Polycythemia in Neonates causes and management.pptx
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Polycythemia in neonates can be a life threatening condition, a comorbidity due to many causes which needs immediate action. Here's my take on the same. My references are from, Nelson, Gomella, Cloherty. And Special thanks to Dr. Pavitra Viswanathan, who runs her Youtube channel by the name Pediatric Takes by Dr.Pavitra Viswanathan @pediatrictakesbydr.pavitra9813 and teaches Pediatrics. This presentation has hand written notes as well, which i've incorporated, in-spite of my handwriting, because i loved these. In case ppl need it to be typed, kindly reach me out, i'll type these as well.
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Polycythemia in Neonates causes and management.pptx
- 2. Definition & Epidemiology • Venous HCT > 65% • or • Venous Hb > 22 gm/dL • 1 - 5 % in ter m neonates. Almost 1/2 of these have symptoms.
- 3. Hyperviscosity Definition • Viscosity > 14.6 centipedes at shear rate of 11.5 per second • Or • Viscosity > 2 SD of the mean.
- 4. Hyperviscosity Causes • Viscosity depends upon • Red cell mass ( PCV / HCT) [ Most important in neonates] • Plasma Protein (esp. Fibrinogen) [ Most important in adults ] • Deformability of Erythrocytes - heighten the deformability, lower is viscosity • Erythrocyte aggregation • Interaction of cell components with vessel wall
- 5. Hyperviscosity Gold standard • Measurement of viscosity is done by a whole blood viscometer that can accurately measure the viscosity of blood. Because the erythrocyte number is the most important factor affecting viscosity, measurement of the neonatal HCT has been suggested as the best clinical screening test for identifying infants with presumed Hyperviscosity.
- 6. Relationship between Viscosity and Hct • Relationship between HCT and viscosity is linear below HCT of 60%, but viscosity increases exponentially when HCT >/= 70%
- 7. Physiological changes in postnatal life • Hematocrit peaks @2HOL - 60% • @6 HOL - 57% • @ 12-18 HOL - 52%
- 8. CAUSES OF RAISED HCT A. Placental red Cell Transfusion • 1. Cord stripping • 2. Holding baby below mother • 3. Maternal to Fetal transfusion • 4. Twin twin transfusion • 5. Forceful uterine contractions Before Cord Clamping • 6. Delayed cord clamping • Cord clamping @1 minute - blood volume = 80 ml/kg • Cord clamping @2 minute - blood volume = 90 ml/kg
- 9. CAUSES OF RAISED HCT B. Placental Insufficiency (Chronic Intrauterine Hypoxia —> increased Fetal Erythropoiesis) • 1. IUGR and SGA • 2. Maternal Smoking • 3. POST-TERM • 4. Maternal Hypertension (per-eclampsia, Renal Disease) • 5. Infants born to mother with Chronic Hypoxia (Heart Ds, Pulmonary Ds.) • 6. Pregnancy at high Altitude
- 10. C. Others • IODM (Increased Erythropoietin) • LGA • Infants with • CAH, Beckwith - Weidmann Syndrome, Congenital Hypothyroidism, Congenital Thyrotoxicosis, Trisomy 13, 18, 21 • Drugs (Maternal Use of Propanolol) • Dehydration • Sepsis CAUSES OF RAISED HCT
- 13. Screening • In high risk groups • SGA, IUGR • LGA • IODM • Monochorionic twins • Schedule - 2, 6, 12, 24, 48, 72 HOL.
- 14. diagnosis • Either cord blood or peripheral venous blood hematocrit • If capillary blood Hct is >65% ——> do peripheral venous hematocrit • Measure blood viscosity (if available).
- 16. Partial Exchange Therapy (PET) • Removing some of blood volume and replacing it with NS to bring the Hct down to 65%. • Volume to be transfused (ml) =
- 18. Partial Exchange Therapy • Blood can be withdrawn from umbilical vein and replaced with NS in peripheral vein. • Or • By Push and Pull technique. • S/e of PET - increased risk of NEC.