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Polycythemia of the Newborn Workup

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

Approach Considerations

Laboratory studies

The central venous hematocrit (Hct) measurement is used as a surrogate for diagnosing hyperviscosity in newborns with polycythemia because it is readily available. Most clinical laboratories are not able to measure blood viscosity.

Other laboratory tests include measurements of the following:

  • Serum  glucose and calcium levels: Measure these to determine if the patient has decreased levels that require treatment.
  • Bilirubin level: Measure this level in the infant with jaundice and polycythemia because the increased RBC mass leads to an increased load of bilirubin precursors that can result in hyperbilirubinemia.
  • Arterial blood gases (ABG): Consider measuring ABG values to assess oxygenation in the symptomatic infant with respiratory distress and cyanosis.
  • Platelet count: This count may demonstrate thrombocytopenia if thrombosis or disseminated intravascular coagulation (DIC) are present. Increased hematocrit is associated with decreased platelet count. [3]

Doppler ultrasonography

Middle cerebral artery peak systolic velocity may be a reliable tool for estimating hemoglobulin level in cases of twin anemia-polycythemia sequence (TAPS).[6, 7] In a study involving 20 cases of TAPS, Veujoz et al reported a relationship between the hemoglobin level and the middle cerebral artery peak systolic velocity, although there was a 71% sensitivity and 50% specificity of prenatal diagnosis correspondence with postnatal diagnosis.[7]

 
 
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
  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. 2011 Oct. 100(10):1290-6. [Medline].

  3. Vlug RD, Lopriore E, Janssen M, et al. Thrombocytopenia in neonates with polycythemia: incidence, risk factors and clinical outcome. Expert Rev Hematol. 2015 Feb. 8 (1):123-9. [Medline].

  4. Rincon D, Foguet A, Rojas M, et al. [Time of cord clamping and neonatal complications, a prospective study]. An Pediatr (Barc). 2014 Sep. 81(3):142-8. [Medline].

  5. Andersson O, Hellstrom-Westas L, Andersson D, et al. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011 Nov 15. 343:d7157. [Medline]. [Full Text].

  6. Sainz JA, Romero C, García-Mejido J, Soto F, Turmo E. Analysis of middle cerebral artery peak systolic velocity in monochorionic twin pregnancies as a method for identifying spontaneous twin anaemia-polycythaemia sequence. J Matern Fetal Neonatal Med. 2014 Jul. 27 (11):1174-6. [Medline].

  7. Veujoz M, Sananès N, Severac F, et al. Evaluation of prenatal and postnatal diagnostic criteria for twin anemia-polycythemia sequence. Prenat Diagn. 2015 Mar. 35 (3):281-8. [Medline].

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

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

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

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

  12. 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. 2006 Jan. 91(1):F2-6. [Medline].

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

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

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

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

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

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

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

  20. 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. 1997 Sep. 77(2):F115-8. [Medline].

  21. Watchko JF. Common hematologic problems in the newborn nursery. Pediatr Clin North Am. 2015 Apr. 62 (2):509-24. [Medline].

  22. Taniguchi K, Sumie M, Sugibayashi R, Wada S, Matsuoka K, Sago H. Twin anemia-polycythemia sequence after laser surgery for twin-twin transfusion syndrome and maternal morbidity. Fetal Diagn Ther. 2015. 37 (2):148-53. [Medline].

 
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