Effect of Maternal Diabetes on Time to Full Oral Feedings in Infant’s Admitted to the Neonatal Intensive Care Unit

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Study Design : Retrospective study of infants born at or after 34 weeks gestational age and admitted between 1/1/2020 to 01/31/2022. Time to full oral feedings was compared between infants born to mothers with and without diabetes (267 versus 918) Continuous and binomial variables were analyzed with the Mann Whitney U test and the Chi-Square test respectively. Linear regression was then conducted to explore identified potential relationships from these analyses. Result Comparison of groups via univariate analysis revealed a mean difference of two more days to establish full oral feedings (p = 0.0001). Maternal pregestational diabetes (PGDM) and obesity (Body mass index;BMI > 30kg/m 2 ) were associated with longer time for infants to complete oral feeds (p 0.034 and 0.013 respectively) Conclusion Infants born to mothers with diabetes took longer to achieve full oral feedings. Health sciences/Endocrinology/Endocrine system and metabolic diseases/Diabetes Health sciences/Health care/Paediatrics Introduction The Centers for Disease Control and Prevention estimates that 1–2% of pregnant women in the United States have type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and that 6–9% of pregnant women develop gestational diabetes mellitus (GDM) which describes insulin resistance first recognized during pregnancy. 1 It is widely documented that maternal diabetes poses an increased risk for both the mother and infant affected. Rates of maternal pre-eclampsia, stillbirth, macrosomia (and subsequently shoulder dystocia) are increased as well as birth trauma and neonatal encephalopathy in the infant. 1 Many articles focus on the long-term impacts of diabetes on infant health and wellness including infant feeding practices (breastfeeding vs. bottle/formula feeding), however, few discuss the early impact of diabetes on infant feeding ability. A prospective study described shorter duration of breast feeding in mothers with GDM; a one-month shorter mean duration was noted by Manaker et. al. 1 , 2 Infants of diabetic mothers were 40% more likely to have breastmilk supplementation prior to hospital discharge and 30% less likely to be breastfeeding at a year of life. “Infants exposed to GDM also have increased incidence of obesity and insulin resistance in childhood, and impaired glucose tolerance and type 2 diabetes mellitus in adulthood.” 1 Poorer sucking patterns were found at 3 days of age among infants of insulin-managed mothers with diabetes. 3 Children of mothers with diabetes who have oral feeding difficulties underwent pH impedance monitoring to evaluate the utility of this modality of diagnostic testing . 4 It showed that there was no impact on the diagnosis of gastroesophageal reflux disease on feeding outcomes of infants born to mothers with diabetes. Multiple studies have also compared the incidence and mode of feeding with the future incidence of diabetes in the infants of mothers with diabetes. Although a retrospective study of term neonates with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) identified a 7-day difference in the time to oral feedings in the infants of mothers with and without diabetes, 5 no study to date has evaluated the difference between time to oral feedings in infants born to mothers with and without diabetes who did not have HIE. Wang et. al evaluated the impact of maternal diabetes (both pre-gestational and gestational) on the development of feeding and eating disorders (FED). “FED are characterized by persistent eating disturbances” including refusal of food, eating non-edible substances, regurgitation after eating without nausea, retching, or disgust. 6 It was found that exposure of the fetus to any type of diabetes increased the risk of development of FED – potentially due to the neurodevelopmental impact diabetes has on the developing brain. 6 Objectives: This study was performed to evaluate the difference in the time to oral feedings between infants of mothers with and without diabetes born at or after 34 weeks of gestation and admitted to the NICU. Subjects and Methods We included all infants born at or after 34 weeks gestation who were admitted to the NICU for greater than 24 hours between January 1, 2020, and January 31, 2022. Exclusion criteria included: infants who died, transferred to another facility for higher care, infants with genetic defects or congenital anomalies such as cleft lip or cleft palate, neurological disorders such as encephalopathy, seizures or intracranial hemorrhage, and infants with heart failure. Each infant’s characteristics including birth parameters were collected as well as APGAR scores, time on respiratory support (invasive and/or non-invasive), length of stay, need for a swallow study, requirement of gastrointestinal tube, and days to full feedings. Infant growth parameters were assessed using the Fenton growth chart. Appropriate for gestational age was documented if birth weight was between 10th and 90th centile, small for gestational age if less than 10th centile and large for gestational age if birth weight was more than 90th centile. It is important to note that oral feedings are initiated in our NICU only after the infant is off noninvasive respiratory support or requiring ≤ 2 liters per minute of humidified high flow nasal cannula. Noninvasive ventilation includes nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and noninvasive neurally adjusted ventilator assist. Any ventilation with an endotracheal tube is considered invasive ventilation. Endotracheal intubation for surfactant administration was not deemed as invasive ventilation. The date oral feedings were first allowed was considered the first day of oral feeds and full volume oral feedings were defined by the ability of the infant to take 150 mL/kg of current body weight per day. If the infant was exclusively or predominantly breast fed, then the day of full volume oral feeds was determined by weight gain on two successive days. Prior to discharge, an infant should not have required any gavage feeds or gavage supplementation for a minimum of 24 hours. It was also important to verify the infant was gaining weight adequately before discharging home. When categorizing maternal disease, pregestational diabetes was defined by type 1 or type 2 diabetes diagnosed before pregnancy. This determination was made by the obstetricians and obtained from maternal charts. Gestational diabetes was also determined by the obstetrician and the diagnosis was obtained from maternal charts. Pre-pregnancy body mass index (BMI) was gathered from mother’s first prenatal visit. Hemoglobin A 1 C (HBA1C) was obtained from maternal charts, if available, and is not routinely determined in mothers with gestational diabetes. All data was collected on RedCap database hosted by University of Missouri. Univariate analysis was performed was performed using GraphPad Prism v10.0.1 (GraphPad Software, Inc., Boston, MA) Continuous variables were analyzed with the Mann Whitney U test and are presented as mean (S.D.) unless otherwise specified. Binomial variables were analyzed with the Chi-Square test and are presented as number (%). Propensity score matching and linear regression analysis were performed using SPSS version 28 (IBM SPSS Statistics, IBM Corporation, Armonk, NY). A p-value of < 0.05 was used to define statistical significance. Using baby’s sex, gestational age at birth in completed weeks, and anthropometry as independent variables, a 1:1 Propensity Score Matched Dataset was generated. Exact matches were found for 226 babies of mothers with diabetes. Linear regression analysis was run on this matched set of 452 babies to find the variables significantly associated with time to full feeds. Factors clinically considered to be affecting the time to oral feeds were used as independent variables, namely, baby’s sex, gestational age, birth weight, anthropometry, maternal age at delivery and maternal diabetes. The institutional review board at University of Missouri, Columbia approved this retrospective chart review study. Results ALL BABIES Infant of mother without diabetes N: 918 Infant of mother with diabetes N: 267 P value Gestational age, (weeks) Mean (SD) 36.9 (2.11) 36.37 (1.77) < 0.0001 Male Sex 534 (58%) 154 (57%) 0.886 Birth Weight Mean (SD) 2895 (666.7) 3195 (796) 796 < 0.0001 Anthropometry LGA 62 (6%) SGA 134 (14%) AGA 721 (78%) LGA 77 (28%) SGA 21 (7%) AGA 168 (62%) LGA: <0.0001 SGA: 0.0040 AGA: <0.0001 Apgar Scores 1 min: 6.56 (1.99) 5 min: 8.02 (1.33) 1 min: 6.32 (2.03) 5 min:7.9 (1.37) 1 min: 0.05547 5 min: 0.07015 Invasive Ventilation 121 (13%) 34 (12%) 0.8651 Duration of invasive ventilation (days) Mean (SD) 2.12 (2.15) 1.62 (1.94) 0.0007 Noninvasive ventilation 657 (71%) 194 (72%) 0.7274 Duration of noninvasive ventilation Mean (SD) 4.46 (14.31) 4.76 (6.43) 0.7393 Length of stay (days) Mean (SD) 11.7 (14.5) 13 (11.3) 0.01711 Duration to all PO feeds after PO feeds were commenced (days) Mean (SD) 4.82 (5.99) 6.52 (7.51) 0.0001 Swallow study 25 (2%) 15 (5%) 0.0212 G Tube 2 (0.2%) 4 (1.4%) 0.0093 Independent variable of Interest: Time to full PO feeds after initiation of PO feeds: Linear regression: Entire cohort (n = 1185) All Cases Unstandardized Coefficients Standardized Coefficients t p Value B Std. Error Beta (Constant) 10.695 1.499 7.136 0.000 Male Baby -0.085 0.433 -0.006 -0.197 0.844 Gestational Age > 37 Weeks -3.582 0.597 -0.262 -6.004 0.000 BW: <2500; 2500 to 4000 -1.866 0.382 -0.267 -4.887 0.000 BW > 4000 (Yes/No) 2.862 1.020 0.107 2.806 0.005 Small/ Appropriate or Large for GA 0.316 0.596 0.024 0.530 0.596 Mother's age at delivery 0.010 0.038 0.008 0.267 0.789 Maternal Diabetes 1.311 0.508 0.085 2.581 0.010 Linear regression: Infants more than 37 weeks gestational age 37 weeks or Higher Unstandardized Coefficients Standardized Coefficients t p Value B Std. Error Beta (Constant) 5.900 1.816 3.249 0.001 Male Baby -0.381 0.487 -0.037 -0.783 0.434 BW: <2500; 2500 to 4000 -1.095 0.517 -0.165 -2.119 0.035 BW > 4000 (Yes/No) 2.585 0.990 0.164 2.611 0.009 Small/ Appropriate or Large for GA -0.095 0.818 -0.010 -0.116 0.907 Mother's age at delivery 0.015 0.045 0.015 0.326 0.745 Maternal Diabetes 1.251 0.583 0.106 2.146 0.032 Linear regression: Infants less than 37 weeks gestational age Less than 37 weeks Unstandardized Coefficients Standardized Coefficients t p Value B Std. Error Beta (Constant) 11.259 2.332 4.829 0.000 Male Baby 0.332 0.746 0.023 0.445 0.657 BW: <2500; 2500 to 4000 -2.321 0.584 -0.254 -3.972 0.000 BW > 4000 (Yes/No) 0.832 3.220 0.014 0.258 0.796 Small/ Appropriate or Large for GA 0.327 0.884 0.022 0.370 0.712 Mother's age at delivery 0.005 0.062 0.004 0.085 0.933 Maternal Diabetes 1.610 0.865 0.100 1.861 0.063 Linear regression: Infants of diabetic mothers Unstandardized Coefficients Standardized Coefficients t p Value B Std. Error Beta (Constant) 3.207 4.389 0.731 0.466 Male Baby -0.356 1.109 -0.024 -0.321 0.749 Gestational Age > 37 Weeks -5.196 1.349 -0.359 -3.852 0.000 BW: <2500; 2500 to 4000 -0.243 0.917 -0.033 -0.265 0.791 BW > 4000 (Yes/No) -0.263 2.020 -0.013 -0.130 0.896 Small/ Appropriate or Large for GA -0.444 1.271 -0.036 -0.349 0.727 Mother's age at delivery 0.016 0.096 0.013 0.170 0.865 Maternal BMI 0.164 0.065 0.191 2.521 0.013 Pregestational Diabetes 2.420 1.129 0.167 2.143 0.034 We compared time to oral feeding in infants born at or after 34 weeks gestational age born to mothers with and without diabetes and admitted to the NICU for more than 24 hours. It was found that amongst the entire cohort of infants, infants born to mothers with any type of diabetes in their pregnancy take two additional days to reach full volume oral feeds compared to the infants born to mothers without diabetes. The difference in time to attain full volume oral feeds was significant in infants born to mothers with diabetes if they were born after 37 weeks of gestational age but not before 37 weeks of gestational age. This indicates that at lower gestation, prematurity may be playing a bigger role in the time to attain full volume oral feedings than maternal diabetes. Linear regression analysis of infants born to mothers with diabetes showed that gestational age more than 37 weeks, maternal BMI (more than 30kg/cm 2 ) and pregestational diabetes significantly affected the time to oral feeding. Linear regression on propensity scores matched infants (by weight and gestational age) revealed birth weight and maternal diabetes significantly affected time to oral feeding. Regression analysis (not shown here) also indicated there was no difference in time to full oral feedings if mother was treated with insulin or diet controlled. There were 4 infants born to mothers with diabetes and 2 infants born to mothers without diabetes who needed a gastrostomy tube. The numbers were too small for a meaningful statistical analysis. Discussion Anecdotally, infants born to mothers with diabetes appeared to require more time to reach full oral feedings than those not exposed to diabetes. In order to test this theory, we evaluated the time to full oral feedings in infants born at or after 34 weeks gestational age to mothers with and without diabetes who were admitted to the NICU for greater than 24 hours. It was discovered that infants born to mothers with any type of diabetes in their pregnancy take two additional days to reach full volume oral feeds compared to infants born to mothers without diabetes. It was further identified that amongst the infants born to mothers with diabetes in their pregnancy, mothers with a pre-pregnancy BMI more than 30kg/cm 2 and pregestational diabetes were more likely to take longer to feed by mouth. We believe that this is the first study to investigate the difference in oral feeding between the two groups of infants. Interestingly, in our cohort of infants born to mothers without diabetes, there was an increase in number of days spent on invasive ventilation. They spent an average of 2.1 days on invasive ventilation versus 1.6 days which was statistically significant. Knowing that infants who are born to mothers with diabetes often struggle with surfactant deficiency and respiratory distress, this finding was opposite of what was expected. A prior study evaluating oral sucking in infants of mothers with diabetes and treated with insulin describe poorer sucking at 3 days of age. These infants were compared to a cohort of infants born to mothers with diabetes treated with diet alone, and a group of healthy infants born to mothers without diabetes. The sucking pattern was evaluated only on day 3 after birth. 3 The study hypothesized that sucking pattern reflects neurobehavioral maturity. They further report that sucking was poorer in infants of mothers treated with insulin whereas infants born to mothers with diabetes treated with diet alone had suck comparable to healthy infants. They postulate that the former group of infants had a greater effect of diabetes on their neurologic status. Our study did not find that the treatment of maternal diabetes with insulin or diet had any role in the time to oral feeding. A prior article discussed the relevance and utility of pH impedance monitoring to elucidate if infants born to mothers with diabetes suffered from feeding difficulties. 4 Acid reflux index was found to be significant in 40% of infants. Treatment with proton pump inhibitors did not affect the short-term outcomes. It is not routine to perform pH studies in our hospital. If an infant is struggling with oral feedings, a speech consult is obtained, and swallow study is performed as indicated. We found more infants born to mothers with diabetes received a swallow study, signifying an issue with oral feeding skills. However, all the swallow study results were normal. This finding redemonstrates the evidence that discusses infants born to mothers with diabetes are more likely to have feeding difficulties. It is a common belief that infants born to mothers with diabetes take longer to feed orally. There is no evidence in the literature to substantiate this common belief. A study revealed a difference of 7 days in infants born to mothers with and without diabetes if they were treated with neonatal hypothermia . 5 This difference could be due to maternal diabetes but more importantly reflect the effect of HIE on the infants. The current study excluded infants with encephalopathy to avoid this confounding influence of encephalopathy on oral feeding. It has also been noted that infants who are exposed to diabetes during fetal life are at an increased risk of developing FED. 6 The findings in this study need to be confirmed with larger studies and if validated, may provide impetus to focusing on pre pregnancy health of mothers with diabetes given the impact of BMI on feeding outcomes. Control of diabetes with continuous glucose monitoring may also provide valuable data on feeding outcomes based on maternal control of diabetes. Strengths of the study include its unique nature, a large sample size, and propensity score matched group analysis. This confirmed that maternal diabetes is associated with delayed oral feeding in infants born to mothers with any form of diabetes in their pregnancy. Excluding infants not admitted to the NICU prevented the impact of healthy infants on both groups. These infants would go home with their mothers in 2 or 4 days after birth, depending on the mode of their birth (vaginal versus Cesarean section). They were presumed to be feeding well orally as otherwise they would be admitted to the NICU. Similarly, excluding infants admitted for less than 24 hours prevented infants who were otherwise healthy but admitted for delayed transitional physiology (e.g., transient tachypnea of newborn) from being included in the data. Excluding infants born less than 34 weeks gestational age and with other exclusion criteria prevented the associated confounding factors affecting oral feeding. Limitations include the retrospective nature of the study from a single center. Maternal data on the duration of maternal diabetes was missing in 36% of cases. If this data was available, it may have allowed us to predict the ability of the infant to feed based on when mother was diagnosed with diabetes and the present duration of her disease. Hemoglobin A 1C is not estimated in mothers with gestational diabetes and hence feeding outcomes based on this maternal variable were not possible. Future directions for research include assessing pre-pregnancy health and interventions for healthy lifestyles given that high BMI is impacting oral feeding status. With improved blood sugar control plus a lower BMI, we would hope to see improved outcomes among infants born to mothers with diabetes. Declarations Author contributions: Madyson Williams, Meredith Schoenig, Laith Almashharawi, Destri Eichman: Acquisition and analysis of the data References Manerkar K, Harding J, Conlon C, McKinlay C. Maternal gestational diabetes and infant feeding, nutrition and growth: a systematic review and meta-analysis. Br J Nutr. 2020;123(11):1201–1215. doi: 10.1017/S0007114520000264 Nguyen PTH, Binns CW, Nguyen CL, et al. Gestational Diabetes Mellitus Reduces Breastfeeding Duration: A Prospective Cohort Study. Breastfeed Med Off J Acad Breastfeed Med. 2019;14(1):39–45. doi: 10.1089/bfm.2018.0112 Bromiker R, Rachamim A, Hammerman C, Schimmel M, Kaplan M, Medoff-Cooper B. Immature sucking patterns in infants of mothers with diabetes. J Pediatr. 2006;149(5):640–643. doi: 10.1016/j.jpeds.2006.07.034 Viswanathan S, Batchu S, Osborn E, Jadcherla S. Diagnostic utility of impedance-pH monitoring in infants of diabetic mothers with oral feeding difficulties. J Perinatol. 2021;41(8):1886–1892. doi: 10.1038/s41372-020-00832-7 Laval N, Paquette M, Talsmat H, et al. Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic–Ischemic Encephalopathy. Am J Perinatol. Published online March 14, 2023:a-2053-7904. doi: 10.1055/a-2053-7904 Wang H, He H, Yu Y, Su X, Li F, Li J. Maternal diabetes and the risk of feeding and eating disorders in offspring: a national population-based cohort study. BMJ Open Diabetes Res Care. 2020;8(1):e001738. doi: 10.1136/bmjdrc-2020-001738 Additional Declarations There is NO conflict of interest to disclose. Cite Share Download PDF Status: Published Journal Publication published 07 Aug, 2024 Read the published version in Journal of Perinatology → Version 1 posted Editorial decision: revise 19 Jun, 2024 Review # 2 received at journal 18 Jun, 2024 Review # 1 received at journal 17 Jun, 2024 Reviewer # 2 agreed at journal 03 Jun, 2024 Reviewer # 1 agreed at journal 30 May, 2024 Reviewers invited by journal 29 May, 2024 Submission checks completed at journal 24 May, 2024 First submitted to journal 23 May, 2024 Unknown event 23 May, 2024 Editor assigned by journal 22 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4463218","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":308157323,"identity":"2958fcea-b3b6-4b7a-8ab0-56eb07884a3d","order_by":0,"name":"Akshaya 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07:10:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":988689,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4463218/v1/ac44b027-2eae-4540-9196-0facaaa47194.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Effect of Maternal Diabetes on Time to Full Oral Feedings in Infant’s Admitted to the Neonatal Intensive Care Unit","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Centers for Disease Control and Prevention estimates that 1\u0026ndash;2% of pregnant women in the United States have type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and that 6\u0026ndash;9% of pregnant women develop gestational diabetes mellitus (GDM) which describes insulin resistance first recognized during pregnancy.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e It is widely documented that maternal diabetes poses an increased risk for both the mother and infant affected. Rates of maternal pre-eclampsia, stillbirth, macrosomia (and subsequently shoulder dystocia) are increased as well as birth trauma and neonatal encephalopathy in the infant.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMany articles focus on the long-term impacts of diabetes on infant health and wellness including infant feeding practices (breastfeeding vs. bottle/formula feeding), however, few discuss the early impact of diabetes on infant feeding ability. A prospective study described shorter duration of breast feeding in mothers with GDM; a one-month shorter mean duration was noted by Manaker et. al.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Infants of diabetic mothers were 40% more likely to have breastmilk supplementation prior to hospital discharge and 30% less likely to be breastfeeding at a year of life. \u0026ldquo;Infants exposed to GDM also have increased incidence of obesity and insulin resistance in childhood, and impaired glucose tolerance and type 2 diabetes mellitus in adulthood.\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Poorer sucking patterns were found at 3 days of age among infants of insulin-managed mothers with diabetes.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Children of mothers with diabetes who have oral feeding difficulties underwent pH impedance monitoring to evaluate the utility of this modality of diagnostic testing .\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e It showed that there was no impact on the diagnosis of gastroesophageal reflux disease on feeding outcomes of infants born to mothers with diabetes.\u003c/p\u003e \u003cp\u003eMultiple studies have also compared the incidence and mode of feeding with the future incidence of diabetes in the infants of mothers with diabetes. Although a retrospective study of term neonates with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) identified a 7-day difference in the time to oral feedings in the infants of mothers with and without diabetes, \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e no study to date has evaluated the difference between time to oral feedings in infants born to mothers with and without diabetes who did not have HIE.\u003c/p\u003e \u003cp\u003eWang et. al evaluated the impact of maternal diabetes (both pre-gestational and gestational) on the development of feeding and eating disorders (FED). \u0026ldquo;FED are characterized by persistent eating disturbances\u0026rdquo; including refusal of food, eating non-edible substances, regurgitation after eating without nausea, retching, or disgust.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e It was found that exposure of the fetus to any type of diabetes increased the risk of development of FED \u0026ndash; potentially due to the neurodevelopmental impact diabetes has on the developing brain.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eObjectives:\u003c/h2\u003e \u003cp\u003eThis study was performed to evaluate the difference in the time to oral feedings between infants of mothers with and without diabetes born at or after 34 weeks of gestation and admitted to the NICU.\u003c/p\u003e \u003c/div\u003e"},{"header":"Subjects and Methods","content":"\u003cp\u003eWe included all infants born at or after 34 weeks gestation who were admitted to the NICU for greater than 24 hours between January 1, 2020, and January 31, 2022. Exclusion criteria included: infants who died, transferred to another facility for higher care, infants with genetic defects or congenital anomalies such as cleft lip or cleft palate, neurological disorders such as encephalopathy, seizures or intracranial hemorrhage, and infants with heart failure.\u003c/p\u003e \u003cp\u003eEach infant\u0026rsquo;s characteristics including birth parameters were collected as well as APGAR scores, time on respiratory support (invasive and/or non-invasive), length of stay, need for a swallow study, requirement of gastrointestinal tube, and days to full feedings. Infant growth parameters were assessed using the Fenton growth chart. Appropriate for gestational age was documented if birth weight was between 10th and 90th centile, small for gestational age if less than 10th centile and large for gestational age if birth weight was more than 90th centile.\u003c/p\u003e \u003cp\u003eIt is important to note that oral feedings are initiated in our NICU only after the infant is off noninvasive respiratory support or requiring\u0026thinsp;\u0026le;\u0026thinsp;2 liters per minute of humidified high flow nasal cannula. Noninvasive ventilation includes nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and noninvasive neurally adjusted ventilator assist. Any ventilation with an endotracheal tube is considered invasive ventilation. Endotracheal intubation for surfactant administration was not deemed as invasive ventilation.\u003c/p\u003e \u003cp\u003eThe date oral feedings were first allowed was considered the first day of oral feeds and full volume oral feedings were defined by the ability of the infant to take 150 mL/kg of current body weight per day. If the infant was exclusively or predominantly breast fed, then the day of full volume oral feeds was determined by weight gain on two successive days. Prior to discharge, an infant should not have required any gavage feeds or gavage supplementation for a minimum of 24 hours. It was also important to verify the infant was gaining weight adequately before discharging home.\u003c/p\u003e \u003cp\u003eWhen categorizing maternal disease, pregestational diabetes was defined by type 1 or type 2 diabetes diagnosed before pregnancy. This determination was made by the obstetricians and obtained from maternal charts. Gestational diabetes was also determined by the obstetrician and the diagnosis was obtained from maternal charts. Pre-pregnancy body mass index (BMI) was gathered from mother\u0026rsquo;s first prenatal visit. Hemoglobin A 1 C (HBA1C) was obtained from maternal charts, if available, and is not routinely determined in mothers with gestational diabetes.\u003c/p\u003e \u003cp\u003eAll data was collected on RedCap database hosted by University of Missouri. Univariate analysis was performed was performed using GraphPad Prism v10.0.1 (GraphPad Software, Inc., Boston, MA) Continuous variables were analyzed with the Mann Whitney U test and are presented as mean (S.D.) unless otherwise specified. Binomial variables were analyzed with the Chi-Square test and are presented as number (%). Propensity score matching and linear regression analysis were performed using SPSS version 28 (IBM SPSS Statistics, IBM Corporation, Armonk, NY). A p-value of \u0026lt;\u0026thinsp;0.05 was used to define statistical significance.\u003c/p\u003e \u003cp\u003eUsing baby\u0026rsquo;s sex, gestational age at birth in completed weeks, and anthropometry as independent variables, a 1:1 Propensity Score Matched Dataset was generated. Exact matches were found for 226 babies of mothers with diabetes. Linear regression analysis was run on this matched set of 452 babies to find the variables significantly associated with time to full feeds. Factors clinically considered to be affecting the time to oral feeds were used as independent variables, namely, baby\u0026rsquo;s sex, gestational age, birth weight, anthropometry, maternal age at delivery and maternal diabetes.\u003c/p\u003e \u003cp\u003eThe institutional review board at University of Missouri, Columbia approved this retrospective chart review study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eALL BABIES\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfant of mother without diabetes\u003c/p\u003e \u003cp\u003eN: 918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInfant of mother with diabetes\u003c/p\u003e \u003cp\u003eN: 267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age, (weeks)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.9 (2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.37 (1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale Sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e534 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Weight\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2895 (666.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3195 (796)\u003c/p\u003e \u003cp\u003e796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnthropometry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLGA 62 (6%)\u003c/p\u003e \u003cp\u003eSGA 134 (14%)\u003c/p\u003e \u003cp\u003eAGA 721 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLGA 77 (28%)\u003c/p\u003e \u003cp\u003eSGA 21 (7%)\u003c/p\u003e \u003cp\u003eAGA 168 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLGA: \u0026lt;0.0001\u003c/p\u003e \u003cp\u003eSGA: 0.0040\u003c/p\u003e \u003cp\u003eAGA: \u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApgar Scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 min: 6.56 (1.99)\u003c/p\u003e \u003cp\u003e5 min: 8.02 (1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 min: 6.32 (2.03)\u003c/p\u003e \u003cp\u003e5 min:7.9 (1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 min: 0.05547\u003c/p\u003e \u003cp\u003e5 min: 0.07015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8651\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of invasive ventilation (days)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.12 (2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.62 (1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNoninvasive ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e657 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of noninvasive ventilation\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.46 (14.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.76 (6.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7393\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.7 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration to all PO feeds after PO feeds were commenced (days)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.82 (5.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.52 (7.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwallow study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG Tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variable of Interest: Time to full PO feeds after initiation of PO feeds:\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eLinear regression: Entire cohort (n\u0026thinsp;=\u0026thinsp;1185)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.695\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.499\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.136\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale Baby\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.085\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.433\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.197\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.844\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGestational Age\u0026thinsp;\u0026gt;\u0026thinsp;37 Weeks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-3.582\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.597\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.262\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-6.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW: \u0026lt;2500; 2500 to \u0026lt;\u0026thinsp;3000; 3000 to 4000; \u0026gt;4000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-1.866\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.382\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.267\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-4.887\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW\u0026thinsp;\u0026gt;\u0026thinsp;4000 (Yes/No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.862\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.107\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.806\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmall/ Appropriate or Large for GA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.316\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.596\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.530\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.596\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's age at delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.267\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.789\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Diabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.311\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.508\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.085\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.581\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eLinear regression: Infants more than 37 weeks gestational age\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e37 weeks or Higher\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.900\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.816\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.249\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale Baby\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.381\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.487\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.783\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.434\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW: \u0026lt;2500; 2500 to \u0026lt;\u0026thinsp;3000; 3000 to 4000; \u0026gt;4000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-1.095\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.517\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.165\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-2.119\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW\u0026thinsp;\u0026gt;\u0026thinsp;4000 (Yes/No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.585\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.990\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.164\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.611\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmall/ Appropriate or Large for GA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.095\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.818\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.116\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.907\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's age at delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.326\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.745\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Diabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.251\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.583\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.106\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.146\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLinear regression: Infants less than 37 weeks gestational age\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLess than 37 weeks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.259\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.332\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.829\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale Baby\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.332\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.746\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.445\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.657\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW: \u0026lt;2500; 2500 to \u0026lt;\u0026thinsp;3000; 3000 to 4000; \u0026gt;4000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-2.321\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.584\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.254\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-3.972\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW\u0026thinsp;\u0026gt;\u0026thinsp;4000 (Yes/No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.832\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.220\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.258\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.796\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmall/ Appropriate or Large for GA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.327\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.884\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.370\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.712\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's age at delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.062\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.085\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.933\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Diabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.610\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.865\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.861\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.063\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLinear regression: Infants of diabetic mothers\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.207\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.389\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale Baby\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.356\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.109\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.321\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.749\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGestational Age\u0026thinsp;\u0026gt;\u0026thinsp;37 Weeks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-5.196\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.349\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.359\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-3.852\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW: \u0026lt;2500; 2500 to \u0026lt;\u0026thinsp;3000; 3000 to 4000; \u0026gt;4000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.243\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.917\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.265\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.791\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBW\u0026thinsp;\u0026gt;\u0026thinsp;4000 (Yes/No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.263\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.130\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.896\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmall/ Appropriate or Large for GA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.444\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.271\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.349\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.727\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's age at delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.096\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.170\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.865\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.164\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.065\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.191\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.521\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePregestational Diabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.420\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.129\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.167\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.143\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe compared time to oral feeding in infants born at or after 34 weeks gestational age born to mothers with and without diabetes and admitted to the NICU for more than 24 hours. It was found that amongst the entire cohort of infants, infants born to mothers with any type of diabetes in their pregnancy take two additional days to reach full volume oral feeds compared to the infants born to mothers without diabetes. The difference in time to attain full volume oral feeds was significant in infants born to mothers with diabetes if they were born after 37 weeks of gestational age but not before 37 weeks of gestational age. This indicates that at lower gestation, prematurity may be playing a bigger role in the time to attain full volume oral feedings than maternal diabetes.\u003c/p\u003e \u003cp\u003eLinear regression analysis of infants born to mothers with diabetes showed that gestational age more than 37 weeks, maternal BMI (more than 30kg/cm\u003csup\u003e2\u003c/sup\u003e) and pregestational diabetes significantly affected the time to oral feeding. Linear regression on propensity scores matched infants (by weight and gestational age) revealed birth weight and maternal diabetes significantly affected time to oral feeding. Regression analysis (not shown here) also indicated there was no difference in time to full oral feedings if mother was treated with insulin or diet controlled.\u003c/p\u003e \u003cp\u003eThere were 4 infants born to mothers with diabetes and 2 infants born to mothers without diabetes who needed a gastrostomy tube. The numbers were too small for a meaningful statistical analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnecdotally, infants born to mothers with diabetes appeared to require more time to reach full oral feedings than those not exposed to diabetes. In order to test this theory, we evaluated the time to full oral feedings in infants born at or after 34 weeks gestational age to mothers with and without diabetes who were admitted to the NICU for greater than 24 hours. It was discovered that infants born to mothers with any type of diabetes in their pregnancy take two additional days to reach full volume oral feeds compared to infants born to mothers without diabetes. It was further identified that amongst the infants born to mothers with diabetes in their pregnancy, mothers with a pre-pregnancy BMI more than 30kg/cm\u003csup\u003e2\u003c/sup\u003e and pregestational diabetes were more likely to take longer to feed by mouth. We believe that this is the first study to investigate the difference in oral feeding between the two groups of infants.\u003c/p\u003e \u003cp\u003eInterestingly, in our cohort of infants born to mothers without diabetes, there was an increase in number of days spent on invasive ventilation. They spent an average of 2.1 days on invasive ventilation versus 1.6 days which was statistically significant. Knowing that infants who are born to mothers with diabetes often struggle with surfactant deficiency and respiratory distress, this finding was opposite of what was expected.\u003c/p\u003e \u003cp\u003e A prior study evaluating oral sucking in infants of mothers with diabetes and treated with insulin describe poorer sucking at 3 days of age. These infants were compared to a cohort of infants born to mothers with diabetes treated with diet alone, and a group of healthy infants born to mothers without diabetes. The sucking pattern was evaluated only on day 3 after birth.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The study hypothesized that sucking pattern reflects neurobehavioral maturity. They further report that sucking was poorer in infants of mothers treated with insulin whereas infants born to mothers with diabetes treated with diet alone had suck comparable to healthy infants. They postulate that the former group of infants had a greater effect of diabetes on their neurologic status. Our study did not find that the treatment of maternal diabetes with insulin or diet had any role in the time to oral feeding.\u003c/p\u003e \u003cp\u003eA prior article discussed the relevance and utility of pH impedance monitoring to elucidate if infants born to mothers with diabetes suffered from feeding difficulties.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Acid reflux index was found to be significant in 40% of infants. Treatment with proton pump inhibitors did not affect the short-term outcomes. It is not routine to perform pH studies in our hospital. If an infant is struggling with oral feedings, a speech consult is obtained, and swallow study is performed as indicated. We found more infants born to mothers with diabetes received a swallow study, signifying an issue with oral feeding skills. However, all the swallow study results were normal. This finding redemonstrates the evidence that discusses infants born to mothers with diabetes are more likely to have feeding difficulties.\u003c/p\u003e \u003cp\u003eIt is a common belief that infants born to mothers with diabetes take longer to feed orally. There is no evidence in the literature to substantiate this common belief. A study revealed a difference of 7 days in infants born to mothers with and without diabetes if they were treated with neonatal hypothermia .\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This difference could be due to maternal diabetes but more importantly reflect the effect of HIE on the infants. The current study excluded infants with encephalopathy to avoid this confounding influence of encephalopathy on oral feeding. It has also been noted that infants who are exposed to diabetes during fetal life are at an increased risk of developing FED.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe findings in this study need to be confirmed with larger studies and if validated, may provide impetus to focusing on pre pregnancy health of mothers with diabetes given the impact of BMI on feeding outcomes. Control of diabetes with continuous glucose monitoring may also provide valuable data on feeding outcomes based on maternal control of diabetes.\u003c/p\u003e \u003cp\u003eStrengths of the study include its unique nature, a large sample size, and propensity score matched group analysis. This confirmed that maternal diabetes is associated with delayed oral feeding in infants born to mothers with any form of diabetes in their pregnancy. Excluding infants not admitted to the NICU prevented the impact of healthy infants on both groups. These infants would go home with their mothers in 2 or 4 days after birth, depending on the mode of their birth (vaginal versus Cesarean section). They were presumed to be feeding well orally as otherwise they would be admitted to the NICU. Similarly, excluding infants admitted for less than 24 hours prevented infants who were otherwise healthy but admitted for delayed transitional physiology (e.g., transient tachypnea of newborn) from being included in the data. Excluding infants born less than 34 weeks gestational age and with other exclusion criteria prevented the associated confounding factors affecting oral feeding.\u003c/p\u003e \u003cp\u003eLimitations include the retrospective nature of the study from a single center. Maternal data on the duration of maternal diabetes was missing in 36% of cases. If this data was available, it may have allowed us to predict the ability of the infant to feed based on when mother was diagnosed with diabetes and the present duration of her disease. Hemoglobin A 1C is not estimated in mothers with gestational diabetes and hence feeding outcomes based on this maternal variable were not possible.\u003c/p\u003e \u003cp\u003eFuture directions for research include assessing pre-pregnancy health and interventions for healthy lifestyles given that high BMI is impacting oral feeding status. With improved blood sugar control plus a lower BMI, we would hope to see improved outcomes among infants born to mothers with diabetes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor contributions:\u003c/h2\u003e \u003cp\u003eMadyson Williams, Meredith Schoenig, Laith Almashharawi, Destri Eichman: Acquisition and analysis of the data\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eManerkar K, Harding J, Conlon C, McKinlay C. Maternal gestational diabetes and infant feeding, nutrition and growth: a systematic review and meta-analysis. Br J Nutr. 2020;123(11):1201\u0026ndash;1215. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/S0007114520000264\u003c/span\u003e\u003cspan address=\"10.1017/S0007114520000264\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen PTH, Binns CW, Nguyen CL, et al. Gestational Diabetes Mellitus Reduces Breastfeeding Duration: A Prospective Cohort Study. Breastfeed Med Off J Acad Breastfeed Med. 2019;14(1):39\u0026ndash;45. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/bfm.2018.0112\u003c/span\u003e\u003cspan address=\"10.1089/bfm.2018.0112\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBromiker R, Rachamim A, Hammerman C, Schimmel M, Kaplan M, Medoff-Cooper B. Immature sucking patterns in infants of mothers with diabetes. J Pediatr. 2006;149(5):640\u0026ndash;643. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpeds.2006.07.034\u003c/span\u003e\u003cspan address=\"10.1016/j.jpeds.2006.07.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViswanathan S, Batchu S, Osborn E, Jadcherla S. Diagnostic utility of impedance-pH monitoring in infants of diabetic mothers with oral feeding difficulties. J Perinatol. 2021;41(8):1886\u0026ndash;1892. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41372-020-00832-7\u003c/span\u003e\u003cspan address=\"10.1038/s41372-020-00832-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaval N, Paquette M, Talsmat H, et al. Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic\u0026ndash;Ischemic Encephalopathy. Am J Perinatol. Published online March 14, 2023:a-2053-7904. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/a-2053-7904\u003c/span\u003e\u003cspan address=\"10.1055/a-2053-7904\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, He H, Yu Y, Su X, Li F, Li J. Maternal diabetes and the risk of feeding and eating disorders in offspring: a national population-based cohort study. BMJ Open Diabetes Res Care. 2020;8(1):e001738. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjdrc-2020-001738\u003c/span\u003e\u003cspan address=\"10.1136/bmjdrc-2020-001738\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4463218/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4463218/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo compare the time to oral feeds in infants born to mothers with and without diabetes.\u003c/p\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003e: Retrospective study of infants born at or after 34 weeks gestational age and admitted between 1/1/2020 to 01/31/2022. Time to full oral feedings was compared between infants born to mothers with and without diabetes (267 versus 918) Continuous and binomial variables were analyzed with the Mann Whitney U test and the Chi-Square test respectively. Linear regression was then conducted to explore identified potential relationships from these analyses.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003e Comparison of groups via univariate analysis revealed a mean difference of two more days to establish full oral feedings (p\u0026thinsp;=\u0026thinsp;0.0001). Maternal pregestational diabetes (PGDM) and obesity (Body mass index;BMI\u0026thinsp;\u0026gt;\u0026thinsp;30kg/m\u003csup\u003e2\u003c/sup\u003e) were associated with longer time for infants to complete oral feeds (p 0.034 and 0.013 respectively)\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInfants born to mothers with diabetes took longer to achieve full oral feedings.\u003c/p\u003e","manuscriptTitle":"Effect of Maternal Diabetes on Time to Full Oral Feedings in Infant’s Admitted to the Neonatal Intensive Care Unit","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:21:04","doi":"10.21203/rs.3.rs-4463218/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2024-06-19T10:05:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-06-18T16:35:27+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-06-17T19:37:38+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-06-03T22:24:04+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-05-30T12:36:47+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2024-05-29T10:32:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-24T09:51:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Perinatology","date":"2024-05-23T11:39:49+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2024-05-23T09:36:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-22T22:38:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1095e38d-d40d-4e78-9585-a51fc86b84f8","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":32551072,"name":"Health sciences/Endocrinology/Endocrine system and metabolic diseases/Diabetes"},{"id":32551073,"name":"Health sciences/Health care/Paediatrics"}],"tags":[],"updatedAt":"2024-08-08T07:10:11+00:00","versionOfRecord":{"articleIdentity":"rs-4463218","link":"https://doi.org/10.1038/s41372-024-02087-y","journal":{"identity":"journal-of-perinatology","isVorOnly":false,"title":"Journal of Perinatology"},"publishedOn":"2024-08-07 04:00:00","publishedOnDateReadable":"August 7th, 2024"},"versionCreatedAt":"2024-06-11 18:21:04","video":"","vorDoi":"10.1038/s41372-024-02087-y","vorDoiUrl":"https://doi.org/10.1038/s41372-024-02087-y","workflowStages":[]},"version":"v1","identity":"rs-4463218","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4463218","identity":"rs-4463218","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}