Polycythemia in neonatal intensive care unit, risk factors, symptoms, pattern, and management controversy

Abstract

Background:Polycythemia (PC) is defined as venous hematocrit (hct) ≥65%. Its incidence is high among certain risk factors (RFs). Its management is controversy.Aims:To determine: (1) The incidence of PC in our neonatal intensive care unit (NICU). (2) Most common RF, symptoms, and laboratory abnormalities (LA) associated with PC and their effect on the length of hospital stay (LOS). (3) Whether noninvasive interventions are effective in reducing hct. (4) Hct pattern of PC neonates.Design:Retrospective cohort study.Setting:NICU at a maternity and children hospital.Materials and Methods:Records review of all neonates from March 2011 to August 2013. Inclusions criteria were: (1) Venous hct ≥65%. (2) Neonates born in our institution. (3) Early umbilical cord clamping. (4) Gestational age ≥34 weeks.Statistical Analysis:Chi-square and multiple regression analysis.Results:One hundred and one PC neonates were eligible. Incidence of PC in our NICU is 14.5%. The most common RF, symptoms, and LA were: Small for gestational age, jaundice and hypoglycemia respectively. Tachypnea ( P - 0.04) and oliguria (P - 0.03) significantly prolonged LOS. Noninvasive interventions or observation could not reduce the hct significantly (P - 0.24). The hcts mean peaked maximally at a mean of 2.8 h of age.Conclusion:PC incidence in our NICU is higher than the reported incidence in healthy newborns. Most of the PC neonates were either symptomatic or having LA. Noninvasive interventions or observation were not effective in reducing hct in polycythemic neonates. Hct in both healthy and PC neonates peaked at the same pattern.

Haemoglobin discordances in twins: due to differences in timing of cord clamping?

“…In both twin groups, polycythaemia occurred more often in second-born twins when delivered through vaginal birth, although the incidence of polycythaemia was only particularly increased in second-born MC twins 15 16. Since polycythaemia is associated with a higher risk of complications such as hypoglycaemia and jaundice,17 delayed cord clamping may not be advisable in second-born MC twins after vaginal birth.…”

Evaluation of Neonatal Polycythemia in Terms of Gestational Age, Hematocrit, and Platelet Levels

“…In our study group, SGA was present in 32% of our patients. The literature on this topic reports ranging from 24.7% to 55.5% (9)(10)(11). Although data is limited on this topic, it is possible that these variations are caused by populationbased characteristics.…”

Safety of delayed umbilical cord clamping in preterm neonates of less than 34 weeks of gestation: a randomized controlled trial

“…Hyperbilirubinemia was defined according to American Academy of Pediatrics criteria [ 11 ]. Polycythemia was defined as a venous hematocrit ≥65% [ 12 ]. Secondary outcomes included need for resuscitation; axillary temperature at 5 and 30 minutes of life; incidence of major morbidities such as respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage, hypoperfusion requiring fluid bolus, and/or vasopressors; and need for blood transfusion.…”