Question

A neonate delivered at 38 weeks of gestation with a birth weight of 2.2 kg develops intolerance to feeds on the 2nd day. Physical examination reveals no abnormalities. Sepsis screen is negative and PCV is 70%. What is the next step in management?

• A. IV fluid
• B. Presumptive treatment of sepsis
• C. Exchange transfusion
• D. Repeat sepsis screen

Hint:

A symptomatic SGA neonate with PCV greater than 65 percent needs partial exchange transfusion.

Answer 1

The Correct Option is C

Step 1: Interpret the PCV. A packed cell volume (haematocrit) of 70% indicates polycythemia in a neonate (a central venous haematocrit greater than 65 percent defines polycythemia).
Step 2: Link to the clinical scenario. This is a small-for-gestational-age term infant (38 weeks, 2.2 kg), a classic setting for neonatal polycythemia and hyperviscosity.
Step 3: Recognise the symptom. Feed intolerance is a recognised symptom of hyperviscosity from polycythemia, and the sepsis screen is negative, so infection is not the cause.
Step 4: Apply management. A symptomatic neonate with a venous haematocrit greater than 65 percent (here 70 percent) is treated with partial exchange transfusion to lower the haematocrit and reduce viscosity.
Step 5: Eliminate the others. IV fluid alone does not adequately correct symptomatic polycythemia, antibiotics are not indicated with a negative screen and a non-septic picture, and repeating the sepsis screen does not address the high PCV.
Step 6: The correct answer is exchange transfusion (partial exchange transfusion) (option 3).