The infants tend to be tremulous and hyperexcitable during the first 3 days of live, although hypotonia, lethargy,and poor sucking also may occur. They may have any of the diverse manifestations of hypoglycemia. Perinatal asphyxia or hyperbilirubinemia may produce similar signs. Rarely, hypomagnesemia may be associated with the hypocalcemia. Many infants of diabetic mothers develop tachypnea during the first 5 days of live,which may be a transient manifestation of hypoglycemia, hyporthermia,polycythemia,cardiac failure, transient tachypnea,or cerebral edema from birth trauma or asphyxia.
Birth trauma is also common due to fetal macrosomia.
Additional anomalies include neural tube defects, hydronephrosis, renal agenesia, duodenal or anorectal atresia, holoprosencefaly. These infants may also develop abdominal distention caused by a transient delay in the development of the left side of the colon,the left colon syndrome. Prognosis Physical development is normal,but oversized infants may be predisposed to be obesity in childhood that may extend into adult live. Treatment Management of these infants should be initiated before birth by frequent prenatal evaluation of all pregnant women with overt or gestational diabetes,by evaluation of fetal maturity, by biophysical profile, by Doppler velocimetry,and by planning delivery of these infants in hospitals where expert obstetric and pediatric care is continuously available. Hypoglycemia should be treated, even in asymptomatic infants, with intravenous infusions of glucose sufficient to keep the blood levels well above this level.