Neonatology pp 1125-1139 | Cite as

Polycythemia and Hyperviscosity in Neonates

  • Otwin LinderkampEmail author
Reference work entry


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.





Necrotizing enterocolitis


Partial exchange transfusion


Red blood cell


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of NeonatologyDepartment of Pediatrics, University of HeidelbergHeidelbergGermany

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