eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Polycythemia of the Newborn: Follow-up

Author: Karen J Lessaris, MD, Clinical Faculty, Department of Pediatrics, Division of Neonatology, Carolinas Medical Center
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Inpatient Care

  • Carefully monitor vital signs and bilirubin, glucose, and electrolyte levels as needed in newborns with polycythemia.
  • Feedings may cautiously be introduced hours after completing the partial exchange transfusion.

Further Outpatient Care

  • Perform routine newborn follow-up care.

Complications

  • Apnea
  • Arrhythmia
  • Vasospasm
  • Vessel perforation
  • Air embolus
  • Thrombosis
  • Infarction
  • Thrombocytopenia
  • Hemolysis
  • Electrolyte abnormalities
  • Hypoglycemia
  • Hypocalcemia
  • Intrahepatic hematoma
  • Necrotizing enterocolitis

Prognosis

  • Infants are at increased risk for neurological deficits including speech abnormalities, fine-motor delays, and gross-motor delays.
  • Partial exchange transfusion has not been shown to reduce these problems, and umbilical partial exchange continues to show increased risk for necrotizing enterocolitis (NEC). Recent data suggest that the cause of impaired long-term outcome is also the cause of the polycythemia; both conditions are associated with intrauterine fetal hypoxia.

Miscellaneous

Medicolegal Pitfalls

  • Use of a blood product (eg, albumin) in an exchange transfusion may result in the transmission of infection. Infections related to blood products can be avoided by using normal saline, which is sterile and which has been shown to be as effective as albumin.
  • Informed consent must be obtained as exchange transfusions have multiple risks (see Treatment).
  • Umbilical partial exchange transfusion increases risk of necrotizing enterocolitis (NEC), especially if colloid is used.
  • No improvement in neurologic outcomes has been reported with partial exchange transfusion. However, polycythemia and neurologic abnormalities have been linked. Because of this, a symptomatic infant who has not been treated with partial exchange transfusion, and who subsequently develops neurologic abnormalities, may be considered inadequately treated.
 


More on Polycythemia of the Newborn

Overview: Polycythemia of the Newborn
Differential Diagnoses & Workup: Polycythemia of the Newborn
Treatment & Medication: Polycythemia of the Newborn
Follow-up: Polycythemia of the Newborn
References
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References

  1. Jeevasankar M, Agarwal R, Paul VK, et al. Polycythemia in the newborn. Indian J Pediatr. January 2008;75(1):68-73.

  2. [Guideline] AAP. American Academy of Pediatrics Committee on Fetus and Newborn: routine evaluation of blood pressure, hematocrit, and glucose in newborns. Pediatrics. Sep 1993;92(3):474-6. [Medline].

  3. Awonusonu FO, Pauly TH, Hutchison AA. Maternal smoking and partial exchange transfusion for neonatal polycythemia. Am J Perinatol. Oct 2002;19(7):349-54. [Medline].

  4. [Best Evidence] Dempsey EM, Barrington K. Short and long term outcomes following partial exchange transfusion in the polycythaemic newborn: a systematic review. Arch Dis Child Fetal Neonatal Ed. Jan 2006;91(1):F2-6. [Medline].

  5. Drew JH, Guaran RL, Grauer S, Hobbs JB. Cord whole blood hyperviscosity: measurement, definition, incidence and clinical features. J Paediatr Child Health. Dec 1991;27(6):363-5. [Medline].

  6. Pappas A, Delaney-Black V. Differential diagnosis and management of polycythemia. Pediatr Clin North Am. Aug 2004;51(4):1063-86, x-xi. [Medline].

  7. Rosenkrantz TS. Polycythemia and hyperviscosity in the newborn. Semin Thromb Hemost. Oct 2003;29(5):515-27. [Medline].

  8. Schimmel MS, Bromiker R, Soll RF. Neonatal polycythemia: is partial exchange transfusion justified?. Clin Perinatol. Sep 2004;31(3):545-53, ix-x. [Medline].

  9. Shohat M, Reisner SH, Mimouni F, Merlob P. Neonatal polycythemia: II Definition related to time of sampling. Pediatrics. Jan 1984;73(1):11-3. [Medline].

  10. Werner EJ. Neonatal polycythemia and hyperviscosity. Clin Perinatol. Sep 1995;22(3):693-710. [Medline].

  11. Wirth FH, Goldberg KE, Lubchenco LO. Neonatal hyperviscosity: I. Incidence. Pediatrics. Jun 1979;63(6):833-6. [Medline].

  12. Wong W, Fok TF, Lee CH, et al. Randomised controlled trial: comparison of colloid or crystalloid for partial exchange transfusion for treatment of neonatal polycythaemia. Arch Dis Child Fetal Neonatal Ed. Sep 1997;77(2):F115-8. [Medline].

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Further Reading

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Keywords

neonatal polycythemia, polycythemia of the newborn, erythrocythemia, hematocrit, Hct, hyperviscosity, sludged blood, microthrombi, microthrombus, diabetes, respiratory distress, treatment, diagnosis

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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 and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Scott MacGilvray, MD, Clinical Associate Professor of Pediatrics, East Carolina University School of Medicine
Scott MacGilvray, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: MedImmune Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Brian S Carter, MD, FAAP, Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Co-director, Pediatric Advance Comfort Team, Monroe Carell Jr Children's Hospital at Vanderbilt
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 Society for Bioethics and Humanities, American Society of Law Medicine and Ethics, National Hospice and Palliative Care Organization, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
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 Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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