Polycythemia of the Newborn Treatment & Management

  • Author: Karen J Lessaris, MD; Chief Editor: Ted Rosenkrantz, MD   more...
 
Updated: Mar 27, 2012
 

Medical Care

Therapy in newborns with polycythemia is based on both the measured central venous hematocrit (Hct) level and the presence or absence of symptoms.[3]

Treatment of polycythemia with partial exchange transfusion (PET) remains controversial. Regarding treatment with partial exchange, the Committee of the Fetus and Newborn of the American Academy of Pediatrics states, "The accepted treatment of polycythemia is partial exchange transfusion (PET)." The group also acknowledges that no evidence suggests that exchange transfusion affects the long-term outcome.[4, 5]

  • Treatment for asymptomatic patients
    • Hct level of 65-75%: Perform cardiorespiratory monitoring and monitoring of Hct and glucose levels every 6-12 hours and observe the patient for symptoms. Continue this monitoring for at least 24 hours or until the Hct level declines.
    • Hct level of more than 75% on repeated measurements: Consider PET.
  • Treatment for symptomatic patients
    • Hct level of 60-65%: Consider alternative explanations for the symptoms. Although polycythemia and hyperviscosity may be the etiology of the symptoms, other causes for the symptoms must be excluded.
    • Hct level more than 65% with symptoms attributable to polycythemia and hyperviscosity: Consider PET or observation with intravenous fluids for added hydration. Proceed to PET if symptoms worsen.
  • PET
    • Perform PET using an umbilical venous catheter to reduce the central Hct level to 50-55%.
    • The total blood volume to be exchanged is determined as follows: [blood volume(patient's Hct – desired Hct)]/(patient's Hct), where blood volume = the patient's weight in kilograms multiplied by 90 mL/kg.
    • Normal saline is the replacement fluid of choice for exchange transfusions because it is effective and inexpensive. As alternatives, Plasmanate, 5% albumin, or fresh frozen plasma can be used. However, none of these is more effective than normal saline. In addition, both 5% albumin and fresh frozen plasma are blood products, and certain religious beliefs prohibit their use. Lastly, these colloid products have been associated with complications such as necrotizing enterocolitis (NEC).
    • Sterile technique is required.
    • An exchange transfusion can be performed in 3 ways, depending on the type of vascular access that is available. Regardless of the method used, aliquots should not exceed approximately 5 mL/kg delivered or removed over 2-3 minutes.
      • If only a single umbilical venous catheter is in place, use a push-pull technique. With this technique, the withdrawal of blood is alternated with the administration of replacement fluid through the single catheter. Do not remove more than 5 mL/kg in any single withdrawal.
      • If both umbilical venous and arterial catheters are in place, withdraw blood from the arterial catheter while administering the replacement fluid through the venous catheter.
      • If a venous or arterial umbilical catheter and a peripheral venous catheter are in place, the former can be used for blood withdrawal, whereas the latter is used to simultaneously and continuously infuse the replacement fluid.
Proceed to Follow-up
 
 
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.

Specialty Editor Board

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.

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 (Neonatology), Vanderbilt University School of Medicine; Director, Neonatal Follow-up Program, 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 & Ethics, National Hospice and Palliative Care Organization, Society for Pediatric Research, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

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.

References

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

  2. Mimouni FB, Merlob P, Dollberg S, Mandel D. Neonatal polycythaemia: critical review and a consensus statement of the Israeli Neonatology Association. Acta Paediatr. Oct 2011;100(10):1290-6. [Medline].

  3. Sankar MJ, Agarwal R, Deorari A, Paul VK. Management of polycythemia in neonates. Indian J Pediatr. Oct 2010;77(10):1117-21. [Medline].

  4. [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].

  5. Morag I, Strauss T, Lubin D, Schushan-Eisen I, Kenet G, Kuint J. Restrictive management of neonatal polycythemia. Am J Perinatol. Oct 2011;28(9):677-82. [Medline].

  6. 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].

  7. [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].

  8. 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].

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

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

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

  12. 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].

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

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

  15. 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].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.