Maternal smoking and partial exchange transfusion for neonatal polycythemia

The aim of this study was to determine if maternal smoking was associated with an increased need for partial exchange transfusion for symptomatic polycythemia in term neonates. The study population consisted of 8961 term neonates, of whom 28.7% were categorized as babies born to mothers who smoked. The incidence of partial exchange transfusion was determined in neonates whose mothers smoked and in neonates of nonsmokers. Partial exchange transfusion was performed in 41 neonates of mothers who smoked (1.59%; n = 2572) versus 41 neonates of nonsmokers (0.64%; n = 6389) ( p = 0.000). In babies requiring a partial exchange transfusion birth weights were 2908 +/- 659 g (smokers) versus 3474 +/- 770 g, (nonsmokers) (p <0.001) and the babies born to mothers who smoked were 9 times more likely to be small-for-gestational age (SGA) and 5 times less likely to be large-for-gestational age (LGA). Term neonates of mothers who smoke during pregnancy require a partial exchange transfusion for neonatal polycythemia approximately two and a half times as often as neonates of mothers who do not smoke.