Neonatal polycythemia: incidence and associated factors

Authors

  • Ashaben Ranchhodbhai Chaudhari Department of Pediatrics, GCS Medical College, Hospital and Research centre, Ahmedabad, Gujarat, India
  • Aabha Mohan Phalak Department of Pediatrics, GCS Medical College, Hospital and Research centre, Ahmedabad, Gujarat, India
  • Priyanka Girishchandra Chauhan Department of Pediatrics, GCS Medical College, Hospital and Research centre, Ahmedabad, Gujarat, India
  • Ankit Narbherambhai Goriya Department of Pediatrics, GCS Medical College, Hospital and Research centre, Ahmedabad, Gujarat, India
  • Baldev S. Prajapati Department of Pediatrics, GCS Medical College, Hospital and Research centre, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20230078

Keywords:

Hyperbilirubinemia, Jaundice, Neonates, Polycythemia

Abstract

Background: The chief concern in neonatal polycythemia (NPC) is the development of complications due to hyper viscosity. We aimed to study risk factors, clinical features, laboratory investigations, management and outcome of neonates with polycythemia at our set up.

Methods: A prospective study was conducted in the frame of January 2021 to January 2022 at tertiary care institute in Ahmedabad, all neonates with gestational age ≥34 weeks were evaluated and those with venous hematocrit more than 65% or hemoglobin exceeding 22 mg/dl were included in the study. The clinical features and laboratory parameters were noted. Asymptomatic neonates or neonates with mild polycythemia were observed for rising hematocrit or development of symptoms whereas symptomatic neonates or neonates with moderate and severe polycythemia were subjected to interventions as needed.

Results: Incidence of polycythemia in this study was 11.18 per 100 neonates. The most common symptoms observed were jaundice in 68 (43.3%) neonates, followed by lethargy in 33 (21%). Other symptoms observed were refusal to feed (18.4%), respiratory distress (11.4%), jitteriness (6.3%), decrees urine output (2.5%), and cyanosis (1.2%). The noted laboratory abnormalities were hyperbilirubinemia (43.3%) followed by thrombocytopenia (40.1%), hypoglycemia (28%) and hypocalcemia (4.4%). The 35.6% neonates require hydration and 22.5% of neonates required partial exchange transfusion, rest were managed conservatively.

Conclusions: the study suggested that polycythemia is a frequent problem among neonates. More than one third of them can be asymptomatic indicating the importance of assessing the associates’ risk factors.

 

References

Donepudi R, Papanna R, Snowise S, Johnson A, Bebbington M, Moise KJ Jr. Does anemia-polycythemia complicating twin-twin transfusion syndrome affect outcome after fetoscopic laser surgery? Ultrasound Obstet Gynecol. 2016;47(3):340-4.

Slaghekke F, Kist WJ, Oepkes D, Pasman SA, Middeldorp JM, Klumper FJ et al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther. 2010;27(4):181-90.

Djaafri F, Stirnemann J, Mediouni I, Colmant C, Ville Y. Twin-twin transfusion syndrome-What we have learned from clinical trials. Semin Fetal Neonatal Med. 2017;22(6):367-75.

Ozek E, Soll R, Schimmel MS. Partial exchange transfusion to prevent neurodevelopmental disability in infants with polycythemia. Cochrane Database Syst Rev. 2010;(1):CD005089.

Vlug RD, Lopriore E, Janssen M, Middeldorp JM, Rath ME, SmitsWintjens VE. Thrombocytopenia in neonates with polycythemia: incidence, risk factors and clinical outcome. Expert Rev Hematol. 2015;8(1):123-9.

Jeevasankar M. Agarwal R, Paul. Polycythemia in the newborn. Indian J Pediatr. 2008;75:68-73.

Lessaris KJ, Rosenkrantz T. Polycythemia of the newborn. Medscape. 2012;1-3.

Stevens K, Wirth FH. Incidence of neonatal hyperviscosity at sea level. Pediatrics. 1980;97:118.

Singh S, Narang A, Bhakoo ON. Polycythemia in the newborn. Ind Pediatr. 1990;27:349-52.

Alsafadi TR, Hashmi SM, Youssef HA, Suliman AK, Abbas HM, Albaloushi MH. Polycythemia in Neonatal Intensive Care Unit, Risk Factors, Symptoms, Pattern, and Management Controversy. J Clin Neonatol. 2014;3(2):93-8.

Pappas A, Delaney-Black V. Differential diagnosis and management of polycythemia. Pediatr Clin North Am. 2004;51:1063-86.

Wexner EJ. Neonatal polycythemia and hyperviscosity. Clin Perinatol. 1995;22:693.

Wirth FH, Goldberg KE, Lubchenco LO. Neonatal hyperviscosity I. Incidence J Pediater. 1979;63:833.

Allen M. Polycythemia. In Manual of Neonatal Care, 6th ed. United States: Lippincott Williams. 2008;26:450-55.

Babara J. Stoll: Plethora in the Newborn Infant, In Nelson Textbook of Pediatrics 18th ed. Philadelphia, WB Sunders Co. 2007;103.3:773.

Singh M, Singhal PK, Paul VK, Deorari AK, Sundaram KR. Polycythemia in the newborn: do asymptomatic babies need exchange transfusion. Indian Pediatr. 1990;27:61-5.

Singh S, Narang A, Bhakoo ON. Polycythemia in the newborn. Ind Pediatr. 1990;27:349-52.

Krishnan L, Rahim A. Neonatal polycythemia. Ind J Pediatr. 1997;64:541-46.

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Published

2023-01-24

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Original Research Articles