title: Outcomes of Extremely Preterm Infants Born to Insulin-Dependent Diabetic Mothers.
abstract: Little is known about in-hospital morbidities and neurodevelopmental outcomes among extremely preterm infants born to women with insulin-dependent diabetes mellitus (IDDM). We examined risks of mortality, in-hospital morbidities, and neurodevelopmental outcomes at 18 to 22 months' corrected age between extremely preterm infants of women with insulin use before pregnancy (IBP), with insulin use started during pregnancy (IDP), and without IDDM.
  
  
  
  Infants 22 to 28 weeks' gestation born or cared for at a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network center (2006-2011) were studied. Regression models compared the association between maternal IDDM and timing of insulin use and the outcomes of the 3 groups.
  
  
  
  Of 10 781 infants, 536 (5%) were born to women with IDDM; 58% had IBP, and 36% had IDP. Infants of mothers with IBP had higher risks of necrotizing enterocolitis (adjusted relative risk [RR] = 1.55 [95% confidence interval (CI) 1.17-2.05]) and late-onset sepsis (adjusted RR = 1.26 [95% CI 1.07-1.48]) than infants of mothers without IDDM. There was some indication of higher in-hospital mortality risk among infants of mothers with IBP compared with those with IDP (adjusted RR = 1.33 [95% CI 1.00-1.79]). Among survivors evaluated at 18 to 22 months' corrected age, average head circumference z score was lower for infants of mothers with IBP compared with those without IDDM, but there were no differences in risk of neurodevelopmental impairment.
  
  
  
  In this cohort of extremely preterm infants, infants of mothers with IBP had higher risks of necrotizing enterocolitis, sepsis, and small head circumference.
authors.affiliation: Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina;
authors.forename: Nansi S
authors.initials: NS
authors.lastname: Boghossian
authors.affiliation: Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina;
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, Iowa; edward-bell@uiowa.edu.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, Iowa;
authors.forename: Jane E
authors.initials: JE
authors.lastname: Brumbaugh
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia;
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.affiliation: Department of Pediatrics, Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island;
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan;
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System and Children's Medical Center Dallas, Dallas, Texas;
authors.forename: Myra H
authors.initials: MH
authors.lastname: Wyckoff
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, Iowa;
authors.forename: Tarah T
authors.initials: TT
authors.lastname: Colaizy
authors.affiliation: Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland; and.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006257:Head / Q000033:anatomy & histology*; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000254:growth & development; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D065886:Neurodevelopmental Disorders / Q000453:epidemiology; D009929:Organ Size; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000188:drug therapy*; D012044:Regression Analysis; D018805:Sepsis / Q000453:epidemiology*
chemical_list: D007328:Insulin