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Leitlinie zur Betreuung von Neugeborenen diabetischer Mütter

Empfehlungen für die Überwachung und Behandlung

Guideline to neonatal care of infants born to diabetic mothers

Treatment and monitoring recommendations

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Zusammenfassung

Für alle Schwangeren mit diabetischer Stoffwechsellage: Geburt in einem Krankenhaus mit neonatologischer Überwachung und der Möglichkeit einer i.v. Glukosebehandlung des Kindes ohne Verlegung in ein anderes Haus

Bei prägravidem Diabetes mellitus oder Insulinbehandlung in der Schwangerschaft: Geburt in einem Zentrum mit neonatologischer Betreuung rund um die Uhr

Konsequentes Anlegen/Frühfütterung (30 min nach der Geburt, danach alle 2–3 h)

Obligate präprandiale Blutglukosebestimmung 2–3 h nach der Geburt und noch vor der Verlegung aus dem Kreißsaal, weitere präprandiale Messungen mit 6, 12, evtl. 24 h

Liegen 3 aufeinanderfolgende Blutglukosewerte >2,5 mmol/l (45 mg/dl), kann in der Regel auf weitere Kontrollen verzichtet werden.

Im gleichen Rhythmus klinische Überwachung auf Hypoglykämiesymptome durch eine Hebamme oder Pflegeperson der Mutter-Kind-Station, bei hypoglykämieverdächtigen Symptomen sofortige Blutglukosebestimmung

Rasche Intervention bei Werten unter 2 mmol/l (36 mg/dl; bei asymptomatischen Kind) bzw. 2,5 mmol/l (45 mg/dl; bei symptomatischem Kind, Hypoglykämierezidiv oder nach Asphyxie) in Form von Nahrung (vorzugsweise Muttermilch, sonst hydrolysierte Formula, Maltodextrinlösung nur vorübergehend), ggf. via Magensonde; bei Werten unter 1,7 mmol/l (30 mg/dl) in der Regel zusätzlich Glukose i.v.

Keine routinemäßige Testung auf Hypokalzämie, Hypomagnesiämie, Hyperbilirubinämie oder Polyglobulie, keine routinemäßige Echokardiographie

Konsequente prä- und postpartale Stillförderung

Abstract

All diabetic women are advised to give birth in a hospital with a pediatric service that allows for continuous intravenous glucose administration, precluding the need for out-of-house transfer of the infant.

Women with pre-pregnancy diabetes or on insulin treatment during pregnancy should give birth in a hospital offering round-the-clock neonatal care.

Early (breast) feeding is of paramount importance and should be started 30 min after birth, subsequently every 2–3 h.

A mandatory preprandial blood glucose measurement should be taken 2–3 h after birth and again immediately before the infant is transferred out of the delivery room; subsequent preprandial measurements at 6, 12, and possibly 24 h of age.

In the event of three consecutive values of >2.5 mmol/l (45 mg/dl), further controls may be dispensed with.

Simultaneously, infants should be checked for symptoms of hypoglycemia by a midwife or nurse on the maternity unit. Clinical findings suspicious for hypoglycemia should prompt immediate blood glucose determinations.

Blood glucose concentrations below 2 mmol/l (36 mg/dl; in infants without symptoms) or 2.5 mmol/l (45 mg/dl; in infants with hypoglycemia-related symptoms, prior hypoglycemia, or following asphyxia) require immediate intervention in the form of feeding (preferably breast milk, otherwise hydrolyzed formula, or hydrolyzed starch solution only temporarily), by gavage if necessary. Intravenous glucose administration if blood glucose falls below 1.7 mmol/l (30 mg/dl).

Routine echocardiography or laboratory tests (Ca2+, Mg2+, hematocrit, bilirubin) are not necessary unless otherwise indicated.

Breast feeding should be consistently encouraged before and after delivery.

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Authors and Affiliations

  1. Abteilung Kinderheilkunde I, Kinderkrankenhaus auf der Bult Hannover, Hannover, Deutschland

    E. Kattner

  2. Zentrum für Kinder- und Jugendmedizin, Universitätsklinik Marburg, Marburg, Deutschland

    F. Maier

  3. Klinik für Geburtshilfe und Pränatalmedizin, Dr. Horst Schmidt-Klinik Wiesbaden, Wiesbaden, Deutschland

    M. Gonser

  4. Frauenklinik, Technische Universität München , München, Deutschland

    K.T.M. Schneider

  5. Frauenklinik Innenstadt, LMU München, München, Deutschland

    F. Kainer

  6. Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg , Hamburg, Deutschland

    T. Somville

  7. Klinik für Geburtsmedizin, Vivantes Klinikum Berlin-Neukölln, Berlin, Deutschland

    K. Vetter

  8. Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Deutschland

    U. Schäfer-Graf

  9. Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum Berlin-Friedrichshain, Berlin, Deutschland

    K. Schunk

  10. Klinik für Kinder und Jugendliche, Klinikum Deggendorf, Deggendorf, Deutschland

    M. Mandl

  11. Abteilung für Neonatologie, Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Tübingen, Deutschland

    I. Müller-Hansen

  12. Klinik für Neonatologie, Charité Universitätsmedizin Berlin, 13344 , Berlin, Deutschland

    C. Bührer

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  1. E. Kattner
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  2. F. Maier
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Leitlinie der Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin, der Deutschen Gesellschaft für Perinatale Medizin, der Deutschen Diabetesgesellschaft, der Deutschen Gesellschaft für Kinder- und Jugendmedizin und der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe

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Kattner, E., Maier, F., Gonser, M. et al. Leitlinie zur Betreuung von Neugeborenen diabetischer Mütter. Monatsschr Kinderheilkd 159, 57–62 (2011). https://doi.org/10.1007/s00112-010-2276-3

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