ABSTRACT
Objective: To study the perinatal outcomes of infants born to mothers with gestational diabetes treated with insulin or oral hypoglycemic agents in a developing country. Design: Prospective observational cohort study. Setting: Tertiary-care perinatal center in southern India. Participants: Babies born to mothers with gestational diabetes. Methods: Maternal details were obtained and physical examination was performed on the neonates. Babies were given hourly feeds soon after birth and blood glucoses checked at 1, 3, 5, 9 and 12 hours of life; hematocrit and calcium levels were also measured. Perinatal outcomes were compared between mothers who required insulin or an oral hypoglycemic agent for treatment of diabetes. Results: Of the 10,394 mothers who delivered during the study period, 574 (5.5%) were diagnosed to have gestational diabetes. 137 were treated with insulin and 141 with oral hypoglycemic agents. 44 (15.8%) babies were born preterm, 97 (35%) were large for gestational age, 13 (4.7%) were small for gestational age and 9 (3.2%) were macrosomic. Hypoglycemia was seen in 26 (9.3%) babies, congenital anomalies in 15 (5.4%) and birth injuries in 7 (2.5%). There was no difference between the two groups in any of the outcomes except for hyperbilirubinemia, which was more in the insulin group (13.7% vs 6.5%, P=0.04). Conclusions: There was no difference in the perinatal outcome whether the mother received insulin or an oral hypoglycemic agent for treatment of gestational diabetes other than the increased incidence of hyperbilirubinemia in the insulin group.
ABSTRACT
Objective: To determine the feasibility and safety of whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting. Design: Feasibility trial. Setting: Tertiary care perinatal centre. Subjects: Infants born at 35 weeks gestation with perinatal asphyxia were included in the study. Interventions: Infants were cooled to a rectal temperature of 33±0.5°C for 72 hours using cloth-covered ice-gel packs. Vital parameters were monitored continuously. Outcome measures: The primary outcome was the achievement of target temperature within 1 hour of initiation of treatment and maintaining the target temperature for 72 hours. Adverse events and possible complications of hypothermia were the secondary outcomes measured. Results: Twenty infants were included in the study. The mean time taken to achieve target rectal temperature was 52±25 minutes. The mean rectal temperature during cooling was 32.9±0.11ºC. The target temperature could be maintained for 72 hours without difficulty in all babies. Adverse events observed during cooling were thrombocytopenia (25%), sinus bradycardia (25%), deranged bleeding parameters (20%), aposteatonecrosis (15%), hyperglycemia (15%), hypoglycemia (10%), hypoxemia (5%), life-threatening coagulopathy (5%) and death (5%). Shivering was noted in many of the babies, especially in the initial phase of cooling. Conclusion: Whole body cooling in term infants with perinatal asphyxia is achievable, safe and inexpensive in a low-resource setting.