Polycythemia of the Newborn Clinical Presentation

Updated: Dec 22, 2017
  • Author: Jegen Kandasamy, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Neonates with polycythemia may have the following signs/symptoms:

  • Lethargy

  • Irritability

  • Jitteriness

  • Tremors

  • Seizures

  • Cerebrovascular accidents

  • Oliguria and/or hematuria

  • Respiratory distress

  • Cyanosis

  • Apnea


Physical Examination

General findings

The most obvious finding is plethora or ruddiness.

Nervous system

Neurologic manifestations include lethargy, irritability, jitteriness, tremors, seizures, and cerebrovascular accidents. These symptoms/signs are most often due to the reduced blood flow and hypoxia associated with polycythemia, but they could also be secondary to polycythemia-induced hypoglycemia and hypocalcemia. 


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, cyanosis, and pulmonary hypertension. Decreased perfusion to the lungs can lead to hypoxia, and decreased glomerular perfusion can decrease the glomerular filtration rate and lead to oliguria. 


Poor feeding is reported in 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. [14]


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

Priapism may be observed in male patients.


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.


Polycythemia can affect coagulation. 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. [13]

Disseminated intravascular coagulation (DIC) is rare.