DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
RECOGNITION AND ASSESSMENT
Definition
- Peripheral venous haematocrit (Hct) >65%
- Symptoms rarely occur with peripheral Hct of <70%
- Hct peaks at 2 hr after birth and then decreases with significant changes occurring by 6 hr
Clinical consequences
- Hyperviscosity
- Decreased blood flow and impaired tissue perfusion
- Thrombus formation
Complications
- Cerebral micro-infarction and adverse neurodevelopmental outcome
- Renal vein thrombosis
- Necrotising enterocolitis (NEC)
Causes
Intra-uterine increased erythropoiesis | Erythrocyte transfusion |
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Symptoms and signs
- Commonly plethoric but asymptomatic
Cardiorespiratory |
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CNS |
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GIT |
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Metabolic |
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Haematological |
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Renal |
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INVESTIGATIONS
In all unwell babies and at-risk babies who look plethoric (as mentioned above)
- FBC/Hct
- If Hct >65%, repeat a free-flowing venous sample or obtain arterial Hct (capillary Hct sample unreliable)
- If polycythaemic, check blood glucose and serum calcium
IMMEDIATE TREATMENT
- Ensure babies at risk have liberal fluid intake 1 day ahead of usual requirement (see Intravenous fluid therapy guideline)
Asymptomatic babies with Hct >70%
- Repeat venous Hct after 6 hr
- if still high, discuss with consultant
Symptomatic babies with Hct >65%
- Possible symptoms: fits and excessive jitteriness, with neurological signs and refractory hypoglycaemia
Treatment
- Dilutional/partial exchange transfusion. Discuss with consultant
- use of haemodilution for treatment of polycythaemia is not supported by evidence and treatment of asymptomatic babies is not recommended
- explain to parents the need for exchange and possible risks before performing partial exchange transfusion. Partial exchange transfusion increases risk of NEC
- use sodium chloride 0.9% (see Exchange transfusion guideline)
- Volume to be exchanged = 20 mL/kg
- Perform exchange via peripheral arterial and IV lines or via umbilical venous catheter
- Take 5–10 mL aliquots and complete procedure over 15–20 min
SUBSEQUENT MANAGEMENT
- Babies who required partial exchange transfusion require long-term neurodevelopmental follow-up
- Otherwise, follow-up will be dependent on background problem