Delayed postnatal adaptation of pulmonary hemodynamics in infants of diabetic mothers

Objective: 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. Study Design: 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. Results: 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. Conclusions: 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. (J Pediatr 1997;131:545-8)