NEONATAL POLYCYTHEMIA

Polycythemia (Hct gt;65%) is seen in ~1% of newborns, specially full-terms with following risk factors:

• Delayed clamping of cord,

• Twin-twin transfusion in recipient baby,

• Infants of diabetic mother,

• Cyanotic CHDs (compensatory) or rarely in,

• Endocrinal disorders, e.g.

• Chromosomal disorders, e.g. Down syndrome.

Pathophysiologically, it leads to increased blood visco­sity (thromboembolic episodes), volume overload (CCF) and increased metabolic requirements for cell survival (hypoglycemia, hypocalcemia).

Clinically, visible plethora is the only indicator of polycythemia in most babies, though severe cases may develop complications, e.g. CCF, hypoglycemia, hypocalcemia and seizures.

Management: Plasma exchange is treatment of choice in cases with Hct gt;70, with an aim to bring it lt;55. Exchange volume may be calculated as

(Observed Hct - 55/observed Hct) ? 85 ? Weight (kg). where 55 is desired Hct and 85 is blood volume/Kg.

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