Partial exchang transfusion and polycythemia and neonate

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...

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...

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...

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...

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...

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)...

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...

This randomized controlled trial was conducted to determine the effect of partial exchange transfusion in polycythemic babies. Forty five asymptomatic polycythemic babies with birth weight < or = 2000 g were included and randomly assigned to undergo either partial exchange transfusion using isotonic saline within 4 hours of screening or routine medical management. Outcome measures were neonatal morbidity (especially hypoglycemia and neurological alterations) and mortality; developmental delays using DDST-II, neurological deficits, tone and DTR abnormalities over 18 months follow up period...

The dramatic advances that have taken place in recent years in the care of sick and premature infants also have been matched by a similar increase in the use of blood transfusion therapy. Haematological features indicate that a newborn has a blood volume of 85-125 ml/kg the foetal haemoglobin is 60-85% and average Hb in full term infant is 18 gm/dl. By 2-3 months it falls to 11-12 g/dl the main cause of anemia are iron poor diet, weaning diets recurrent or chronic infections and hemolytic episodes in malarious areas...

Neonatal polycythemia, a venous hematocrit >65%, occurs in 1% to 5% of the total newborn population. Polycythemia can result from an excess production of red blood cells (active form) or from an increase in fetal blood volume (passive form). Clinical manifestations of polycythemia are caused by an increase in whole blood viscosity with a subsequent decrease in blood flow to organ systems. However, little information exists in the nursing literature concerning neonatal polycythemia. This article addresses the two categories of polycythemia and their etiologies; the involved pathophysiology; clinical manifestations of affected organ systems; supportive and specific therapies that can be used to treat polycythemic infants; the prognosis for polycythemic infants; and the difficulty healthcare providers face in deciding whether to treat this disorder...

The aim of this study was to determine if maternal smoking was associated with an increased need for partial exchange transfusion for symptomatic polycythemia in term neonates. The study population consisted of 8,961 term neonates, of whom 28.7% were categorized as babies born to mothers who smoked. The incidence of partial exchange transfusion was determined in neonates whose mothers smoked and in neonates of nonsmokers. Partial exchange transfusion was performed in 41 neonates of mothers who smoked (1.59%; n = 2,572) versus 41 neonates of nonsmokers (0...

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461 consecutive inborn babies, delivered during the period September 1993-March 1994 were subjected to a microhematocrit assessment at 6 hours of age to determine the incidence of polycythemia. 47 babies (inborn and out born), admitted to the neonatal unit with confirmed polycythemia were studied for clinical and laboratory abnormalities. These 47 babies were then randomly assigned to receive partial exchange transfusion with either normal saline or fresh plasma. The incidence of polycythemia was 27 of 461 (5...

BACKGROUND: Neonatal polycythemia remains a significant clinical problem in Thailand. Partial exchanges transfusion (PET) with fresh frozen plasma (FFP) has been the mainstay of management for this condition in Thailand. Since FFP is difficult to find in certain areas and can cause concerns of transfusion related diseases, this study was undertaken to investigate the possibility of using plasma substitute and normal saline (NSS) for PET in the newborn infant with polycythemia. OBJECTIVE: 1...

AIM: To compare the efficacy of using isotonic saline (crystalloid) or 5% albumin (colloid) as replacement fluid in partial exchange transfusion (PET) for the treatment of neonatal polycythaemia. METHODS: One hundred and two polycythaemic full term infants were randomly allocated to receive PET with either isotonic saline or 5% albumin. The criteria for PET were: (a) venous haematocrit > or = 0.7; or (b) venous haematocrit 0.65-0.69 with symptoms or signs attributable to polycythaemia...

A prospective study to evaluate efficacy and safety of partial exchange blood transfusion (PEBT) with normal saline or plasma was conducted in 30 symptomatic polycythemic newborns. Babies were randomly assigned to receive PEBT either with normal saline or plasma. Both groups were comparable in terms of birth weight, gestational age, preexchange hematocrit and viscosity. A significant fall in hematocrit and viscosity was noticed at 6 hours following PEBT which persisted even at 24 hours (P < 0.001). Hematocrit and viscosity were comparable in the two groups at 6 and 24 hours (p > 0...

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is prevalent in Thailand. This condition can cause acute hemolysis during oxidative stress and also severe hyperbilirubinemia in the newborn in some populations. Our aim was to study the prevalence of G6PD deficiency in relation to neonatal jaundice. We performed quantitative red blood cell (RBC) G6PD assay in the cord blood of 505 male subjects. Observation of jaundice and determination of bilirubin level as well as work up for other causes of jaundice were made in the G6PD deficiency group compared to a G6PD normal group...

The neonatal polycythemia/hyperviscosity syndrome continues to perplex the pediatrician. Although it is reasonably common, with an incidence of 1% to 5%, significant symptoms are less frequent and may be more due to predisposing factors such as perinatal asphyxia, intrauterine hypoxia, or hypoglycemia. Infants who are small for gestational age or affected by maternal gestational diabetes are at high risk for the disorder. Partial exchange transfusion used to lower hematocrit will decrease viscosity, reverse many of the physiologic abnormalities, and ameliorate most symptoms, but has not been shown to significantly impact the long-term outcomes of these children...

Dopamine is frequently used in neonatal intensive care for its vasopressor, renal vasodilating, and cardiac inotropic properties. The effect of i.v. dopamine infusion on neonatal pituitary hormone secretion is currently unknown. We observed strikingly low serum concentrations of growth hormone (GH) and prolactin (PRL) during a therapeutic, standardized, isovolumetric, partial exchange transfusion (blood sampling every 20 min for 6 h) in two polycythemic neonates requiring intensive therapy, including continuous dopamine infusion...

UNLABELLED: We tested whether crystalliod solutions could be used instead of colloid solutions for partial exchange transfusions (PET) in polycythaemic neonates because crystalloid solutions are cheap, carry no risk of anaphylactic reactions and can be sterilized. We randomly assigned 20 term neonates with venous haematocrit (Hct) > 0.65 l/l to PET with either a serum preparation (BISEKO) or Ringer solution. Plasma volume (PV) was measured with Evans blue dilution. Blood volume (BV) and red cell mass were calculated from PV and venous Hct...