A.

Abrreviation
1. IDM (Infant of Diabetic Mother)
1.1 Definition
The infant of a diabetic mother (IDM) is at an increased risk of
hypoglycemia at 1 to 3 hours after birth. The factor mainly protective
against fetal hypoglycemia is optimal control of maternal
hypoglycemia, especially during the third trimester and during labor. It
has been shown that a mean maternal plasma glucose more than 6
mmol/L during the last four hours in a diabetic mother leads to a higher
incidence of neonatal hypoglycemia (Murthy dkk, 2012).
An infant born with a high serum glucose during pregnancy
features larger than other infants with enlarged organs, pospartum
hypoglycemia, given increased fetal production of insulin, increased
risk of stillbirth (McGraw-Hill, 2012).
Hypoglicemia in baby if the plasma glucose levels less than 45
mg/dL in infants or children, with or without symptoms, full-term
neonates during 72 hours is less than 35 mg/dl, and neonatal preterm
less than 25 mg/dl (Hakimi dkk, 2010)
1.2 Etiology
Women may have diabetes during pregnancy in 2 ways:
a. Gestational diabetes is high blood glucose (diabetes) that starts or is
first diagnosed during pregnancy.
b. Other women have type 1 diabetes before their pregnancy begins.
If the diabetes is not well controlled during pregnancy, the baby is
exposed to high blood sugar levels. This can affect the baby and mom
during the pregnancy, at the time of birth, and after birth. Infants who
are born to mothers with diabetes are often larger than other babies.
Larger infants make vaginal birth harder. This can increase the risk for
nerve injuries and other trauma during birth. Also, C-sections are more
likely.
The infant is more likely to have periods of low blood glucose
(hypoglycemia) shortly after birth, and during first few days of life.
Mothers with poorly controlled diabetes are also more likely to have a
miscarriage or stillborn child. If the mother had diabetes before her
 pregnancy, her infant has an increased risk of birth defects if the disease
was not well controlled (Kimberly, 2015).

1.3 Patofisiology
After birth, the babies are not getting the blood glucose from the
mother through the placenta, but the insulin from the pancreas still
produce a lot of babies. This condition causes the amount of insulin is
higher than in blood glucose that can be called hypoglycemia (Joan &
Michael, 2004).
1.4 Sign and Symptoms
 The infant is often larger than most baby's born after the same
amount of time in the mother's womb. Other symptoms, mostly caused
by low blood sugar, may include:
Blue or patchy (mottled) skin color, rapid heart rate, rapid
breathing (signs of immature lungs or heart failure)
Newborn jaundice (yellow skin)
Poor feeding, lethargy, weak cry, seizures (signs of severe low
blood sugar)
Puffy face
Reddish appearance
Tremors or shaking shortly after birth. (Kimberly, 2015)

1.5 Exams and Test (Kimberly, 2015)

a. Before the baby is born:
- Ultrasound performed on the mother in the last few months of
pregnancy to monitor the baby's size.
- Lung maturity testing may be done on the amniotic fluid if the
baby is going to be delivered more than a week before the due
date.
b. After the baby is born:
- Tests may show that the infant has low blood sugar and low
blood calcium.
- An echocardiogram may show an abnormally large heart, which
can occur with heart failure.

1.6 Treatment
All infants who are born to mothers with diabetes should be tested
for low blood sugar (hypoglycemia), even if they have no symptoms. If
an infant had one episode of low blood sugar, tests to check blood sugar
levels will be done over several days. Testing will be continued until the
infant's blood sugar remains stable with normal feedings.
Efforts are made to ensure the baby has enough glucose in the
blood:
 Feeding soon after birth may prevent low blood sugar in mild
cases. Even if the plan is to breastfeed, the health care provider
may suggest some formula during the first 8 to 24 hours.
Low blood sugar that does not go away is treated with fluid
containing sugar (glucose) and water given through a vein.
In severe cases, if the baby needs (large amounts of sugar, the fluid
and glucose must be given through an umbilical (belly button) vein
for several days.
Rarely, the infant may need breathing support or medicines to treat
other effects of diabetes. High bilirubin levels are treated with light
therapy (phototherapy). Rarely, the baby's blood will be replaced with
blood from a donor (exchange transfusion) for this problem (Kimberly,
2015).

1.7 Prevention (Haksari, 2013)

The management of breastfeeding infants hypoglycemia:
a. Asymptomatic (without clinical manifestations)
Breastfeeding early and often will stabilize blood glucose levels.
Continue breastfeeding (approximately every 1-2 hours), or rate
of 3-10 ml of breast milk per kg of body weight baby, or give
supplementation (donor breast or infant formula).
Women with diabetes need special care during pregnancy to
prevent problems.
Controlling blood glucoe can prevent many problems. Carefully
monitoring the infant in the first hours and days after birth may
prevent health problems due to low blood glucose.
If glucose levels remain low despite being given a drink, start
intravenous glucose therapy and adjust the blood glucose levels.
ASI continued for intravenous glucose therapy. Lower the
amount and concentration of glucose intravenously according to
blood glucose levels.
Record the clinical manifestations, physical examination, blood
glucose screening levels, laboratory confirmation, treatment and
changes in infant clinical condition (eg, the response of a given
therapy).
 b. Symptomatic with clinical manifestations or plasma glucose levels
<20-25 mg / dL or <1.1 to 1.4 mmol / L
Give glucose 200 mg per kilogram of body weight or 2 mL per
kilogram of body weight 10% dextrose fluids. Continue to
continue giving 10% glucose intravenously with speed (glucose
infusion rate or GIR) 6-8 mg per kilogram of body weight per
minute.
Correction extreme or symptomatic hypoglycemia, should not
be given orally or pipe orogastrik.
Keep the baby glucose levels were symptomatic at> 45 mg / dL
or> 2.5 mmol / L.
Adjust the administration of intravenous glucose with blood
glucose levels were obtained.
Support breastfeeding as often as possible after the
manifestations of hypoglycemia disappear.
Monitor blood glucose levels before giving a drink and as a
decline in the provision of intravenous glucose gradually
(weaning), until stable blood glucose levels at the time had no
liquid glucose intra vena. Sometimes it takes 24-48 hours to
prevent recurrent hypoglycemia.
Keep records of manifasi clinical, physical examination, blood
glucose screening levels, laboratory confirmation, treatment and
clinical conditions change (eg, the response of a given therapy).

1. Murthy EK, Renar IP, and Metelko Z. 2012. Diabetes and Pregnancy.
Diabetologia Croatica.
2. McGraw-Hill Concise Dictionary of Modern Medicine. 2012. The McGraw-Hill
Companies, Inc.
3. Hakimi, Deliana M, Lubis SM. 2010. Hipoglikemia pada Bayi dan Anak. USU
Oper Course Ware. [cited 2017 March 03]. Available from
http://ocw.usu.ac.id/course/download/1125-
ENDOKRINOLOGI/mk_end_slide_hipoglikemia_pada_bayi_dan_anak.pdf
4. Joan L. Nold & Michael K. Georgieff. 2004. Infants of Diabetic Mothers.
Elseiver Saunders Pediatric Clinics of North America, 619-637. [cited 2017
March 03]. Available from
http://www.ohsu.edu/xd/health/services/doernbecher/research-
education/education/residency/upload/res_lounge_infant-of-diabetic-mother.pdf
5. Kimberly G. Lee. 2015. Infant of Diabetic Mother. Universiti of Maryland
Medical Center. [cited 2017 March 03]. Available from
http://umm.edu/health/medical/ency/articles/infant-of-diabetic-mother
6. Haksari, EL. 2013. Menyusui Bayi dengan Risiko Hipoglikemia. Indonesian
Pediatric Society. [cited 2017 March 03]. Available from
http://www.idai.or.id/artikel/klinik/asi/menyusui-bayi-dengan-risiko-
hipoglikemia