Neonate of diabetic mother is at the risk of all the following EXCEPT?

WCL Staff Nurse - 2019

Pediatric Nursing

Medium

Appeared in: WCL Staff Nurse - 2019

Explanation

The primary and most immediate metabolic derangement in a neonate of a diabetic mother (IDM) is hypoglycemia, not hyperglycemia.
During pregnancy, maternal hyperglycemia causes the fetus to produce excess insulin (hyperinsulinemia).
After birth, the maternal glucose supply is abruptly cut off, but the infant's high insulin levels persist, leading to a rapid drop in blood glucose.
Therefore, hyperglycemia is the opposite of the expected physiological state in an IDM immediately after birth.

Option A: This is incorrect because hypoglycemia is the most common and immediate metabolic risk for a neonate of a diabetic mother.
Option B: This is incorrect because hypocalcemia is a known complication in IDMs, typically appearing within the first 2-3 days of life.
Option D: This is incorrect because hyperbilirubinemia (jaundice) is a common finding in IDMs, often due to polycythemia and increased red blood cell breakdown.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications in Infants of Diabetic Mothers (IDM) as background academic context rather than a clinical decision trigger.
Nurses must prioritize blood glucose screening for all infants of diabetic mothers within 30-60 minutes of birth and before each feeding to detect and manage hypoglycemia promptly.
Early and frequent feeding (breast milk or formula) is a critical nursing intervention to provide a glucose source and prevent severe hypoglycemia.
What if? If an IDM is lethargic and has a weak cry, the nurse's first action should be to perform a heel stick to check the blood glucose level, as these are classic signs of symptomatic hypoglycemia requiring immediate intervention.

How to Approach the Question

First, identify the keyword "EXCEPT" in the question stem. This signals that you need to find the option that is NOT a risk for the neonate.
Recall the core pathophysiology for an infant of a diabetic mother (IDM). The key is the transition from a high-glucose intrauterine environment to a normal extrauterine environment.
Think through the sequence: High maternal glucose → high fetal glucose → high fetal insulin.
At birth, the glucose supply from the mother stops, but the baby's high insulin level persists. High insulin drives glucose into cells, causing blood sugar to drop.
Evaluate each option based on this pathophysiology: Hypoglycemia is the direct result. Hypocalcemia and hyperbilirubinemia are well-known associated complications. Hyperglycemia is the opposite of the expected immediate outcome.
Select the option that is inconsistent with this physiological process, which is hyperglycemia.

Concept Tested & Keywords

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

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