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

Abstract

Objective: The main concern in neonatal polycythemia is complication development due to hyperviscosity. We aimed to compare symptoms, clinical and laboratory features, and organ dysfunctions of polycythemic newborns with respect to gestational age, hematocrit (hct) levels and presence of thrombocytopenia.

Material and Methods: Between January 2013 and December 2016, all hospitalized newborns with a gestational age of ≥ 34 weeks were retrospectively evaluated and those with a venous hct value exceeding 65% were included. Exclusion criteria were infections, metabolic diseases and congenital anomalies. Newborns were grouped and compared according to hct values (65–69.9% vs. ≥70%), gestational age (late preterm vs. term) and thrombocytopenia (present/ absent).

Results: Polycythemia incidence was 7.7% in the study group. The most common symptoms were hypoglycemia and hyperbilirubinemia, while 35.1% of newborns were asymptomatic. Hypoglycemia, hypocalcemia, and plethora were significantly more frequent in the severe polycythemia (hct ≥70%) group than in the moderate polycythemia (hct between 65–69.9%) group (p = 0.027, p = 0.014, p < 0.001, respectively). Hyperbilirubinemia was more common in late preterm babies than term babies (p = 0.014). Feeding difficulty, convulsion, hypoglycemia, hypocalcemia and liver function test abnormalities were significantly more common in newborns with thrombocytopenia than those without (p = 0.002, p = 0.004, p < 0.001, p = 0.022, p = 0.043, respectively).

Conclusion: It should be kept in mind that more than one-third of polycythemic newborns may be asymptomatic. While the most common symptoms were hypoglycemia and hyperbilirubinemia, liver function tests may also be adversely affected.

Keywords

• Hematocrit
• hyperviscosity
• late preterm
• newborn
• thrombocytopenia

Yenidoğan Polisitemisinin Gebelik Yaşı, Hematokrit ve Trombosit Düzeyleri Açısından Değerlendirilmesi

Abstract

Amaç: Yenidoğan polisitemisinde esas sorun hiperviskoziteye bağlı komplikasyonlardır. Bu çalışmanın amacı polisitemik yenidoğanların semptomlarını, klinik ve laboratuvar özelliklerini ve organ işlev bozukluklarını; gestasyonel yaş, hematokrit (hct) düzeyleri ve trombositopeni varlığı açısından değerlendirmektir.

Gereç ve Yöntemler: Ocak 2013 ile Aralık 2016 tarihleri arasında, hastanede yatan gestasyonel yaşı≥34 hafta olan tüm yenidoğanlar geriye dönük olarak değerlendirildi. Venöz hct değerleri %65’in üzerinde olan yenidoğanlar çalışmaya dahil edildi. Enfeksiyon, metabolik hastalık ve konjenital anomalileri olan yenidoğanlar çalışma dışı bırakıldı. Yenidoğanlar hct değerlerine (Orta derece polisitemi [%65-69] ve Şiddetli derece polisitemi [≥%70]), gestasyonel yaşa göre (geç preterm/ term) ve trombositopeni durumuna (var/yok) göre gruplandırıldı ve karşılaştırıldı.

Bulgular: Çalışma grubunda polisitemi insidansı %7.7 olarak saptandı. En sık görülen semptomlar hipoglisemi ve hiperbilirubinemi iken, yenidoğanların %35.1’i asemptomatikti. Hipoglisemi, hipokalsemi ve pletore şiddetli polisitemi grubunda orta polisitemi grubuna göre anlamlı olarak daha sıktı (sırasıyla p= 0.027, p= 0.014, p< 0.001). Hiperbilirubinemi, geç preterm bebeklerde term olanlara göre daha sıktı (p= 0.014). Trombositopenisi olan yenidoğanlarda, beslenme güçlüğü, konvülziyon, hipoglisemi, karaciğer fonksiyon testleri anormallikleri, trombositopenik olmayanlara göre anlamlı olarak daha fazlaydı (sırasıyla p= 0.002, p = 0.004, p < 0.001, p = 0.022, p = 0.043).

Sonuç: Polisitemik yenidoğanların asemptomatik olabileceği akılda tutulmalıdır. En sık görülen semptomlar hipoglisemi ve hiperbilirubinemi iken, karaciğer onksiyon testleri de polisitemik yenidoğanlarda etkilenebilir. 

Keywords

• hematokrit
• hiperviskozite
• geç preterm
• yenidoğan
• trombositopeni

References

1. Stevens K, Wirth FH. Incidence of neonatal hyperviscosity at sea level. J Pediatr 1980;97:118-9.
2. Fanaroff AA, Martin RJ, Walsh MC. Fanaroff and Martin’s neonatal-perinatal medicine : diseases of the fetus and infant. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2006.
3. Norman M, Fagrell B, Herin P. Effects of neonatal polycythemia and hemodilution on capillary perfusion. J Pediatr. 1992;121:103-8.
4. Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966;37:403-8.
5. Carlo WA. The Fetus and the Neonatal Infant. In: Kliegman R, Nelson WE, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia, PA: Elsevier/Saunders; 2016. p. 830.e1.
6. Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2004;114:297-316.
7. Lo SF. Reference Intervals for Laboratory Tests and Procedures. In: Kliegman R, Nelson WE, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia, PA: Elsevier/Saunders; 2016. p. 3465 to 72 (Table 727-5).
8. Finney H, Newman DJ, Thakkar H, Fell JM, Price CP. Reference ranges for plasma cystatin C and creatinine measurements in premature infants, neonates, and older children. Arch Dis Child 2000;82:71-5.

9. Merchant RH, Phadke SD, Sakhalkar VS, Agashe VS, Puniyani RR. Hematocrit and whole blood viscosity in newborns: analysis of 100 cases. Indian Pediatr 1992;29:555-61.
10. Narang A, Chaudhuri MK, Kumar P. Small for gestational age babies: Indian scene. Indian J Pediatr 1997;64:221-4.
11. Alsafadi TR, Hashmi SM, Youssef HA, Suliman AK, Abbas HM, Albaloushi MH. Polycythemia in neonatal intensive care unit, risk factors, symptoms, pattern, and management controversy. J Clin Neonatol 2014;3:93-8.
12. Singh S, Narang A, Bhakoo ON. Polycythemia in the newborn. Indian Pediatr 1990;27:349-52.
13. Wiswell TE, Cornish JD, Northam RS. Neonatal polycythemia: frequency of clinical manifestations and other associated findings. Pediatrics 1986;78:26-30.
14. Mentzer WC, Clark MR. Disorders of erythrocyte cation permeability and water content associated with hemolytic anemia. Biomembranes 1983;11:79-118.
15. Black VD, Lubchenco LO, Koops BL, Poland RL, Powell DP. Neonatal hyperviscosity: randomized study of effect of partial plasma exchange transfusion on long-term outcome. Pediatrics 1985;75:1048-53.
16. Black VD, Lubchenco LO, Luckey DW, Koops BL, McGuinness GA, Powell DP, et al. Developmental and neurologic sequelae of neonatal hyperviscosity syndrome. Pediatrics 1982;69:426-31.
17. Hopewell B, Steiner LA, Ehrenkranz RA, Bizzarro MJ, Gallagher PG. Partial exchange transfusion for polycythemia hyperviscosity syndrome. Am J Perinatol 2011;28:557-64.
18. Gross GP, Hathaway WE, McGaughey HR. Hyperviscosity in the neonate. J Pediatr 1973;82:1004-12.
19. Ramamurthy RS, Brans YW. Neonatal polycythemia: I. Criteria for diagnosis and treatment. Pediatrics 1981;68:168-74.
20. Pressler RM, Cilio MR, Mizrahi EM, Moshé SL, Nunes ML, Plouin P, et al. The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures. Epilepsia. 2021;62:615-28.
21. Remon JI, Raghavan A, Maheshwari A. Polycythemia in the Newborn. Neo Reviews 2011;12:e20.
22. Vanderpool RR, Naeije R. Hematocrit-corrected Pulmonary Vascular Resistance. Am J Respir Crit Care Med 2018;198:305-9.
23. Sankar MJ, Agarwal R, Deorari A, Paul VK. Management of polycythemia in neonates. Indian J Pediatr 2010;77:1117-21.
24. Tan JH, Poon WB, Lian WB, Ho SK. A Comparison of the Short-term Morbidity and Mortality Between Late Preterm and Term Newborns. Ann Acad Med Singap 2014;43:346- 54.
25. Acunas B, Celtik C, Vatansever U, Karasalihoglu S. Thrombocytopenia: an important indicator for the application of partial exchange transfusion in polycythemic newborn infants? Pediatr Int 2000;42:343-7.
26. Morag I, Strauss T, Lubin D, Schushan-Eisen I, Kenet G, Kuint J. Restrictive management of neonatal polycythemia. Am J Perinatol 2011;28:677-82.
27. Vlug RD, Lopriore E, Janssen M, Middeldorp JM, Rath ME, Smits-Wintjens VE. Thrombocytopenia in neonates with polycythemia: incidence, risk factors and clinical outcome. Expert Rev Hematol 2015;8:123-9.