From the Guidelines
Yes, neonates with intrauterine growth restriction (IUGR) are at risk of developing polycythemia.
Rationale
- IUGR neonates often experience chronic hypoxaemia in utero, which can lead to increased fetal erythropoiesis 1.
- This increased erythropoiesis can result in an increased packed cell volume, a hallmark of polycythemia, particularly in the presence of sufficient iron 1.
- While half of polycythaemic infants may remain asymptomatic, growth-restricted babies are at a greater risk of symptoms and clinical consequences due to altered blood viscosity 1.
- The development of polycythemia in IUGR neonates is a well-established concern, and healthcare providers should be vigilant for signs of this condition in affected infants.
From the Research
Neonates with Intrauterine Growth Restriction (IUGR) and Polycythemia
- Neonates with IUGR are at risk of developing polycythemia, as stated in the study 2, which mentions that these infants have many acute neonatal problems, including polycythemia.
- The study 3 found that neonatal polycythemia is a frequent finding after pregnancies complicated by diabetes and by maternal hypertension with intrauterine growth retardation (IUGR).
- However, the study 4 found that delayed cord clamping (DCC) was associated with significantly higher venous hematocrit levels, but the incidence of polycythemia was comparable between the DCC and early cord clamping (ECC) groups.
- The study 5 defines polycythemia as a venous hematocrit above 65% and mentions that neonates born small for gestational age (SGA), infants of diabetic mothers (IDM), and multiple births are at risk for polycythemia.
Risk Factors and Associations
- Maternal hypertension poses a significant risk for polycythemia, regardless of fetal growth, as found in the study 3.
- The study 2 mentions that IUGR is an important cause of fetal and neonatal morbidity and mortality, and polycythemia is one of the acute neonatal problems associated with it.
- The study 6 found that thrombocytopenia and prolonged standard coagulation tests are common in growth-restricted neonates, but the data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting.
Diagnosis and Management
- The study 5 provides guidelines for the management of polycythemia in neonates, including screening at 2,12, and 24 h of age for high-risk infants.
- The study 4 found that DCC was a safe and beneficial intervention in IUGR infants, with improved systemic blood flow and hematocrit levels, but without an increased incidence of polycythemia.