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Partial exchang transfusion and polycythemia and neonate

Mangalabharathi Sundaram, Sourabh Dutta, Anil Narang
OBJECTIVE: To compare supplemental intravenous fluids with no supplementation in asymptomatic polycythemic late preterm and term neonates. METHODS: 55 infants with venous haematocrit of 65-75 were randomly allocated to receive either 25 mL/kg IV normal saline over 6-8 hours or routine fluids. They were followed up for 48 hours. RESULTS: There was no significant difference between fluid supplementation and control groups regarding need for partial exchange transfusion [6/27 (22...
November 15, 2016: Indian Pediatrics
Lisanne S A Tollenaar, Femke Slaghekke, Johanna M Middeldorp, Frans J Klumper, Monique C Haak, Dick Oepkes, Enrico Lopriore
Monochorionic twins share a single placenta and are connected with each other through vascular anastomoses. Unbalanced inter-twin blood transfusion may lead to various complications, including twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). TAPS was first described less than a decade ago, and the pathogenesis of TAPS results from slow blood transfusion from donor to recipient through a few minuscule vascular anastomoses. This gradually leads to anemia in the donor and polycythemia in the recipient, in the absence of twin oligo-polyhydramnios sequence (TOPS)...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Erbu Yarci, Evrim Alyamac Dizdar, Mehmet Yekta Oncel, Aslihan Kose Cetinkaya, Turan Derme, Fuat Emre Canpolat, Serife Suna Oguz, Ugur Dilmen
Twin anemia/polycythemia sequence (TAPS) is characterized by large intertwin hemoglobin (Hb) differences without signs of twin oligopolyhydramnios. The spontaneous form complicates approximately 3-5% of monochorionic twin pregnancies. TAPS placentas are characterized by the presence of only very few and small unidirectional arteriovenous anastomoses, which allow a slow transfusion of blood from the donor to the recipient, gradually leading to highly discordant Hb levels. Neonatal morbidity in TAPS appears to be mainly limited to hematological problems at birth...
2014: Fetal Diagnosis and Therapy
S Patil, S S Saini, P Kumar, R Shah
OBJECTIVE: We compared intra-procedural neonatal pain, agitation and sedation scale (N-PASS) scores between a novel 'continuous arteriovenous exchange' (CAVE) and conventional pull-push (PP) techniques of partial exchange transfusion (PET) among neonates with polycythemia. STUDY DESIGN: Neonates >32-0/7 weeks gestation, requiring PET for polycythemia, were randomized to PP or CAVE techniques. The procedure was video-recorded and edited to mask the technique. Intra-procedural N-PASS scores assigned by two trained and masked neonatal fellows were compared...
September 2014: Journal of Perinatology: Official Journal of the California Perinatal Association
A Mabuchi, K Ishii, R Yamamoto, T Taguchi, M Murata, S Hayashi, N Mitsuda
OBJECTIVES: To evaluate neonatal outcomes and clinical characteristics of monochorionic diamniotic (MCDA) twins with a large intertwin hemoglobin (Hb) difference at birth. METHODS: This was a retrospective cohort study of MCDA twin gestations delivered at Osaka Medical Center and Research Institute for Maternal and Child Health between 2003 and 2012. Cases of pregnancy termination, acardiac twins or intrauterine death were excluded. A large intertwin Hb difference at birth was defined as > 8...
September 2014: Ultrasound in Obstetrics & Gynecology
Ji-mei Wang, Guo-qiang Cheng, Bei-qian Qian, Yong-qin Meng
OBJECTIVE: To summarize and review the clinical characteristics including clinical features, prenatal characteristics, diagnosis, treatments and short-term outcomes of the twin anemia-polycythemia sequence (TAPS) to improve the recognition of the disease. METHOD: The clinical data of one case with twin anemia-polycythemia sequence and the reports of 15 cases seen in the past 5 years were reviewed and analyzed. RESULT: There was an increasing number of reports of cases with TAPS...
January 2013: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
W Diehl, P Glosemeyer, M Tavares De Sousa, B Hollwitz, G Ortmeyer, K Hecher
Twin anemia-polycythemia sequence (TAPS) complicates up to 6% of monochorionic diamniotic twin pregnancies, typically in the late second or third trimester. The presence of only a few and very small arteriovenous vascular anastomoses characterizes the underlying angioarchitecture at the chorionic plate in cases of TAPS. In monoamniotic twins, large vascular anastomoses can usually be seen at the placental vascular equator, and therefore one would not expect the development of TAPS in monoamniotic twins. We report a case of TAPS in a monoamniotic pregnancy at 26 + 5 weeks' gestation which responded favorably to fetoscopic laser coagulation of the small placental anastomoses, resolving severe anemia in one twin and polycythemia in the other...
July 2013: Ultrasound in Obstetrics & Gynecology
Iris Morag, Tzipora Strauss, Daniel Lubin, Irit Schushan-Eisen, Gili Kenet, Jacob Kuint
Partial exchange transfusion (PET) is traditionally suggested as treatment for neonates diagnosed with polycythemia. Nevertheless, justification of this treatment is controversial. We evaluated the risk for short-term complications associated with a restrictive treatment protocol for neonatal polycythemia. A retrospective cross-sectional analytical study was conducted. Three treatment groups were defined and managed according to their degree of polycythemia, defined by capillary tube filled with venous blood and manually centrifuged hematocrit: group 1, hematocrit 65 to 69% and no special treatment was recommended; group 2, hematocrit 70 to 75% and intravenous fluids were given and feedings were withheld until hematocrit decreased to < 70%; and group 3, hematocrit ≥ 76% or symptomatic neonates and PET was recommended...
October 2011: American Journal of Perinatology
Francis B Mimouni, Paul Merlob, Shaul Dollberg, Dror Mandel
UNLABELLED: 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...
October 2011: Acta Paediatrica
Bridget Hopewell, Laurie A Steiner, Richard A Ehrenkranz, Matthew J Bizzarro, Patrick G Gallagher
The objective of this study was to examine the use of partial exchange transfusion (PET) performed for polycythemia hyperviscosity syndrome (PHS) over time. A retrospective review of 141 infants who received a PET for PHS at Yale-New Haven Hospital between 1986 and 2007 was performed, querying maternal and neonatal medical records. Patient demographics, risk factors for PHS, indications for PET, and complications associated with PET and PHS were collected. Overall, there was no change in the number of PET performed over the study period ( R(2)=0...
August 2011: American Journal of Perinatology
Sinan Uslu, Hamus Ozdemir, Ali Bulbul, Serdar Comert, Emrah Can, Asiye Nuhoglu
OBJECTIVES: To evaluate the clinical characteristics and risk factors of symptomatic and asymptomatic polycythemic neonates performed partial exchange transfusion (PET) and to determine the time of resolution of symptoms and effect of PET on short-term morbidity. METHODS: This prospective cohort study was conducted with symptomatic (hematocrit; Hct>65% plus a clinical symptom) and asymptomatic (Hct level>70% without any symptoms) neonates who underwent PET due to polycythemia...
December 2011: Journal of Maternal-fetal & Neonatal Medicine
Arzu Akdag, Dilek Dilli, Omer Erdeve, Serife Suna Oğuz, Uğur Dilmen
INTRODUCTION: Neonatal polycythemia may result in increased cytokine production. We aimed to investigate whether polycythemia and partial exchange transfusion (PET) affect interleukin-6 (IL-6) response pattern in early neonatal period. METHODS: Ninety-four newborns, 57 with polycythemia (Group 1) and 37 as control group (Group 2) were enrolled in the study. PET was performed at 4-6 hr following birth in the first group. Blood levels of IL-6 were measured at 2-4 hr following birth; measurements were repeated at 6 and 24 hr after PET in newborns with polycythemia and at similar hours in Group 2...
2010: Journal of Clinical Laboratory Analysis
Eren Ozek, Roger Soll, Michael S Schimmel
BACKGROUND: Hyperviscosity of blood results in increased resistance to blood flow and decreased oxygen delivery. In the neonate, hyperviscosity can cause abnormalities of central nervous system function, hypoglycemia, decreased renal function, cardiorespiratory distress, and coagulation disorders. Hyperviscosity has been reported to be associated with long-term motor and cognitive neurodevelopmental disorders. Blood viscosity exponentially increases when an infant has polycythemia (hematocrit >/= 65%)...
2010: Cochrane Database of Systematic Reviews
N Demirel, M Aydin, A Zenciroglu, A Y Bas, N Yarali, N Okumus, G Cinar, M S Ipek
BACKGROUND: There are few data with respect to prothrombotic risk factors in neonates. AIM: To determine the associated risk factors, clinical features and outcome in newborn infants diagnosed with thrombo-embolism. METHODS: Case records of 25 infants (17 full-term and eight preterm) diagnosed with thrombo-embolism between January 2005 and April 2008 in a neonatal intensive care unit were reviewed. RESULTS: Of the 25 infants, 18 cases of venous (72%) and seven of arterial (28%) thrombo-embolism were recorded; in 18 it was associated with central catheterisation...
December 2009: Annals of Tropical Paediatrics
Shikha Sarkar, Ted S Rosenkrantz
Neonatal polycythemia and hyperviscosity are defined as a hematocrit > or =65% and a viscosity value >2 standard deviations greater than the norm. Although polycythemia can reflect normal fetal adaptation, it has been thought to be responsible for abnormalities in the neonate. Polycythemia and hyperviscosity are associated with blood-flow changes in some organs, which alter their function. Partial exchange transfusion (PET) has been used to treat both symptomatic and asymptomatic patients. At present, no data support the use of PET in asymptomatic infants; the potential benefit in symptomatic infants depends on the symptoms...
August 2008: Seminars in Fetal & Neonatal Medicine
Shaul Dollberg, Ronela Marom, Francis B Mimouni, Yoav Littner
OBJECTIVE: Hypothermia is a known symptom of neonatal polycythemia (NP) and its pathophysiology is unclear. The effect of partial dilutional exchange transfusion (PET) upon resting energy expenditure (REE) is unknown. We aimed to test the hypothesis that PET leads to an increase in REE. STUDY DESIGN: 11 patients with NP who underwent PET and 10 controls without polycythemia were studied. NP was defined as a venous HCT >/=0.65. Per protocol, symptomatic infants and/or those with venous HCT > or =0...
October 2007: Journal of the American College of Nutrition
E Lopriore, J M Middeldorp, D Oepkes, H H Kanhai, F J Walther, F P H A Vandenbussche
Placental vascular anastomoses in monochorionic twins may lead to acute or chronic inter-twin transfusion. We report an uncommon form of chronic inter-twin transfusion, referred to as twin anemia-polycythemia sequence (TAPS), with severe anemia in one twin and polycythemia in the other, without the characteristically associated twin oligo-polyhydramnios sequence (TOPS) seen in the classical twin-to-twin transfusion syndrome (TTTS). The clinical course and placental characteristics of two pairs of monochorionic twins with TAPS born at, respectively, 33 and 34 weeks' gestation were reviewed...
January 2007: Placenta
Eugene M Dempsey, Keith Barrington
AIMS: To determine whether crystalloid solutions are as effective as colloid solutions when a partial exchange transfusion is performed in newborns with polycythemia. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register of the Cochrane Library (1966-2004). Keywords used were: polycythemia, partial exchange transfusion, hyperviscosity, and limited to newborn. Randomized studies in newborns with polycythemia were selected for evaluation...
November 2005: Acta Paediatrica
Musbah Omar Emhamed, Patrick van Rheenen, Bernard J Brabin
This study was conducted to evaluate the haematological effects of the timing of umbilical cord clamping in term infants 24 h after birth in Libya. Mother-infant pairs were randomly assigned to early cord clamping (within 10s after delivery) or delayed clamping (after the cord stopped pulsating). Maternal haematological status was assessed on admission in the delivery room. Infant haematological status was evaluated in cord blood and 24 h after birth. Bilirubin concentration was assessed at 24 h. 104 mother-infant pairs were randomized to delayed (n=58) or early cord clamping (n=46)...
October 2004: Tropical Doctor
Michael S Schimmel, Ruben Bromiker, Roger F Soll
In clinical practice, neonatal polycythemia has been used as a marker for neonatal hyperviscosity, implicated as a cause of long-term neurologic delay and damage in the growing child. Clinicians have focused on the newborn infant's hematocrit (Hct) level as the criterion for therapeutic intervention. Partial exchange transfusion is traditionally used as the method to lower the Hct and treat hyperviscosity; however, it is unclear whether this is an effective approach in preventing the long-term neurologic consequences...
September 2004: Clinics in Perinatology
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