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Polycythemia and Hyperviscosity in Neonates

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Abstract

Polycythemia and the resulting increase in blood viscosity are common in the neonatal period. However, neonatal blood has several favorable properties including lower plasma viscosity, RBC aggregation, and increased red blood cell deformability compared with adults. Oxygen transport to vital organs is, therefore, usually not compromised when the hematocrit (HCL) is below 0.70 L/L. Polycythemia may develop before (increased erythropoiesis, prenatal transfusion syndromes) or after birth (late cord-clamping). Nevertheless, delayed or late cord-clamping should be encouraged because of favorable circulatory effects – among other advantages. Signs of polycythemia often result from the underlying disorder (e.g., intrauterine asphyxia, maternal diabetes) rather than from the increased HCT and blood viscosity. Postnatal blood volume loss contributes to the development of polycythemia in most affected infants. Early oral feeding or, if necessary, additional i.v. fluid is therefore the first-line treatment and prophylaxis against polycythemia. Because partial exchange transfusion (PET) did not improve the long-term neurodevelopmental outcome and even increased the risk of early complications (necrotizing enterocolitis, septicemia) in polycythemic infants, indications for PET should be restricted to symptomatic neonates with HCT ≥0.70 L/L and to asymptomatic infants with HCT ≥0.75 L/L.

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Abbreviations

HCT:

Hematocrit

NEC:

Necrotizing enterocolitis

PET:

Partial exchange transfusion

RBC:

Red blood cell

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Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany

    Otwin Linderkamp

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  1. Otwin Linderkamp
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Correspondence to Otwin Linderkamp .

Editor information

Editors and Affiliations

  1. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Rodolfo Bracci

  3. Liverpool Women’s Hospital Neonatal Unit, Liverpool, UK

    Michael Weindling

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Linderkamp, O. (2018). Polycythemia and Hyperviscosity in Neonates. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29489-6_218

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  • DOI: https://doi.org/10.1007/978-3-319-29489-6_218

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