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Polycythemia of the Newborn Clinical Presentation

  • Author: Karen J Lessaris, MD; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Jan 02, 2016
 

History

Neonates with polycythemia may have the following signs/symptoms:

  • Lethargy
  • Irritability
  • Jitteriness
  • Tremors
  • Seizures
  • Cerebrovascular accidents
  • Respiratory distress
  • Cyanosis
  • Apnea
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Physical

General

The most obvious finding is plethora or ruddiness.

Priapism may be observed in male patients.

Central nervous system (CNS)

CNS manifestations are the most common problems observed with polycythemia and hyperviscosity. Symptoms include lethargy, irritability, jitteriness, tremors, seizures, and cerebrovascular accidents.

Cardiopulmonary

Manifestations include respiratory distress, tachypnea, cyanosis, apnea, and congestive heart failure. Increases in hematocrit (Hct) are associated with a decrease in pulmonary blood flow in all newborns. In those with a Hct level of 65% or more, the decrease in pulmonary blood flow may be associated with respiratory distress and cyanosis.

Gastrointestinal

Poor feeding is reported in more than one half of all infants with polycythemia and hyperviscosity.

Necrotizing enterocolitis (NEC) is a rare but devastating complication of polycythemia or hyperviscosity. Historically, about 44% of term infants with NEC have polycythemia. More recent data suggest that polycythemia may not have a large role in the development of NEC in the term infant but may be related to partial exchange transfusion (PET) with colloid to reduce the Hct.

Renal

Manifestations include decreased glomerular filtration rates, oliguria, hematuria, proteinuria, and renal vein thrombosis.

Metabolic

Hypoglycemia is the most common metabolic derangement and is observed in 12-40% of infants with polycythemia.

Hypocalcemia is the next most common metabolic derangement and is found in 1-11% of neonates with polycythemia.

Coagulation

Coagulation can be affected. Thrombocytopenia may be noted; in a retrospective study (2006-2013) from the Netherlands, thrombocytopenia occurred in 51% and severe thrombocytopenia affected 91% of 140 neonates with polycythemia.[3]

Disseminated intravascular coagulation (DIC) is rare.

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Causes

Increased fetal erythropoiesis secondary to fetal hypoxia

Underlying causes include the following:

  • Placental insufficiency can be secondary to preeclampsia, primary renovascular disease, chronic or recurrent abruptio placenta, maternal cyanotic congenital heart disease, postdate pregnancy, and maternal smoking; most of these maternal conditions may also be associated with intrauterine growth restriction (IUGR)
  • Endocrine abnormalities associated with increased fetal oxygen consumption resulting in fetal hypoxia include congenital thyrotoxicosis and Beckwith-Wiedemann syndrome or infants of a diabetic mother (IDM) with poor glycemic control
  • Genetics disorders (eg, trisomy 13, trisomy 18, trisomy 21) are also underlying causes

Hypertransfusion

Delayed cord clamping allows for an increased blood volume to be delivered to the infant. When cord clamping is delayed more than 3 minutes after birth, blood volume increases 30%. Gravity also may be a factor because of the position of the delivered infant in relation to the maternal introitus before cord clamping.

In the event of delayed cord clamping, blood flow to the infant is enhanced by oxytocin. A study by Rincn et al demonstrated changes in laboratory blood values in newborns based on the period of time between birth and clamping of the umbilical cord. In the study, of 242 newborns, 80 infants were clamped less than 60 seconds after delivery, while 31 were clamped at between one minute and just under two minutes, and 131 were clamped at between two and three minutes following birth. Lab studies were performed at birth and at 48 hours postdelivery. Hct levels were found to have risen in accordance with the amount of time to clamping, with values at 48 hours of 53.4%, 58%, and 59%, respectively. Ferritin and hemoglobin levels also increased in association with later cord clamping. In addition, the number of infants with polycythemia symptoms was significantly higher in the group that was clamped at 2-3 minutes.[4]

However, a study by Andersson et al found, at four-month follow-up, no significant difference in the incidence of polycythemia in infants who had been clamped at or before ten seconds postdelivery and those who had been clamped at three minutes or later.[5]

Twin-to-twin transfusion syndrome due to a vascular communication occurs in approximately 10% of monozygotic twin pregnancies. In intrapartum asphyxia, blood volume is shifted from the placenta to the fetus.

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Contributor Information and Disclosures
Author

Karen J Lessaris, MD Clinical Faculty, Department of Pediatrics, Division of Neonatology, Carolinas Medical Center

Karen J Lessaris, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Scott S MacGilvray, MD Clinical Professor, Department of Pediatrics, Division of Neonatology, The Brody School of Medicine at East Carolina University

Scott S MacGilvray, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

References
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