Neonatal Polycythemia and Hypoglycemia in Newborns: Are They Related?

Abstract

Objective This study aimed to test whether neonatal hypoglycemia (NH) is more common in infants with neonatal polycythemia (NP).

Study Design This is a retrospective study based on universal screening of NH and targeted screening for NP. Polycythemia was defined as venous hematocrit ≥ 65%. NH was defined as whole blood glucose (BG) concentration < 48 mg/dL (measured using a “point-of-care” analyzer [Accu-Chek]).

Results The study population consisted of 119 consecutive term polycythemic infants and 117 controls. There were no significant differences between the two groups in perinatal characteristics, minimal BG concentration, and rate of hypoglycemia. In a stepwise backward multiple regression where NH was the dependent variable, only maternal gestational diabetes mellitus (p = 0.032) and toxemia (p = 0.001) remained significant, whereas NP was insignificant.

Conclusion NH is not more common in NP infants than in non-NP infants. We suggest that the occurrence of NH in infants with NP might be related to the common risk factors of the two morbidities.

Keywords

neonatal polycythemia - hypoglycemia - hematocrit

Authors' Contributions

Y.K., A.B.-N., and F.B.M. conceptualized and designed the study, coordinated and supervised data collection, performed the analyses, drafted the initial manuscript, and reviewed and revised the manuscript. A.H.-F. collected data, performed the analyses, drafted the initial manuscript, and reviewed and revised the manuscript. C.H. conceptualized and designed the study, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Note

Adi Hopfeld-Fogel's participation in this study was performed in fulfillment of research requirements toward the MD degree.

^* Contributed equally as co-first authors.

Publikationsverlauf

Eingereicht: 03. November 2019

Angenommen: 12. Dezember 2019

Artikel online veröffentlicht:
06. Februar 2020

• References

• 1 Shohat M, Reisner SH, Mimouni F, Merlob P. Neonatal polycythemia: II. Definition related to time of sampling. Pediatrics 1984; 73 (01) 11-13
• 2 Martin RJ, Fanaroff AV, Walsh MC. eds. Fanaroff & Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 10th ed. Philadelphia, PA: Elsevier; 2015: 1317-1318
• 3 Shohat M, Merlob P, Reisner SH. Neonatal polycythemia: I. Early diagnosis and incidence relating to time of sampling. Pediatrics 1984; 73 (01) 7-10
• 4 Ramamurthy RS, Brans YW. Neonatal polycythemia: I. Criteria for diagnosis and treatment. Pediatrics 1981; 68 (02) 168-174
• 5 Mimouni FB, Merlob P, Dollberg S, Mandel D. Israeli Neonatal Association. Neonatal polycythaemia: critical review and a consensus statement of the Israeli Neonatology Association. Acta Paediatr 2011; 100 (10) 1290-1296
• 6 Wiswell TE, Cornish JD, Northam RS. Neonatal polycythemia: frequency of clinical manifestations and other associated findings. Pediatrics 1986; 78 (01) 26-30
• 7 Verbeek L, Zhao DP, Middeldorp JM. et al. Haemoglobin discordances in twins: due to differences in timing of cord clamping?. Arch Dis Child Fetal Neonatal Ed 2017; 102 (04) F324-F328
• 8 Malan AF, de V Heese H. The management of polycythaemia in the newborn infant. Early Hum Dev 1980; 4 (04) 393-403
• 9 Goldberg K, Wirth FH, Hathaway WE. et al. Neonatal hyperviscosity. II. Effect of partial plasma exchange transfusion. Pediatrics 1982; 69 (04) 419-425
• 10 Black VD, Lubchenco LO, Koops BL, Poland RL, Powell DP. Neonatal hyperviscosity: randomized study of effect of partial plasma exchange transfusion on long-term outcome. Pediatrics 1985; 75 (06) 1048-1053
• 11 Bada HS, Korones SB, Pourcyrous M. et al. Asymptomatic syndrome of polycythemic hyperviscosity: effect of partial plasma exchange transfusion. J Pediatr 1992; 120 (4 Pt 1): 579-585
• 12 Black VD, Rumack CM, Lubchenco LO, Koops BL. Gastrointestinal injury in polycythemic term infants. Pediatrics 1985; 76 (02) 225-231
• 13 Black VD, Lubchenco LO, Luckey DW. et al. Developmental and neurologic sequelae of neonatal hyperviscosity syndrome. Pediatrics 1982; 69 (04) 426-431
• 14 Rosenkrantz TS, Philipps AF, Skrzypczak PS, Raye JR. Cerebral metabolism in the newborn lamb with polycythemia. Pediatr Res 1988; 23 (03) 329-333
• 15 Bedard MP, Kotagal WR. Hypoglycemia in association with polycythemia. Perinatology-Neonatology 1981; 5: 83-84
• 16 Mimouni F, Miodovnik M, Siddiqi TA, Butler JB, Holroyde J, Tsang RC. Neonatal polycythemia in infants of insulin-dependent diabetic mothers. Obstet Gynecol 1986; 68 (03) 370-372
• 17 de Leeuw R, de Vries IJ. Hypoglycemia in small-for-dates newborn infants. Pediatrics 1976; 58 (01) 18-22
• 18 Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonatal Med 2017; 22 (01) 36-41
• 19 Levy-Khademi F, Perry A, Klinger G, Herscovici T, Kasirer Y, Bromiker R. Normal point of care glucose values after birth in the well-baby nursery. Am J Perinatol 2019; 36 (02) 219-224
• 20 Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birth weight standards in the live-born population in Israel. Isr Med Assoc J 2005; 7 (05) 311-314
• 21 Miodovnik M, Mimouni F, Tsang RC. et al. Management of the insulin-dependent diabetic during labor and delivery. Influences on neonatal outcome. Am J Perinatol 1987; 4 (02) 106-114
• 22 Adamkin DH. Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127 (03) 575-579
• 23 Cissoko H, Jonville-Béra AP, Swortfiguer D, Giraudeau B, Autret-Leca E. Neonatal outcome after exposure to beta adrenergic blockers late in pregnancy. Arch Pediatr 2005; 12: 543-547
• 24 Kermani SK, Khatony A, Jalali R, Rezaei M, Abdi A. Accuracy and precision of measured blood sugar values by three glucometers compared to the standard technique. J Clin Diagn Res 2017; 11 (04) OC05-OC08