A nurse anticipates that new borne of diabetic mother often have tremors, periods of apnoea, cyanosis and poor sucking ability. These signs are associated with?

Appeared in: SCTIMST Staff Nurse - 2016

Explanation

Infants of diabetic mothers (IDMs) are exposed to high maternal glucose in utero, causing the fetal pancreas to produce excess insulin (hyperinsulinism).
After birth, the maternal glucose supply is cut off, but the newborn's high insulin levels persist, leading to a rapid drop in blood glucose (hypoglycemia).
The symptoms listed (tremors, apnea, cyanosis, poor sucking) are classic signs of neuroglycopenia, where the brain is deprived of its primary energy source, glucose.

Option B: Central Nervous System (CNS) oedema typically presents with signs of increased intracranial pressure, such as a bulging fontanelle, separated sutures, and a high-pitched cry. While seizures can occur, the specific combination of tremors, apnea, and poor suck is more characteristic of hypoglycemia.
Option C: Hypercalcemia (high calcium) is not a typical complication for IDMs; they are actually at risk for hypocalcemia (low calcium). Furthermore, hypercalcemia symptoms often include hypotonia (low muscle tone) and lethargy, not tremors and jitteriness.
Option D: This is the opposite of the actual pathophysiology. Infants of diabetic mothers experience hypertrophy and hyperplasia (overgrowth and overactivity) of the pancreatic islets of Langerhans due to chronic stimulation from high glucose levels, leading to hyperinsulinism.

Clinical Relevance

Nursing practice connection: Knowing Neonatal complications in infants of diabetic mothers (IDM) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must anticipate hypoglycemia in every infant born to a diabetic mother and initiate screening protocols immediately after birth.
Prompt recognition of the subtle signs of hypoglycemia (like jitteriness or poor feeding) and timely intervention are critical to prevent seizures and long-term neurological damage.
What if? If an infant is large for gestational age (LGA) but the mother's diabetic status is unknown, the nurse should still have a high index of suspicion for hypoglycemia, as LGA itself is a risk factor and may indicate undiagnosed gestational diabetes.

How to Approach the Question

First, identify the key patient characteristic in the stem: 'new borne of diabetic mother'. This is a critical clue that points to a specific set of potential complications.
Next, analyze the cluster of symptoms presented: 'tremors, periods of apnoea, cyanosis and poor sucking ability'. Recognize these as signs of metabolic or neurologic distress.
Connect the patient's condition (IDM) to the symptoms. Ask yourself, 'What is the most common and immediate metabolic problem an infant of a diabetic mother faces after birth?'
Evaluate the options based on the underlying pathophysiology. Hypoglycemia is a direct and well-known consequence of the hyperinsulinism seen in IDMs.
Eliminate the other options by recalling their typical presentations. CNS edema has different signs, hypercalcemia is incorrect (risk is for hypocalcemia), and depression of islets is the opposite of what occurs.

Concept Tested & Keywords

Concept Tested: Neonatal complications in infants of diabetic mothers (IDM)
Stem keywords: new borne of diabetic mother, tremors, apnoea, cyanosis, poor sucking ability
Lead-in keywords: associated with
Clinical cues: Patient is a newborn of a diabetic mother, which is a major risk factor for specific neonatal complications.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1151-1153

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 181-183

Practise the full SCTIMST Staff Nurse - 2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.