Hypoglycemia 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 (not listed in your options, but this is the correct answer based on the highest quality evidence). Among your provided options, the answer would be B- Hypocalcemia, though hypoglycemia remains the primary metabolic concern. 1
Why Hypoglycemia Takes Priority
Pathophysiologic Basis
- IUGR infants have depleted glycogen stores due to chronic placental insufficiency and prolonged intrauterine malnutrition, making them unable to maintain glucose homeostasis after birth 2
- The degree of placental insufficiency reflected in prenatal Doppler abnormalities directly correlates with the severity of metabolic compromise, including hypoglycemia risk 1
- 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
Clinical Significance
- Hypoglycemia can cause permanent neurological damage if not promptly identified and treated, directly impacting long-term neurodevelopmental outcomes 2
- IUGR infants are prone to acute neonatal problems including perinatal asphyxia, hypothermia, hypoglycemia, and polycythemia 2
Complete Monitoring Algorithm for IUGR Infants
Immediate Priorities (First 24-48 Hours)
- Glucose monitoring: Check blood glucose within 30 minutes of birth, then every 1-3 hours for the first 24 hours depending on stability 2, 3
- Temperature regulation: Monitor for hypothermia due to decreased subcutaneous fat and increased surface area-to-body mass ratio 2, 3
- Respiratory assessment: Watch for meconium aspiration syndrome, persistent pulmonary hypertension, and pulmonary hemorrhage 3
Secondary Metabolic Concerns
- Hypocalcemia monitoring: Check calcium levels within first 24-48 hours, as this is the second most important metabolic complication after hypoglycemia 2
- Polycythemia screening: Obtain hematocrit at 4-6 hours of life, as IUGR infants develop compensatory erythrocytosis from chronic hypoxemia 2, 3
Why the Other Options Are Less Critical
- Hyperglycemia (Option A): This is not a typical complication of IUGR; these infants are at risk for HYPOglycemia, not hyperglycemia 2, 3
- Hyperthermia (Option C): IUGR infants are at risk for HYPOthermia due to decreased fat stores, not hyperthermia 2, 3
- Anemia (Option D): IUGR infants typically develop polycythemia (elevated hematocrit), not anemia, as a compensatory response to chronic intrauterine hypoxemia 2, 3
Common Pitfalls to Avoid
- Delayed feeding: While NEC risk exists, recent evidence shows early enteral feeding in IUGR infants is safe, and breast milk may offer protection against NEC 4
- Assuming normal glucose: Even if the infant appears well, glucose monitoring cannot be skipped—IUGR infants can decompensate rapidly 3
- Overlooking perinatal asphyxia: IUGR fetuses can quickly decompensate during labor, requiring careful intrapartum monitoring and readiness for resuscitation 5