الفهرس 
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Abstract
As maternal diabetes is one of the leading causes of RDS in near-term neonates, finding better methods for the control of maternal diabetes is very important.
Understanding the molecular processes in diabetic mothers during pregnancy, and the mechanisms affecting surfactant production will open other targets for prevention and treatment of RDS in these neonates.
This study was conducted at the Neonatal care unit of hospitals of Ain Shams University, 66 neonates were included in our study.
All neonates included in the study were subjected to the following:
History taking (Type of diabetes, control of blood glucose, HbA1C, in addition to associated obstetric, prenatal, natal, postnatal, and present history), Full clinical examination, Biochemical tests (Serum glucose levels, and blood gases in the 1st two hours after delivery, CBC, and CRP), Imaging (chest x-ray and Echocardiography), gene expression analysis for four genes (Akt, mTOR, SP-B, and SP-C), assessment of hypoglycemia and degree of respiratory distress in IDMs.
We found that the short duration of maternal diabetes is significantly associated with the development of RDS in IDM, compared to 30 months in IDM without RDS.
In our study, most diabetic mothers 65.2% were controlled by Insulin, with 50% of neonates developing RDS and 50% without. However, 17.4% of maternal diabetes was controlled by oral hypoglycemic drugs.
52.2% of neonates in our study had a severe degree of RDS, and 30% had a moderate degree. However, a mild degree of RDS is present in only 4 cases (17%).
Neonates with severe RDS required the longest period of respiratory support and received mixed respiratory support approaches and stayed for a long time in the hospital.
Akt expression was significantly overexpressed in IDM with RDS compared to IDM without RDS and healthy control.
The Akt biomarker has a sensitivity of 95% and 96% specificity to discriminate IDM neonates from healthy controls. However, mTOR and SP-B are also good diagnostic biomarkers for IDM patients.
The lower expression of mTOR was significantly associated with IDM with RDS, compared to IDM without RDS. The mTOR expression was significantly decreased by 3 and 4 folds in IDM with RDS compared to those without RDS and compared to healthy controls.
SP-B significantly decreased in IDM with RDS compared to either IDM without RDS or the healthy control group. In contrast, no significant difference was detected in the expression of the SP-C between the studied groups.
The Akt biomarker in addition to mTOR and SP-B could be used as a diagnostic biomarker for RDS in IDMs. However, SP-C expression didn’t show a significant diagnostic value.
Based on our study, Akt expression is a prognostic biomarker for IDM with RDS as it could discriminate mild/ moderate from patients with severe respiratory distress, however, mTOR, SP-B, and SP-C did not. It has a sensitivity of 75% and 89% specificity to discriminate mild/moderate RD in IDM neonates from cases with severe RD.