Epicardial fat thickness in infants of diabetic mothers.

BACKGROUND: Epicardial fat thickness (EFT) in adults and children has been related to the metabolic syndrome and other cardiovascular risk factors; however, scarce studies have evaluated it in infants of diabetic mothers (IDM) in whom, alterations in the thickness of the interventricular septum have been reported. This study compares the EFT in IDM versus infants of non-diabetic mothers (INDM) and its association with others echocardiographic parameters. METHODS: We performed a cross sectional study in 93 infants (64 IDM and 29 INDM). To evaluate EFT dimensions, an echocardiogram was performed within the first 24h of extrauterine life in both groups. In diabetic mothers, HbA1c was also determined. RESULTS: There was no significant difference in birth weight between the groups although gestational age was lower in IDM. The EFT (3.6 vs. 2.5 mm, p < 0.0001), the interventricular septum thickness (IVST) (6.2 vs. 5.2 mm, p < 0.0001) and the IVST / left ventricle posterior wall (1.3 vs. 1.1, p = 0.001) were higher in the IDM; while the left ventricular expulsion fraction [LVFE] (71.1 vs. 77.8; p < 0.0001) was lower than in the INDM, respectively. We found a positive correlation between EFT with IVST (r = 0.577; p = 0.0001), LVPW (r = 0.262; p = 0.011), IVST/LVPW index (r = 0.353; p = 0.001), and mitral integral early velocity (r = 0.313; p = 0.002), while a negative correlation with LVFE was observed (r = -0.376; p = 0.0001). CONCLUSIONS: The EFT is higher in IDM than in INDM. It was positively related with echocardiographic parameters of left ventricular thickness and negatively with left ventricular ejection function.

Factors associated with early severe intraventricular haemorrhage in very low birth weight infants.

OBJECTIVE: The aim of this study was to identify factors associated with early IVH grades III-IV in the first 72 h of life in very low birth weight (VLBW) preterm infants. METHODS: A case-control study was performed in 28 preterm infants and 55 controls. The mean of all blood gas determinations, presence of arterial hypotension, variables related to mechanical ventilation, as well as antenatal and neonatal comorbidities during the first 3 days of life were evaluated. RESULTS: The proportion of infants with pH<7.2, PaCO (2) >55 mmHg and arterial hypotension was higher in the case group. PaCO (2) >55 mmHg was more frequently found in patients with IVH grades III (16.6 vs. 1.8%; p=0.03) and IV (37.5 vs. 1.8%; p=0.0001) than in controls, respectively. Gestational age (beta=-0.30; p=0.04), BE (beta=0.33; p=0.0005) and arterial hypotension (beta=0.40; p=0.00003) were associated to both grades of IVH (R (2)=0.39; p<0.0001 for the model). However, only birth weight and arterial hypotension were identified as factors related to IVH grade III (R (2)=0.44; p=0.0001 for the model) and PaCO (2) >55 mmHg, and BE as factors for IVH grade IV (R (2)=0.32; p=0.0003 for the model). CONCLUSION: Birth weight and arterial hypotension were factors related to early IVH grade III, whereas hypercapnia and large BE were factors related to IVH grade IV in VLBW infants.

Asymmetrical septal hypertrophy in newborn infants of diabetic mothers.

The objective of this paper is to determine the frequency and outcome of asymmetrical septal hypertrophy (ASH) in large-for-gestational-age infants (LGA) born to diabetic (DM) and nondiabetic mothers (NDM), and to establish the relationship between ASH and maternal diabetes control. A comparative study was design to assess ASH in infants born to DM and NDM. The study was conducted in the Departments of Neonatology and Pediatric Cardiology of the "Hospital de Gineco-Pediatria 48", Instituto Mexicano del Seguro Social from January to December 1997. Eighty-five full-term infants of DM (group A) and 85 LGA infants of NDM (group B) were included. As a control group (group C), we studied 85 healthy, full-term infants. In all cases a Doppler echocardiogram was obtained in the first 48 h after birth, and for the ASH infants, at 2 and 4 months. Chest X ray, electrocardiogram, and laboratory tests were performed as complementary studies. ASH was present in 38.8% of LGA infants of DM and in 7.1% of NDM. The difference was significant (p < 0.01). Interventricular septum (IVS) and IVS/ posterior wall of left ventricle ratio were significantly different between groups A and B with C. There was no correlation between Hb A1 level and the presence of ASH in group A. ASH is a common finding in infants of DM. We could not find a relationship between the degree of metabolic control during pregnancy and the incidence and severity of ASH.