CLINICAL PROFILE OF POLYCYTHEMIA IN SMALL FOR GESTATIONAL AGE NEONATES ADMITTED TO THE NEONATAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Abstract

Background:-Polycythemia is the principal cause of hyperviscosity of blood in neonates and is associated with serious, sometimes life threatening complication of the brain, heart, kidney, lungs and intestines. The incidence is high in small for gestational age neonates. To assess the incidence, clinical prole of Aim:- polycythemia among Inborn small for gestational age newborns admitted in the Neonatal Intensive Care Unit of Jorhat Medical College and Hospital. Objectives:-To determine the incidence of polycythemia among small for gestational babies admitted in the Neonatal Intensive Care Unit of Jorhat Medical College & Hospital, and to assess the pattern of clinical manifestations and complications attributable to polycythemia. Method:-130 consecutive small for gestational age inborn babies admitted into the NICU of Jorhat Medical College and Hospital, Jorhat during the period of 1 year from May 2021 to April 2022 were screened for polycythemia at 2 - 4 hours of postnatal age using venous hematocrit. The newborns were considered polycythemic if the venous hematocrit was ≥65%. The incidence of polycythemia in small for gestational age was 31.5% Results:- (41 out of 130 babies). Among the 130 small for gestational age babies, 57 were preterm,49 were term and 24 were post term. The incidence of polycythemia was 29.2%in preterm, 36.7 % in term and 24.3% in post term babies. Among the polycythemic babies, icterus(70.7%) was the commonest clinical manifestation followed by lethargy (60.9%) and tachypnoea (36.5%).Hyperbilirubinemia (70.7%) was the commonest laboratory abnormality followed by thrombocytopenia(63.4%), hypokalemia (17.07%) , hypernatraemia (9.7%), hypoglycaemia (7.3%) , hypocalcemia (7.3%), hyperkalemia (4.8%) and hyponatremia (2.4%).39 babies underwent partial exchange transfusion with normal saline for correction of polycythemia. There was improvement in clinical features and hematocrit levels following partial exchange transfusion. Two asymptomatic babies did not undergo partial exchange transfusion and were managed conservatively. Conclusion:-Polycythemia is a silent clinical condition which if unrecognized can result in signicant morbidity in neonates. As incidence is high in small for gestational age newborns, these babies must be actively screened for its timely detection and management in order to prevent complications attributable to polycythemia-hyperviscosity syndrome. Key words:- Neonatal polycythemia, small for gestational age, Hematocrit, Partial exchange transfusion