Sections

Polycythemia of the Newborn

Presentation

History

Neonates with polycythemia may have the following signs/symptoms:

Lethargy
Irritability
Jitteriness
Tremors
Seizures
Cerebrovascular accidents
Oliguria and/or hematuria
Respiratory distress
Cyanosis
Apnea

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.

Cardiopulmonary

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.

Gastrointestinal

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]

Genitourinary

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

Priapism may be observed in male patients.

Metabolic

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.

Coagulation

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.

Differential Diagnoses

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Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017 Oct 30. [QxMD MEDLINE Link].
Rincon D, Foguet A, Rojas M, et al. [Time of cord clamping and neonatal complications, a prospective study] [Spanish]. An Pediatr (Barc). 2014 Sep. 81 (3):142-8. [QxMD MEDLINE Link].
Mercer JS, Erickson-Owens DA, Collins J, Barcelos MO, Parker AB, Padbury JF. Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. J Perinatol. 2017 Mar. 37 (3):260-264. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
Hiersch L, Eitan M, Ashwal E, et al. Amniotic fluid discordance in monochorionic diamniotic twin pregnancies is associated with increased risk for twin anemia-polycythemia sequence. Prenat Diagn. 2016 Dec. 36 (12):1099-103. [QxMD MEDLINE Link].
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Author

Jegen Kandasamy, MD Assistant Professor, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Alabama School of Medicine

Jegen Kandasamy, MD is a member of the following medical societies: American Academy of Pediatrics, Indian Academy of Pediatrics, National Neonatology Forum of India

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 Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

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.

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.

Polycythemia of the Newborn Clinical Presentation

History

Physical Examination

General findings

Nervous system

Cardiopulmonary

Gastrointestinal

Genitourinary

Metabolic

Coagulation

Polycythemia of the Newborn Clinical Presentation

History

Physical Examination

General findings

Nervous system

Cardiopulmonary

Gastrointestinal

Genitourinary

Metabolic

Coagulation

References

Tables

Contributor Information and Disclosures

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