Polycythemia in newborns is defined as either venous hematocrit or abnormally high glucose levels above 65% and 22g/dl, respectively. Neonatal polycythemia is seen in around 0.4% to 5% of healthy term newborns. The affected babies may not always show specific symptoms but may occasionally present with ruddy or dusky skin (1) (2).
The excess red blood cells may slow down or block blood flow in the smaller blood vessels, leading to oxygen deprivation and tissue death. It may cause adverse effects on vital organs such as kidneys, lungs, and brain (3). Prompt treatment can help manage the condition.
Read this post to learn about the causes, symptoms, and complications of polycythemia in babies.
Causes Of Polycythemia
Neonatal polycythemia could be caused by any of the following factors, some of which could be due to conditions that develop before birth (3).
- Inherited diseases or genetic disorders such as Down Syndrome, trisomy 13 and trisomy 18.
- Delayed clamping of the umbilical cord
- Poorly controlled diabetes in the mother
- Low oxygen level in the fetus’s blood
- Twin-twin syndrome – When blood from one twin moves to the other, causing excess blood in one fetus and decreased blood volume in the donor twin causing anemia
- Maternal smoking
- Mother lives at a high altitude
- Mother with high blood pressure
Symptoms Of Neonatal Polycythemia
In newborns, the red blood cell levels peak at the second hour of life compared to the cord blood levels. The levels then plateau between two to four hours of life and return to the cord blood levels at 12 to 18 hours of life. It is essential to observe any changes, and the postnatal screening should be done carefully and at the right time (4).
The symptoms of neonatal polycythemia may vary from baby to baby, and in some, it can be asymptomatic. The common symptoms of polycythemia include (3)
- Extreme sleepiness
- Feeding problems
- Seizures, jitteriness
- Trouble breathing
- Low blood sugar
- Decrease urination
- Newborn jaundice (2) (4)
Diagnosis Of Polycythemia
Your child’s doctor would observe the symptoms and order the following tests (3).
- Hematocrit to count the number of red blood cells
- Oxygen level test in the blood
- Blood sugar test
- Creatinine test
- Jaundice test
Once the doctor determines polycythemia in your baby, the treatment will be initiated.
Treatment For Polycythemia
The treatment for polycythemia is done in two ways for symptomatic and asymptomatic polycythemia (1):
- Conservative management with rehydration
- Partial exchange transfusion (PET)
For asymptomatic infants with a red blood cell percentage of 60%–70%, conservative treatment with rehydration (increasing the fluid intake) is often sufficient.
For babies who present with the above symptoms, a partial exchange may be needed, in which a small volume of blood is removed from the neonate and replaced with normal saline.
Prognosis Of Polycythemia
Babies tend to respond positively to the treatment, and good results are seen in infants who receive treatment in the case of severe conditions.
Possible Complications Of Polycythemia
The common complications caused by polycythemia include:
- Necrosis of the intestinal tissues
- Diminishing fine motor skills
- Kidney failure
Prevention Of Polycythemia
The prevention of polycythemia depends on the underlying cause. Studies suggest that early cord clamping and holding the baby at the level of introitus at the time of delivery might help prevent polycythemia. However, there are no significant statistical evidence to support this (4).
Polycythemia in newborns is an uncommon blood disorder that should be treated immediately. It results in oxygen deprivation due to excess red blood cells. Fortunately, the condition shows a good prognosis with early treatment. The doctor generally monitors the symptoms and carries out the necessary treatment to prevent complications such as intestinal tissue necrosis or kidney failure. If any causative factor, such as maternal diabetes and smoking or pregnancy complications, is detected, screening for polycythemia in newborns may be carried out for prompt treatment and effective management.
- Delayed clamping of the umbilical cord and maternal smoking are common causes of polycythemia in newborns.
- Low blood sugar, feeding problems, and troubled breathing indicate polycythemia.
- Partial exchange transfusion and conservative management with the help of rehydration can help treat this condition.
2. Polycythemia – newborn; MedlinePlus
3. S Umit Sarici, Murat Ozcan and Demet Altun; Neonatal Polycythemia: A Review; ClinMed International Library
4. Polycythemia Vera in Children; Stanford Children’s Health