الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 136 |  |  |
| | | from | 136 | | |
Abstract
Diabetes mellitus is a metabolic disorder characterized by hyperglycemia and insufficiency of secretion or action of endogenous insulin. Maternal DM is associated with a five folds increase in risk of cardiovascular anomalies in IDMs.
Echocardiography is of immense value in differentiating between heart disease and lung disease in newborns. Indeed, it has become the standard for the diagnosis of virtually all cardiovascular malformations. Most neonates and infants are now referred directly after ultrasound study for operative repair, without intervening cardiac catheterization so it has become the primary imaging tool in the diagnosis and assessment of congenital and acquired heart disease in infants, children, and adolescents. Transthoracic echocardiography (TTE) is an ideal tool for cardiac assessment, as it is non-invasive, portable, and effective in providing detailed anatomic, hemodynamic and physiologic information about the pediatric heart.
This cross-sectional study was conducted on 60 neonates all were IDMs at NICU of Zagazig university hospital and all the cases are studied in the period from Febrauary 2015 to October 2015. Each of the newly born infants included in this study was subjected to the full history taking; neonatal and maternal (for DM history duration, control & its treatment), also full clinical examinations of the neonates.
The results of the current study were:
The age of these neonates ranged from the 1st day of life to 29 days of life after birth. There were 23 males (38.3%) and 37 females (61.7%), female gender had high percentage in our 60 IDMs. Among the 60 cases 53 (88.3%) of them were delivered by caesarian section and only 7 (11.7%) cases by normal delivery. In concerned with diabetic mothers there were 27 of the mothers had pre-GDM and 33 had GDM, Also the mode of DM controle in these mothers were subdivided into 34 cases controlled (56.7%) with HbA1c (5.97±0.93), and the other 26 cases were uncontrolled (43.3%) with HbA1c (9.32±0.65). The age of the diabetic mothers ranged from 20 to 39 years with mean 28.33 years. Regarding consanguinity only 5% of the cases had consanguinity.
As regarded to clinical presentation of these neonates we found that 38.3% of the cases had respiratory distress, 30% had jaundice, 21.7% had hypoglycemia and 36.7% had macrosamia, Also 38.3% had tachycardia, 10% had poor activity and 6.7% had cyanosis and same percent had weak suckling.
In our study the echocardiographic studying of the frequency distribution of CHDs among the 60 IDM showing that the overall incidence of CHD was 68.33% with the following frequencies: PFO was (45%), PDA (53.3%), ASD (30%), VSD (18.3%), HCM (33.3%), TGA (1.7%), DORV (1.7%), RSAA (1.7%), PS (3.3%), and COA was (1.7%) respectively. Also we found that in some neonates there were more than one type of congenital heart defect.
And as regarded to Echocardiographic measurements of IDMs we found that LA ranged from (7-17)mm with mean 12.07, AO ranged from (8-16)mm with mean 10.52, PW ranged from (3-8)mm with mean 4.45 and LVED ranged from (11-)29mm with mean 16.85, Regarding LVES it ranged from (6-20)mm with mean 9.62, IVS ranged from (3-12)mm with mean 6.31, EF ranged from (57-96)% with mean 76 and FS ranged from (29-69)% with mean 42.25.