Maternal diabetes and neonatal respiratory distress. II. Prediction of fetal lung maturity

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Abstract
Summary: Fifty babies were born at ≤ 37 weeks to mothers with diabetes. Delivery was undertaken in all patients with the reassurance that the L/S ratio was ≥2.0 within the preceding 72 h. Five babies (10%) developed respiratory distress syndrome (RDS). Prediction of fetal lung maturity was improved dramatically by measuring amniotic fluid concentrations of phosphatidylcholine (PC), phosphatidylinositol (PI) and phosphatidyl‐glycerol (PG). Fourteen babies were predicted as having ‘no surfactant’ (PC < 20 mg/1, PI < 2 mg/1 and PG < 2 mg/1), five developed RDS. None of the remaining 36 babies developed the illness: they were predicted as having either ‘early surfactant’ (PC ≥ 20 mg/1, PI ≥ 2 mg/1 but PG < 2 mg/1) or ‘late surfactant’ (PC ≥ 20 mg/1, PI ≥ 2 mg/1 and PG ≥ 2 mg/1). Measurement of PC levels alone was the most accurate method of predicting RDS. There was a significant association between low surfactant phospholipid concentrations and the development of transient tachypnoea of the newborn.

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