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and the 'Gerhard Katsch' Central Research Institute for Diabetes, Karlsburg, G.D.R.). Neonatal jaundice in infants of diabetic mothers. Acta Paediatr Scand Suppl360: 101, 1989. 357 IDMs and 20 healthy newborns of non-diabetic mothers were examined at term for body measurements, red blood cell count, serum bilirubin, cord blood insulin and blood glucose during the first postnatal week. The stage of maternal diabetes did not influence the course of neonatal bilirubin levels, but the IDMs had prolonged and higher bilirubinaemia compared with the controls. Hyperbilirubinaemia was found to be most prominent in newborns with an increased birthweightllength ratio and was not simply related to macrosomia (LGA). These infants had significantly lower blood glucose concentrations immediately after birth, whereas cord blood insulin was found to be identical between the I D M sub-groups. Bilirubinaemia in heavy for length infants was slightly correlated to haematocrit. For the pathogenesis of hyperbilirubinaemia in IDMs induction of heme oxygenase (due to a lack of energy provision following a phosphorylation disorder) is discussed. Nutritional support (early feeding, glucose infusions) does not affect the course of bilirubinaemia. Key words: infants of diabetic mothers, bilirubin metabolism, hyperbilirubinaemia.In spite of remarkably reduced mortality and lower malformation rates in infants of diabetic mothers (IDMs), due to modern strategies in the management of diabetes during pregnancy, the incidence of macrosomia and hyperbilirubinaemia in these newborns has remained relatively high.Opinions concerning the pathogenesis of these phenomena differ to some extent (1-3), but most of them are based on the classical theory of Pedersen (4): maternal hyperglycaemia leads to fetal hyperglycaemia and subsequently to hyperplasia of the fetal pancreatic islets. This basic disorder is thought to be responsible for most of the clinical signs and symptoms which can be observed in IDMs, including hyperbilirubinaemia.But, since the IDMs form a heterogeneous group we speculated that the problem of hyperbilirubinaemia was not identical for all of them. Therefore, the aim of our study was to look for different types of IDMs with reference to their somatic development and metabolic condition and the degree of hyperbilirubinaemia in the first week after birth. MATERIALS AND METHODSFrom January 1984 until December 1987 a total of 382 diabetic women gave birth in the Obstetric Department of the Karlsburg Central Institute. The main principles of management were: ( a ) insulin treatment to keep blood sugar in or near the normal range (if possible already praeconceptionally); (b) hospitalization of pregnant women in the 32nd week of gestation for early treatment of complications related to pregnancy as well as to diabetes; (c) delivery near

Acidosis is known as a risk factor for the development of bilirubin encephalopathy in neonatal jaundice. However, few attempts have been made to evaluate the influence of acid-base state on bilirubin-albumin binding state in blood of newborn infants. Therefore, in 171 appropriate and 83 small for gestational age newborns (birthweight less than 2,500 g) the acid-base state in blood and bilirubin (BR) binding state in serum was measured at the ages of 3, 4, 5, and 8 days. There is a weak but significant correlation between standard base deficit and the ratio BR/reserve albumin as well as the toxic potential of serum BR. The results suggest that the higher risk in acidosis is not only caused by increased tissue binding of BR but also--at least partially--attributable to decreased BR binding in serum.

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