Hypoglycemia (Not Listed) is the Most Critical Complication to Monitor
The most important complication to monitor in a full-term IUGR infant admitted to the NICU is hypoglycemia, which is not among the answer choices provided but represents the highest priority metabolic emergency in this population. 1, 2, 3
Why Hypoglycemia is the Primary Concern
Pathophysiologic Vulnerability
- IUGR infants have severely depleted glycogen and fat stores due to chronic placental insufficiency, making them unable to maintain glucose homeostasis after birth. 2, 3
- Nearly 30-60% of IUGR infants develop hypoglycemia requiring immediate intervention, representing one of the most common and life-threatening complications in this population. 2
- The degree of placental insufficiency (reflected in prenatal Doppler abnormalities) directly correlates with the severity of metabolic compromise and hypoglycemia risk. 1
Clinical Significance and Risk Stratification
- Infants with reverse end-diastolic flow on prenatal umbilical artery Doppler are at highest risk for severe early hypoglycemia and require the most intensive monitoring. 1
- Hypoglycemia in IUGR infants can lead to perinatal asphyxia, seizures, and long-term neurodevelopmental impairment if not promptly identified and treated. 3, 4
Analysis of the Provided Answer Choices
Option A: Hyperglycemia
- This is not a typical complication of IUGR infants; these babies are at risk for hypoglycemia, not hyperglycemia. 2, 3
Option B: Hypocalcemia
- While hypocalcemia can occur in IUGR infants, it is far less common and less immediately life-threatening than hypoglycemia. 3
Option C: Hyperthermia
- IUGR infants are actually at risk for hypothermia (not hyperthermia) due to decreased subcutaneous fat stores and increased surface area-to-body mass ratio. 3, 5
Option D: Anemia
- Polycythemia (elevated hematocrit) is actually more common than anemia in IUGR infants due to chronic intrauterine hypoxia stimulating erythropoietin production. 3, 5
Other Important Acute Complications to Monitor
Beyond hypoglycemia, IUGR infants require surveillance for:
- Perinatal asphyxia and respiratory distress (meconium aspiration, persistent pulmonary hypertension, pulmonary hemorrhage). 3, 5
- Hypothermia due to limited fat stores and impaired thermoregulation. 3, 5
- Polycythemia with associated hyperviscosity complications. 3, 5
Common Pitfall
The critical error would be selecting any of the provided options without recognizing that hypoglycemia—though not listed—is the most important metabolic emergency requiring immediate and intensive monitoring in IUGR infants admitted to the NICU. 1, 2, 3