Therapy in newborns with polycythemia is based on both the measured central venous hematocrit (Hct) level and the presence or absence of symptoms.  Carefully monitor vital signs and bilirubin, glucose, and electrolyte levels as needed in newborns with polycythemia.
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. [9, 10]
Treatment for asymptomatic patients
In asymptomatic patients with a 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.
In asymptomatic patients with a Hct level of more than 75% on repeated measurements, consider PET.
Treatment for symptomatic patients
In symptomatic patients with a 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.
In symptomatic patients with a 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.
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.
Feedings may cautiously be introduced hours after completing the PET.
Perform routine newborn follow-up care.