Subinay Mandal1 , Subhendu Samanta2 , Devidutta Dash3
BACKGROUND Raised haematocrit results in increased blood viscosity which in turn, according to Poiseuille’s law, reduces flow of blood causing sludging of red blood cells within the microcirculations causing ischemic damage to different organs. A good number of neonates suffer from polycythaemia. Data on the extent & severity of this problem is scarce in this part of our country. METHODS Capillary haematocrit was estimated by heel puncture from prewarmed heel in a cohort of 400 consecutively born intramural neonates. Peripheral venous haematocrit was estimated from blood obtained from antecubital vein in neonates with capillary haematocrit ≥65%. Neonates with peripheral venous haematocrit ≥65% were considered to be suffering from polycythaemia. Polycythaemic neonates were clinically screened thoroughly & critically evaluated for signs & symptoms and selective biochemical parameters (bilirubin, glucose calcium etc). Polycythaemic neonates who manifested with two or more signs & symptoms were considered as symptomatic polycythaemia. RESULTS Of the 400 neonates, 196 were boys and 204 were girls. Birth weight ranged from 955 Gms to 4830 Gms with an average of 2744 ± 487 Gms. Gestational age of the neonates ranged from 31 weeks to 42 weeks with an average of 38 ± 1.6 wks. Capillary haematocrit (cap. Hct) ranged from 49% to 89% with an average of (66.5 ± 8)%. Out of the 400 neonates, cap. Hct of 243 neonates was 65% and above. 27 neonates were found to have peripheral venous haematocrit in the range of polycythaemia (≥65%) with an incidence of 6.7%. Of the 27 polycythaemic neonates, 15 (55.5%) were boys and 12 (44.5%) were girls. 19 (70.4%) were with AGA, 7 (25.9%) were SGA and one (3.7%) was LGA. 24 (88.8%) polycythaemic neonates were term and 3 (11.12%) were preterm. 22.2% polycythaemic neonates were symptomatic. Common signs & symptoms were peripheral cyanosis (18.5%), tachycardia (14.8%), systolic murmur (7.4%), tachypnoea (14.8%), jitteriness (11.1%), irritability (7.4%), lethargy (11.1%), seizure (11.1%) and vomiting with feeding difficulty (14.8%). CONCLUSIONS Polycythaemia is an important neonatal health problem, affecting an impressive number (6.7%) of neonates who require special care. So, all the neonates, born out of normal or high-risk pregnancy should be screened for polycythaemia. SGA & LGA are more prone to develop polycythaemia. Premature neonates are also equally likely to develop polycythaemia, like that of term neonates contrary to usual belief.
