The Clinical Study of Swallowing Difficulties in Infants of Diabetic Mothers
Objective To determine the risk of swallowing difficulties in full-term infants of diabetic mothers(IDM).Meth-ods This prospective cohort study analyzed perinatal data from full-term neonates in neonatal intensive care unit(NICU)of u-nion Hospital,Tongji Medical College,Huazhong University of Science and Technology between January 2020 and June 2023.Full-term infants with swallowing difficulties were evaluated by frequency of deglutition apneas and Neonatal Oral Motor Assessment Scale(NOMAS).Then their data of echocardiography,brain magnetic resonance imaging(MRI),amplitude-integrat-ed electroencephalography(aEEG)and neonatal behavioral neurological assessment(NBNA)were collected.According maternal diabetes condition,the infants were divided into IDM group and non-IDM group.The incidence of swallowing difficulties was compared between the two groups.Univariate analysis was performed on swallowing difficulties in IDM.Results A total of 1972 full-term infants were enrolled in this study,including 593 infants in IDM group and 1379 infants in non-IDM group.Compared with the non-IDM group,the gestational age in IDM group was smaller,and the incidence of cesarean section(73.00％vs.56.70％)and large for gestational age(13.90％vs.6.45％)were higher(all P＜0.05).The incidence of swallowing difficulties was higher in IDM group(3.37％vs.0.87％,P＜0.05).During spontaneous swallowing,proportion of deglutition apneas was higher in IDM group(45.00％vs.8.33％,P＜0.05),whereas during adaptive swallowing,proportions of deglutition apnea were similar in IDM group and non-IDM group(20.00％vs.8.33％,P＞0.05).For the NOMAS of the infants of swallo-wing difficulties,the score of disorganized sucking pattern and the score of dysfunctional sucking pattern in IDM group were higher than those in non-IDM group(both P＜0.05).There was no difference between the two groups in normal oral motion scores(P＞0.05).Univariate analyses showed that swallowing difficulties(RR=3.87,95％CI:1.87-7.96),cesarean section(RR=1.29,95％CI:1.05-1.59)and large for gestational age(RR=2.16,95％CI:1.56-2.97)were independent risk factors of IDM.In addition,71.88％of infants with swallowing difficulties had abnormal aEEG and 81.25％of infant with swallowing difficulties had abnormal NBNA scores.The incidence of abnormal aEEG and NBNA in children with swallowing difficulties in IDM group were higher than those in non-IDM group(85.00％vs.50.00％,90.00％vs.58.33％,both P＜0.05).Conclusion Maternal diabetes mellitus is a risk factor for swallowing difficulties in full-term neonates,and swallowing difficulties in IDMs are likely to be associated with brain injury.
infant of diabetic motherswallowing difficultyneonatal oral motor assessment scalebrain injury
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