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Neonatal polycythemia refers to newborns with hemoglobin> 220 g/L, venous haematocrit> 0.6565% or capillary haematocrit> 0.7070% within one week after birth. Although it is rarer than neonatal anemia, its clinical manifestations are complex and may have extremely serious consequences, so it cannot be ignored.

[Etiology and Pathogenesis]

One, excessive transplacental perfusion

① Mother-fetus or fetal-fetus blood transfusion. The former is when the mother's red blood cells enter the fetal blood circulation. The latter is monozygotic twins. The fetus is transfused to the fetus, and the recipient is polycythemia.

② Late ligation of the umbilical cord allows the placenta to transfer blood into the newborn to 72 - 107 ml, of which 51%-78% is transferred within 1 minute after birth, 79%-82% is transferred within 5 minutes after birth, and the rest can be transferred within 10 minutes after birth. As a result, the number of red blood cells in the newborn was increased.

③ Before clamping the umbilical cord, the placenta is positioned higher than the fetus, allowing the blood from the placenta to be transferred to the fetus.

2. Placental dysfunction

It is found in small for gestational age infants, low birth weight infants, and maternal pregnancy poisoning. These diseases often cause fetal hypoxia, promote increased secretion of erythropoietin, and cause strong fetal hematopoiesis.

3 Endocrine and metabolic diseases

Fetal thyrotoxicosis can cause erythropoiesis due to increased intrauterine oxygen consumption and insufficient relative oxygen supply, which promotes the increase of erythropoietin, causing erythropoiesis; when the pregnant mother suffers from diabetes, the blood volume of the newborn child is reduced. Although the newborn's red blood cell volume does not increase much, the hematocrit increases; trisomy 21, 13, 18 syndrome and visceral macrosomia cause erythropoiesis due to increased intrauterine erythropoietin.

[Clinical manifestations]

Mild polycythemia may have no clinical manifestations. In severe cases, due to increased blood viscosity, stagnant blood flow, and increased blood volume, the heart load is aggravated, causing dysfunction of multiple organs, and a series of clinical manifestations appear.

① Nervous system: drowsiness, restlessness, convulsions, hypotonia.

② Respiratory and circulatory system: tachypnea, cyanosis, apnea, cardiac enlargement, pulmonary hypertension, heart failure, edema.

③ Digestive system: milk overflow, milk spitting, abdominal distension, diarrhea.

④ Blood system: jaundice, thrombocytopenia, digestive tract bleeding, DIC.

③ Urinary system: hematuria, proteinuria, oliguria, anuria.

④ Metabolism: hypoglycemia, hypocalcemia, hypomagnesemia, acidosis.

③ Others: necrotizing enteritis, embolism of blood vessels such as brain, coronary artery, kidney and greater omentum, priapism, etc.

[Laboratory Inspection]

① Determination of red blood cell count, hemoglobin and hematocrit.

② When blood transfusion is suspected between mother and fetus, IgM and IgA in children can be measured, and their levels are higher than those in normal newborns. Fetal hemoglobin HbF can also be measured, because after being diluted by the mother's hemoglobin, its HbF content can be lower than that of normal infants.

③ Measuring blood viscosity can not only help diagnosis, but also judge the degree of the disease, prognosis and treatment effect.

④ Blood sugar and blood calcium measurements were lower than normal, and serum indirect bilirubin increased.

③ When there is a tendency to bleed, platelet count and coagulation factors should be measured.

③ Erythropoietin, etc. can be measured under conditions.

X-ray examination: Chest X-ray examination shows that in some cases, heart enlargement, increased pulmonary vessel markings, hyperinflation, hilar infiltration, etc. can be seen.

[Diagnosis]

Newborns are born with too ruddy or deep red complexion; giant babies, small for gestational age babies or twins, one face pale and the other is deep red; there are intrauterine distress; newborns who are short of breath and blue after birth, and cannot be explained by cardiopulmonary diseases should be examined. If Hb> 220 g/L and hematocrit> 0.65, the diagnosis can be established.

[Treatment]

Asymptomatic people do not need treatment. Patients with dyspnea, heart failure and neurological symptoms should be treated as soon as possible. Reduce the hematocrit below 0.60 to reduce the blood viscosity to a safe range. Common methods:

① Partial exchange blood transfusion, that is, plasma is transferred to children to replace or exchange an equal amount of high-viscosity blood containing too many red blood cells. Alternatively, albumin is diluted with physiological saline to a concentration of 4% and infused through the umbilical artery or umbilical vein. Input volume = blood volume x current measured hematocrit-expected hematocrit ÷ current measured hematocrit expected hematocrit should be 0.60, and blood volume can be calculated as 90 ml per kilogram of body weight.

② For patients with cardiac failure, digitalis drugs should be given. For people with increased blood volume, 10% venous bleeding can be used. This method can only reduce the load on the heart and cannot reduce blood viscosity. Do not use it if you have normal blood volume.

③ Appropriate treatment should be given when hypoglycemia, hypocalcemia, hyperbilirubinemia or acidosis.