Hi Wendy
< Is it possible
the mom was undiagnosed gestational diabetes, since the baby was so
large? would that have contributed to the problems>
Although the baby was relatively large, if he/she was a term baby it would
still fit into the normal (upper range) weight range. It is also worthwhile
looking at the parents size and the history os size of other siblings
because what may be a large size for one family is not for another.  Is the
baby well proportion or does baby look obviously macrosomic? It is usually
the babies >4.5kg or > about 10 pounds that we have significant concerns
about possible hyperinsulinaemia in the baby.  However large babies in
petite families or families with a history of significantly smaller babies
could warrant closer investigation. Undiagnosed gestational diabetes is a
technical possibility.

In my experience (in Australia ) all pregnant mothers are rountinely offered
a glucose tolerance test to identify those mothers with gestational diabetes
so they can be appropriately monitored and treated.  Some mothers decline
the offer of this test and a number fail to turn up for the appointment, so
I have seen babies with hypoglycemia  whose mothers were probably
gestational diabetic (untreated because of no glucose tolerance test) and
subsequently developed symptomatic hypoglycaemia.  Where I work macrosomiac
babies > 4.5 kilogram have routine blood sugar levels to rule out
hypoglycaemia but a term baby less than this weight would not routinely have
them done. This is in line with World Health Organisation recommendations
and current research into neonatal hypoglycaemia.

<? Does CP cause
hypoglycemia or vice versa? Should they consult a lawyer?>
If the baby was only a few days old any changes on head ultrasound (apart
from a fresh bleed) would have been caused from an ante-natal insult. No-one
at delivery or subsequent to delivery could have done a thing about it. From
my experience, a subsequent ultrasound at 2 weeks shows up an insult from
birth. Sounds like the baby has been diagnosed with leukomalacia.  Severe
hypoglycaemia and subsequent fitting can cause brain damage but seems like
the baseline ultrasound was done early to pick up any previous insults--and
this is standard practice..  If the child fitted first and suffered an
hypoxic episode this could have  caused the hypoglycaemia.  From now it is a
case of wait and see whether the baby meets its developmental milestones and
how severely handicapped he or she is.  Some babies with seemingly severe
insults do remarkably well and others with only mild insults are severely
disabled.  Again with breast feeding it does depend on the severity of the
insult and how well co-ordinated the baby is.

<In the mean time, I guess just coming to terms with the CP and waiting
to see if it is mild or more (not sure how long it takes to know that)
will be a lot for this family to deal with. I didn't even discuss
breastfeeding with my friend tonight, so maybe this is off topic. I
welcome input about what breastfeeding issues might be complicated by
the CP and how it might benefit this baby. (now I am back ON topic,
right?)>
Breastfeeding is even more important for infants such as these and
breastfeeding or expressing milk is something important and tangible the
mother can do for her baby. Apart from the physiological and immunological
benefits breast milk is optimal for brain development and increased
IQ--sounds like baby needs all the help that can be given.Please don't shy
away from discussing breast feeding. In my experience mothers welcome the
opportunity to help their baby as much as possible and it is important to
discuss this issue early before the mother loses her milk supply.  The
support and empathy of someone such as yourself is an invaluable help to
these mothers.
Marian Rigney



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