VACTERL association in the newborn.

VACTERL association is a non-random association of birth (congenital) defects that affects multiple median and para-median structures. VACTERL association is a useful acronym to denote vertebral abnormalities (V), anal atresia (A), cardiac defects (C), tracheo-esophageal fistula (TE), renal or radial abnormalities (R), and limb abnormalities (L). Atleast 3 or more defects must be present to make a diagnosis of this condition. Most of these cases occur sporadically, although few cases with chromosomal abnormalities have been reported. Herein, we report a newborn who had most of the defects seen in VACTERL association.

A study of clinical, metabolic and hematological profile in infants of diabetic mothers.

Background:Diabetes has long been associated with maternal and perinatal mobidity and mortality. Infants of diabetic mothers (IDMs) have higher risks for serious problems during pregnancy, delivery and early neonatal period. Abnormal fetal metabolism during pregnancy which is complicated by maternal diabetes mellitus results in multiple neonatal sequelae. Objective: To study the clinical, metabolic and hematological profile in infants of diabetic mothers and to compare the neonatal outcome in gestational and pregestational (overt) diabetic mothers. Methods: 69 neonates born to diabetic mothers were enrolled in the study. Gestational age, birth weight, relevant perinatal history and examination findings were recorded. Blood samples were collected to perform relevant biochemical tests and managed as per unit protocol. Echocardiography and ultrasound abdomen was done routinely in all neonates. Results: Of the 69 neonates, 71.01% (49/69) were born to mothers with gestational diabetes mellitus (GDM), while the remaining 28.99% (20/69) were born to mothers with pregestational (overt) diabetes mellitus (PGDM). 53.63% (37/69) of mothers had poor glycemic control. Most of the neonates (73.91% - 51/69) were delivered by cesarean section. 88.40% (61/69) of the babies were born at term. Majority of them (85.50% - 59/69) were appropriate for gestational age with mean birth weight of 3.06±0.82kgs. Hypoglycemia was the most common metabolic abnormality seen in 73.91% (51/69) of neonates. Polycythemia was seen in 60.80% (42/69) of neonates. Congenital malformations were seen in 17.40% (12/69) of neonates, of which most of them had congenital heart disease. 11.60% (8/69) of the babies had suffered birth injuries. 5.80% (4/69) of neonates died in the early neonatal period. Occurrence of hypoglycemia, polycythemia, hyperbilirubinemia, congenital anomalies and birth injuries were significantly higher in infants born to mothers with GDM, whereas hypocalcemia and hypomagnesemia were significantly higher in infants of mothers with PGDM. Conclusions: Among the pregnancies complicated by diabetes, GDM continues to have a major contribution. Hypoglycemia and polycythemia remain the most common biochemical and hematological abnormality respectively. Congenital heart disease forms a major proportion of the congenital anomalies seen in IDMs. Mortality rate is higher in infants born to mothers with GDM.