Our approach to the evaluation and management of newborns with polycythemia

This figure summarizes our suggested approach to evaluating and managing neonates with polycythemia. Neonatal polycythemia is defined as a venous hematocrit >65%. If initial testing was performed on a capillary sample, the result should be confirmed with a venous sample. Neonates with confirmed polycythemia should be evaluated for potential causes, including assessing for dehydration (eg, loss of >7% of birth weight within 5 days), reviewing the pregnancy and birth history for any risk factors (preeclampsia, gestational diabetes, precipitous delivery, delayed cord clamping), and assessing the infant for macrosomia and other features suggestive of endocrinopathy (eg, ambiguous genitalia suggestive of congenital adrenal hyperplasia, large fontanels suggestive of congenital hypothyroidism). This algorithm is intended for use in conjunction with additional UpToDate content on neonatal polycytemia. The steps sumarized here represent the management approach at the UpToDate author's institution. Practice may vary at other centers. Refer to UpToDate's topic on neonatal polycytemia for additional details, including a complete list of causes and the evidence supporting these therapies.