Correlation of Neonatal Respiratory Failure and Gestational Diabetes on Neonates

The researchers of this article studied the correlation of neonatal respiratory failure (NRF) and gestational diabetes (GD) on neonates delivered after 34 weeks. Due to the lack of research, they wanted to determine if neonates had a higher risk of severe neonatal respiratory failure due to GD exposure resulting in NICU admission and mechanical ventilation. Therefore, to identify risk factors, a retrospective cohort study was conducted at Pointe-a-Pitre Academic Teaching Hospital from January 1st, 2006, through August 31st, 2007. 

They had a total of 3,501 deliveries during this period. Women with unknown diabetic status, multiple pregnancies, and those not screened were omitted from this study. All women were screened routinely for diabetes during pregnancy using the 2-step glucose method following the institution's guidelines. As a result, 3,237 women were finalized, 3,039 were non-diabetic, 32 with PGD, and 166 with GD. 

Diagnosis criteria for RDS required early recognition of NRD, radiologic features consistent with respiratory distress syndrome, and oxygen therapy with a 40% FiO2 or greater for a minimum of 24 hours. In addition, NICUs admissions with only severe NRF requiring invasive or non-invasive ventilation for a minimum of 24 hours were used for this study.

The researchers also mentioned that no steroid therapy was given. Researchers stated that the use of corticosteroids has a chance of spontaneous premature delivery. In the event of severe NRF, they withheld steroid therapy after 34 weeks to isolate any variables. The study also considered the mode of delivery, fetal birth weight, median delivery term, and gender. 

Among the 3,237 women, 21 neonates were diagnosed with severe NRF, eight from diabetic mothers, and 13 from non-diabetic mothers. They found no significant difference between women with PGD and non-diabetic women. However, researchers found that neonates born in late preterm had a significantly higher chance of having severe NRF compared to neonates from non-diabetic mothers. In addition, mothers who had a late premature delivery and delivered via cesarean were more likely to have neonates develop severe NRF. In their study, gender did not have a significant role, but the researchers mention that this could be due to their research having a small number of participants. 

This study discovered that GD was an independent risk factor for severe NRF for neonates delivered after 34 weeks of pregnancy. The researchers recommended that having better clinical criteria for NRF could help for more accurate diagnoses. Although they found GD to be an independent risk factor, they cautioned the readers that they could not collect all necessary data and that their results contained bias.