Anemia of Prematurity - Portal Neonatal

CLINICAL Section 3 of 9
History: Neonates with polycythemia may have the following findings:
• Lethargy
• Irritability
• Jitteriness
• Tremors
• Seizures
• Cerebrovascular accidents
• Respiratory distress
• Cyanosis
• Apnea
Physical:
• General
o The most obvious finding is plethora or ruddiness.
o Evaluate the infant for dehydration (eg, sunken fontanelle, dry mucous membranes)
o Priapism may be observed in male patients.
• Central nervous system
o CNS manifestations are the most common problems observed with polycythemia and
hyperviscosity.
o Symptoms include lethargy, irritability, jitteriness, tremors, seizures, and cerebrovascular
accidents.
• Cardiopulmonary: Manifestations include respiratory distress, tachypnea, cyanosis, apnea,
and congestive heart failure.
• Gastrointestinal
o Poor feeding is reported in more than one half of all infants with polycythemia and
hyperviscosity.
o Necrotizing enterocolitis (NEC) is a rare but devastating complication of polycythemia or
hyperviscosity. Historically, about 44% of term infants with NEC have polycythemia.
More recent data suggest that polycythemia may not have a large role in the
development of NEC in the term infant.
• Renal: Manifestations include decreased glomerular filtration rates, oliguria, hematuria,
proteinuria, and renal vein thrombosis.
• Metabolic
o Metabolic alterations are frequent.
o Hypoglycemia is the most common metabolic derangement and is observed in 12-40%
of infants with polycythemia.
o Hypocalcemia is the next most common metabolic derangement and is found in 1-11%
of neonates with polycythemia.
• Coagulation
o Coagulation can be affected.
o Thrombocytopenia may occur secondary to consumption with thrombosis.
o Disseminated intravascular coagulation (DIC) is rare.