Incidence of hypoglycaemia in late preterm and term infants born to women with diabetes mellitus

Background. Diabetes mellitus (DM) is a common metabolic disorder affecting pregnant women and is associated with adverse outcomes in their offspring, including hypoglycaemia. The incidence and factors associated with development of hypoglycaemia in infants of diabetic mothers (IDM) from developing countries such as South Africa are not well known. Objectives. To determine the incidence of hypoglycaemia and factors associated with its development in IDM. Methods. Medical records of mothers diagnosed with DM, and their infants who were term and/or late preterm and admitted to the neonatal unit at Chris Hani Baragwanath Academic Hospital, were retrieved and reviewed. Maternal characteristics, type and management of diabetes, infant characteristics and glucose measurements were captured for analysis. Results. Over the 2-year period, 234 infants were born to diabetic mothers (median age 33 years) and 207 met the diagnostic criteria and were admitted for monitoring of blood glucose using the hemoglucotest. Among the mothers with DM, 56% had gestational diabetes; ~19% of IDM were large for gestational age (LGA) and 10% were macrosomic. Hypoglycaemia occurred in 39% of IDM, and 85% of the infants were diagnosed within the first 6 hours of life. There were no statistically significant differences in maternal characteristics, including type of maternal diabetes and its management between hypoglycaemic and normoglycaemic infants. Hypoglycaemic infants were more likely to be LGA (28.2% v. 12.8%; p=0.009). Conclusion: Hypoglycaemia is a common finding in IDM. It presents early (within the first 6 hours of life) and rarely beyond 24 hours after birth. The only characteristic found to be associated with development of hypoglycaemia in IDM was a neonate being LGA

Effect of Prophylactic Phenobarbital on Seizures; Encephalopathy and Mortality in Neonates with Perinatal Asphyxia

Background. Seizures after an asphyxial insult may result in brain damage in neonates. Prophylactic phenobarbital may reduce seizures.Objective. To determine the effect of prophylactic phenobarbital on seizures; death and neurological outcome at hospital discharge.Methods. Neonates with base deficit 16 mmol/l and Apgar score at 5 minutes 7 or requiring resuscitation for 5 minutes at the time of birth were randomised to prophylactic phenobarbital 40 mg/kg (n=50) or placebo (controls) (n=44) within the first 6 hours of life. They were monitored for clinical seizures; hypoxic ischaemic encephalopathy (HIE) and mortality.Results. Seizures developed in 30.0 of the phenobarbital group as opposed to 47.7 of the control group (relative risk 0.63; 95 confidence interval -0.37 - 1.06; p=0.083). The proportions of patients who had died and/or had HIE II or III at time of discharge from hospital were similar in the two groups (42.0 v. 45.5). There were no differences in mortality between the two groups (14.0 v. 15.9). Conclusion. In infants with asphyxia; prophylactic phenobarbital does not reduce the incidence of seizures; HIE and mortality

Growth of Infants Born To HIV-Positive Mothers Fed a Whey-Adapted Acidified Starter Formula with Prebiotics and Nucleotides

Objectives: The objectives of this study were to evaluate whether infants born to known HIV-positive mothers; but who were not themselves infected with HIV and who were fed a chemically acidified starter formula with prebiotics with or without nucleotides during their first six months; displayed growth rates equal to uninfected infants fed a chemically acidified starter formula without prebiotics or nucleotides. Design: The design was a multi-centre; double-blinded randomised controlled trial. Setting: The study was carried out in four academic hospitals; three in Johannesburg and one in Cape Town; South Africa. Subjects and intervention: The subjects were newborn infants born to consenting HIV-positive women who had previously decided not to breast feed. The infants were randomised to receive one of three milk formulas. The intervention comprised chemically acidified formula without prebiotics or nucleotides; with prebiotics only; or with prebiotics and nucleotides. Outcome measures: The outcome measures were the growth parameters through the first six months of life. Results: Of the 150 randomised infants; 50 did not complete the study and 16 (12.8of those tested) were infected with HIV; leaving 84 infants available for analysis. All three formulas were tolerated well; with no differences in growth parameters seen with the addition of prebiotics and nucleotides. The growth rates of the study infants up to the age of six months were very good; showing an increase in Z-scores from negative values at the time of enrolment in the first week after birth to around zero for length and 0.5 for weight.Conclusions: The three chemically acidified formulas were tolerated well and resulted in good growth over the first six months of life. No benefits were seen with the addition of prebiotics or nucleotides. The growth rates were similar to those found in previous studies of ours on biologically acidified formulas. The chemical acidification of infant formulas appears to be a realistic alternative to biological acidification should an acidified formula be required

Growth of Infants Born To HIV-Positive Mothers Fed a Whey-Adapted Acidified Starter Formula with Prebiotics and Nucleotides

Objectives: The objectives of this study were to evaluate whether infants born to known HIV-positive mothers; but who were not themselves infected with HIV and who were fed a chemically acidified starter formula with prebiotics with or without nucleotides during their first six months; displayed growth rates equal to uninfected infants fed a chemically acidified starter formula without prebiotics or nucleotides. Design: The design was a multi-centre; double-blinded randomised controlled trial. Setting: The study was carried out in four academic hospitals; three in Johannesburg and one in Cape Town; South Africa. Subjects and intervention: The subjects were newborn infants born to consenting HIV-positive women who had previously decided not to breast feed. The infants were randomised to receive one of three milk formulas. The intervention comprised chemically acidified formula without prebiotics or nucleotides; with prebiotics only; or with prebiotics and nucleotides. Outcome measures: The outcome measures were the growth parameters through the first six months of life. Results: Of the 150 randomised infants; 50 did not complete the study and 16 (12.8of those tested) were infected with HIV; leaving 84 infants available for analysis. All three formulas were tolerated well; with no differences in growth parameters seen with the addition of prebiotics and nucleotides. The growth rates of the study infants up to the age of six months were very good; showing an increase in Z-scores from negative values at the time of enrolment in the first week after birth to around zero for length and 0.5 for weight.Conclusions: The three chemically acidified formulas were tolerated well and resulted in good growth over the first six months of life. No benefits were seen with the addition of prebiotics or nucleotides. The growth rates were similar to those found in previous studies of ours on biologically acidified formulas. The chemical acidification of infant formulas appears to be a realistic alternative to biological acidification should an acidified formula be required