Neonatal polycythemia: is partial exchange transfusion justified?

In clinical practice, neonatal polycythemia has been used as a marker for neonatal hyperviscosity, implicated as a cause of long-term neurologic delay and damage in the growing child. Clinicians have focused on the newborn infant's hematocrit (Hct) level as the criterion for therapeutic intervention. Partial exchange transfusion is traditionally used as the method to lower the Hct and treat hyperviscosity; however, it is unclear whether this is an effective approach in preventing the long-term neurologic consequences. This article re-evaluates this clinical approach to the diagnosis and treatment of neonatal polycythemia and suggests that this controversial therapy needs re-evaluation.