational age, overall health, and medical history extent of the condition

your baby's tolerance for specific medications, procedures, or

therapies

expectations for the course of the condition your opinion or preference

Treatment may include:

careful monitoring of blood glucose levels Blood may be drawn from a heel stick, with a needle in the baby's

arm, or through an umbilical catheter (a tube placed in the baby's umbilical cord).

giving the baby a quick source of glucose This may be as simple as giving a glucose/water mixture as an early

feeding. Or, the baby may need glucose given intravenously. The baby's blood glucose levels are closely monitored after treatment to watch for hypoglycemia to occur again. occur in IDM occurs)

checking for hypocalcemia (low calcium levels) which may also

giving oxygen or using a breathing machine (if respiratory distress

care for any problems arising from a birth injury care for any problems that occur with a birth defect

Prevention of problems associated with infants of diabetic mothers:

Prenatal care is essential to a healthy outcome when a mother has diabetes in pregnancy. Careful diet management, blood glucose monitoring, and insulin therapy can help keep a mother's blood glucose levels at normal levels and decrease many of the risks to her baby.