Jornal de relatos de casos clínicos

Born during Maternal Ketoacidosis; Recognition of Neonatal Consequences

Abstract

Lauren C Weeke and Van Straaten HLM

After peripartum asphyxia, metabolic acidosis and neurological derangement are clinical findings. In severe cases, treatment with hypothermia should be started within six hours after birth. A rare cause of neonatal metabolic acidosis is maternal metabolic derangement due to Diabetic Keto Acidosis (DKA). We report characteristics of a boy born at 336/7 weeks gestation to a mother with unrecognized DKA in gestational diabetes mellitus. Persistent metabolic acidosis and severe neurological derangement resulted. Diagnosed as severe peripartum asphyxia, hypothermia was started. Hours after delivery, the mother was diagnosed with DKA. Although the child’s diagnosis of peripartum asphyxia was revised, hypothermia was continued. In newborns with severe metabolic acidosis and normal serum lactate, maternal metabolic derangement due to DKA should be considered. In those cases hypothermia is not proven effective. Early recognition and treatment of maternal DKA potentially prevents fetal death, neonatal sequelae and in less severe cases, unnecessary invasive hypothermic therapy.