Yenidoğan Polisitemisinin Gebelik Yaşı, Hematokrit ve Trombosit Düzeyleri Açısından Değerlendirilmesi

Amaç: Yenidoğan polisitemisinde esas sorun hiperviskoziteye bağlı komplikasyonlardır. Bu çalışmanın amacı polisitemik yenidoğanların semptomlarını, klinik ve laboratuvar özelliklerini ve organ işlev bozukluklarını; gestasyonel yaş, hematokrit (hct) düzeyleri ve trombositopeni varlığı açısından değerlendirmektir. Gereç ve Yöntemler: Ocak 2013 ile Aralık 2016 tarihleri arasında, hastanede yatan gestasyonel yaşı≥34 hafta olan tüm yenidoğanlar geriye dönük olarak değerlendirildi. Venöz hct değerleri %65’in üzerinde olan yenidoğanlar çalışmaya dahil edildi. Enfeksiyon, metabolik hastalık ve konjenital anomalileri olan yenidoğanlar çalışma dışı bırakıldı. Yenidoğanlar hct değerlerine (Orta derece polisitemi [%65-69] ve Şiddetli derece polisitemi [≥%70]), gestasyonel yaşa göre (geç preterm/ term) ve trombositopeni durumuna (var/yok) göre gruplandırıldı ve karşılaştırıldı. Bulgular: Çalışma grubunda polisitemi insidansı %7.7 olarak saptandı. En sık görülen semptomlar hipoglisemi ve hiperbilirubinemi iken, yenidoğanların %35.1’i asemptomatikti. Hipoglisemi, hipokalsemi ve pletore şiddetli polisitemi grubunda orta polisitemi grubuna göre anlamlı olarak daha sıktı (sırasıyla p= 0.027, p= 0.014, p< 0.001). Hiperbilirubinemi, geç preterm bebeklerde term olanlara göre daha sıktı (p= 0.014). Trombositopenisi olan yenidoğanlarda, beslenme güçlüğü, konvülziyon, hipoglisemi, karaciğer fonksiyon testleri anormallikleri, trombositopenik olmayanlara göre anlamlı olarak daha fazlaydı (sırasıyla p= 0.002, p = 0.004, p < 0.001, p = 0.022, p = 0.043). Sonuç: Polisitemik yenidoğanların asemptomatik olabileceği akılda tutulmalıdır. En sık görülen semptomlar hipoglisemi ve hiperbilirubinemi iken, karaciğer onksiyon testleri de polisitemik yenidoğanlarda etkilenebilir.

Anahtar Kelimeler:

hematokrit, hiperviskozite, geç preterm, yenidoğan, trombositopeni

Evaluation of Neonatal Polycythemia in Terms of Gestational Age, Hematocrit, and Platelet Levels

Objective: The main concern in neonatal polycythemia is complication development due to hyperviscosity. We aimed to compare symptoms, clinical and laboratory features, and organ dysfunctions of polycythemic newborns with respect to gestational age, hematocrit (hct) levels and presence of thrombocytopenia. Material and Methods: Between January 2013 and December 2016, all hospitalized newborns with a gestational age of ≥ 34 weeks were retrospectively evaluated and those with a venous hct value exceeding 65% were included. Exclusion criteria were infections, metabolic diseases and congenital anomalies. Newborns were grouped and compared according to hct values (65–69.9% vs. ≥70%), gestational age (late preterm vs. term) and thrombocytopenia (present/ absent). Results: Polycythemia incidence was 7.7% in the study group. The most common symptoms were hypoglycemia and hyperbilirubinemia, while 35.1% of newborns were asymptomatic. Hypoglycemia, hypocalcemia, and plethora were significantly more frequent in the severe polycythemia (hct ≥70%) group than in the moderate polycythemia (hct between 65–69.9%) group (p = 0.027, p = 0.014, p < 0.001, respectively). Hyperbilirubinemia was more common in late preterm babies than term babies (p = 0.014). Feeding difficulty, convulsion, hypoglycemia, hypocalcemia and liver function test abnormalities were significantly more common in newborns with thrombocytopenia than those without (p = 0.002, p = 0.004, p < 0.001, p = 0.022, p = 0.043, respectively). Conclusion: It should be kept in mind that more than one-third of polycythemic newborns may be asymptomatic. While the most common symptoms were hypoglycemia and hyperbilirubinemia, liver function tests may also be adversely affected.

Keywords:

Hematocrit, hyperviscosity, late preterm, newborn, thrombocytopenia,

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