Neonatal polycythaemia: Critical review and a consensus statement of the Israeli Neonatology Association

Francis B. Mimouni, Paul Merlob, Shaul Dollberg, Dror Mandel*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

The aim of this paper is to critically review neonatal polycythaemia (NP) literature, in terms of definition, diagnosis and management. We reviewed all Medline articles on NP up to December 2009. (i) The textbook definition of NP [venous haematocrit (HCT) > 65%] is empirical and not based on statistical definition, symptoms or complications. (ii) Measurement of viscosity is not better than HCT in predicting complications. (iii) Normovolaemic NP because of increased erythropoiesis may be different from hypervolaemic polycythaemia because of excessive foetal transfusion. (iv) Coexisting hypoglycaemia may worsen long-term outcome. (v) Four clinical trials (CTs) studied partial exchange transfusion (PET) on outcomes. In all trials, PET was performed after 6 h of life. There is no evidence that PET improves neurodevelopmental outcome of asymptomatic NP, and it might increase the risk of necrotizing enterocolitis. These CTs have inherent design flaws: (a) CNS 'damage' may occur before PET. (b) Confounding variables that may affect outcome have not been studied. (vi) If PET is performed, normal saline is the best alternative. (vii) The long-term effect of PET on symptomatic infants has not been studied. Conclusion: Current definition and management of NP are little evidence based, thus the need for a consensus based on expert opinion.

Original languageEnglish
Pages (from-to)1290-1296
Number of pages7
JournalActa Paediatrica, International Journal of Paediatrics
Volume100
Issue number10
DOIs
StatePublished - Oct 2011

Keywords

  • Exchange transfusion
  • Neonatal health care
  • Red blood cell

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