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The adverse effects of utilizing altitude-inappropriate fetal growth curves
1Department of Pediatrics, 97th General Hospital, Frankfurt, West Germany.
Insights
Using a sea level fetal growth curve is crucial for accurately identifying newborns at risk for hypoglycemia and polycythemia. High altitude curves may miss infants needing screening, impacting timely intervention for conditions like small for gestational age (SGA) and large for gestational age (LGA) infants.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Perinatal Health
Background:
- Newborn nurseries near sea level often use high-altitude (Denver) fetal growth curves.
- This practice may lead to underestimation of small for gestational age (SGA) infants.
- Consequently, high-risk neonates for hypoglycemia and polycythemia might go undetected.
Purpose of the Study:
- To compare the risk of hypoglycemia and polycythemia in newborns using high-altitude versus sea level fetal growth curves.
- To determine if using an altitude-appropriate curve improves the detection of at-risk infants.
Main Methods:
- Retrospective evaluation of 354 newborn infants.
- Comparison of hypoglycemia and polycythemia risks between infants classified using a high-altitude curve versus a sea level curve.
- Analysis focused on small for gestational age (SGA) and large for gestational age (LGA) neonates.
Main Results:
- Polycythemia was more prevalent in SGA infants compared to LGA and appropriate for gestational age (AGA) infants.
- Transitioning from a high-altitude to a sea level curve in a sea level population identified previously missed infants with hypoglycemia and/or polycythemia.
- No hypoglycemic LGA infants requiring screening were missed by this adjustment, unless already indicated for other reasons.
Conclusions:
- For accurate screening of hypoglycemia and polycythemia in high-risk newborns (SGA and LGA), utilizing an altitude-appropriate fetal growth curve is essential.
- Sea level growth curves are more effective for identifying at-risk infants in sea level nurseries.
- Failure to use an appropriate curve can lead to missed diagnoses and delayed interventions.
Abstract:
Some newborn nurseries located near sea level are utilizing the Denver (high altitude) fetal growth curve to identify and screen infants at high risk for hypoglycemia and/or polycythemia: small for gestational age (SGA) and large for gestational age (LGA) infants. It has been shown that this curve may underestimate the number of SGA infants. Neonates at high risk for these conditions may therefore go undetected and unscreened. To investigate this possibility, we evaluated the risk for hypoglycemia and polycythemia in 354 newborn infants, comparing a high altitude with a sea level fetal growth curve. Polycythemia was more common in SGA than in LGA and appropriate for gestational age (AGA) infants. By changing from a high altitude to a sea level curve in our sea level population, we were able to detect several hypoglycemia and/or polycythemic infants that would have been missed. No hypoglycemic LGA infants were missed that would not have been screened for other medical indications. If newborn nursery screening for hypoglycemia and polycythemia is to be performed only in high-risk infants (ie, LGA and SGA), an altitude-appropriate fetal growth curve should be used.