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Category: Volume 07 Issue 03 March 2019
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Title: Normal Saline versus Fresh Frozen Plasma for Partial Exchange Transfusion in Neonatal Polycythemia

Authors: Dr Prakash Chandra Panda, Dr Rupashree Behera, Dr Sanjukta Panda

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.170

Abstract

Background: Polycythemia in the newborn is defined as a central venous Hct over 65% or a haemoglobin value above 22g/dl. As the viscosity increases, there is an impairment of tissue oxygenation and perfusion and a tendency to form micro thrombi. Significant damage may occur if these events occur in the cerebral cortex, kidneys and adrenal glands. Hence this condition requires urgent diagnosis and prompt management however the choice of replacement fluid remains controversial.

Objective: To assess the hematocrit at 0, 6, 24 hours after partial exchange transfusion with normal saline and fresh frozen plasma and to compare the effects is both the two groups.

Method: The study was performed in neonatal care unit, Department of Pediatrics VIMSAR Burla from October 2016-september 2018. 29 Neonates matching the inclusion criteria were enrolled for this randomised controlled trial having two arms NS arm(neonates in whom NS was used as replacement fluid for PET) and FFP arm(neonates in whom FFP was used as replacement fluid). The various parameters were measured at 6 hour and 24 hour of exchange transfusion and compared between the groups.

Results: There was overall no significant difference in the hematocrit, hemoglobin values measured at 6 hour,24 hour after PET  in both the groups .Similarly in other parameters also there was no significant difference between both the groups. However, the interval between the diagnosis and treatment in NS group was less as compared to FFP group and came out to be significant as p value<0.00. The cost expenses of using FFP was more than that of NS which also was stastistically significant.

Conclusion: PET with normal saline is as safe and effective as Fresh Frozen Plasma as there was no clinically or statistically significant difference between them. Normal saline was cheap, readily available and effective substitute for management of neonates with polycythemia as compared to FFP and hence should be considered as an ideal replacement fluid for PET.

Keywords: PET-Partial exchange transfusion, NS-Normal saline, FFP-Fresh frozen plasma.

References

  1. McMullin MF, Bareford D, Campbell P, Green AR, Harrison C, Hunt B, Oscier D, Polkey MI, Reilly JT, Rosenthal E, Ryan K. Guidelines for the diagnosis, investigation and management of polycythaemia/ erythrocytosis. British journal of haematology. 2005 Jul;130(2):174-95.
  2. O'Brien RT, Pearson HA. Physiologic anemia of the newborn infant. The Journal of pediatrics. 1971 Jul 1;79(1):132-8.
  3. Sankar MJ, Agarwal R, Deorari A, Paul VK. Management of polycythemia in neonates. The Indian Journal of Pediatrics. 2010 Oct 1;77(10):1117-21.
  4. Oh W. Neonatal polycythemia and hyperviscosity. Pediatric Clinics of North America. 1986 Jun;33(3):523-32.
  5. Sarkar S, Rosenkrantz TS. Neonatal polycythemia and hyperviscosity. In Seminars in Fetal and Neonatal Medicine 2008 Aug 1 (Vol. 13, No. 4, pp. 248-255). WB Saunders.
  6. Shohat M, Merlob P, Reisner SH. Neonatal polycythemia: I. Early diagnosis and incidence relating to time of sampling. Pediatrics. 1984 Jan 1;73(1):7-10.
  7. Kurlat I, Sola A. Neonatal polycythemia in appropriately grown infants of hypertensive mothers. Acta Pædiatrica. 1992 Sep;81(9):662-4.
  8. Gatti RA, Muster AJ, Cole RB, Paul MH. Neonatal polycythemia with transient cyanosisand cardiorespiratory abnormalities. The Journal of pediatrics. 1966 Dec 1;69(6):1063-72.
  9. Ramamurthy RS, Brans YW. Neonatal polycythemia: I. Criteria for diagnosis and treatment. Pediatrics. 1981 Aug 1;68(2):168-74.
  10. Black VD, Lubchenco LO. Neonatal polycythemia and hyperviscosity. Pediatric Clinics of North America. 1982 Oct 1;29(5):1137-48.
  11. Krishnan L, Rahim A. Neonatal polycythemia. The Indian Journal of Pediatrics. 1997 Jul 1;64(4):541-6.
  12. Villalta IA, Pramanik AK, Diaz-Blanco J, Herbst JJ. Diagnostic errors in neonatal polycythemia based on method of hematocrit determination. The Journal of pediatrics. 1989 Sep 1;115(3):460-2.
  13. Deorari AK, Paul VK, Shreshta L, Singh ME. Symptomatic neonatal polycythemia: comparison of partial exchange transfusion with saline versus plasma. Indian pediatrics. 1995 Nov;32(11):1167-71.
  14. Mimouni F, Tsang RC, Hertzberg VS, Miodovnik M. Polycythemia, hypomagnesemia, and hypocalcemia in infants of diabetic mothers. American Journal of Diseases of Children. 1986 Aug 1;140(8):798-800.
  15. Linderkamp O, Nelle M, Kraus M, Zilow EP. The effect of early and late cord‐clamping on blood viscosity and other hemorheological parameters in full‐term neonates. Acta Paediatrica. 1992 Oct;81(10):745-50.
  16. Supapannachart S, Siripoonya P, Boonwattanasoontorn W, Kanjanavanit S. Neonatal polycythemia: effects of partial exchange transfusion using fresh frozen plasma, Haemaccel and normal saline. Journal of the Medical Association of Thailand= Chotmaihetthangphaet. 1999 Nov;82:S82-6.

Corresponding Author

Dr Rupashree Behera

VSSIMSAR Burla