Restricción de Crecimiento Intrauterino: Causas, Características Clínicas, y Evaluación de Factores Asociados a Policitemia Sintomática

Abstract

The incidence of newborns (NB) with intrauterine growth restriction (IUGR) in Latin America and the Caribbean is 10%. Objectives: To determine the causes and characteristics of IUGR in children born at the Hospital Nacional in Paraguay from January 1999 to December 2001 and establish which factors are associated with symptomatic polycythemia. Materials and Methods: An observational and descriptive retrospective cohort study with nested case-controls including 259 NB with birth-weight below the 3d percentile. Results: 165 (64%) of NBs were premature, with a mean age of 33.1 ± 3.1 weeks. 220 NB (84.9%) showed symmetrical IUGR and 37 (14.2%) perinatal asphyxia. The most frequent causes of IUGR were maternal hypertension 87 (33.5%), adolescent mother 67 (25.9%), older mothers 44 (17%), twin pregnancy 34 (13%), and STORCH group infections 17 (6.5%). The dominant pathologies in NBs were hyperbilirubinemia 119 (47%), transitory tachypnea 76 (30%), hyaline membrane disease 49 (19%), nosocomial sepsis 43 (17%), and hypoglycaemia 14 (36%). Of the 195 NB with hematocrit (HCT), 53 (27%) developed polycythemia, and of those, 14 (26%) were symptomatic. Symptoms included hypoglycemia 6 (43%), weak suck 6 (43%), apneas 4 (18%), respiratory distress and hypotonia 3 (21%). The NB with symptomatic polycythemia had mostly suffered asphyxia (OR = 2.92), had asymmetric IUGR (OR = 2.39), or been children of preeclamptic mothers (OR=1.73). NB with thrombocytopenia were least frequently symptomatic. No signifi cant difference was shown in mean HCT between symptomatic and asymptomatic NB. Conclusions: The most common cause of IUGR was maternal arterial hypertension (AHT). More than half of NB with IUGR were premature, with the symmetrical form being more common. Factors associated with evolution of polycythemia were NB who were asphyxiated or with preeclamptic mothers. (Key words: Fetal growth retardation, etiology, risk factors, symptomatic polycythemia). Pediatr. (Asunción), 2008; 35(2): 77-87 CONO SUR SOUTH CONE OF AMERICA Rev Chil Pediatr 2010; 81 (4): 366-367Esta sección contiene los artículos originales de las Revistas de Pediatría de las Sociedades de Pediatría del Cono Sur seleccionados en el XIV encuentro de Editores, Brasilia, Brasil 2009, para ser publicados por los países integrantes durante el año 2010.