POLYCYTHEMIA IN A NEWBORN: FROM PLETHORA TO SEPSIS – A CASE REPORT

Abstract

Introduction: Neonatal polycythemia is a hematological condition characterized by an abnormally elevated number of circulating erythrocytes. It is defined by hemoglobin levels exceeding 22 g/dL and hematocrit values of 65% or higher, which represent standardized diagnostic criteria in newborns. This condition poses a significant clinical challenge due to the risk of metabolic disturbances, hyperbilirubinemia, and potential complications affecting vital organs.

Case outline: This paper describes a male infant, born at 38-week of gestation by spontaneous vaginal delivery, initially presenting with plethora and laboratory-confirmed polycythemia (hemoglobin 23.4 g/dL, hematocrit 70%). During the first days of life, intravenous rehydration was administered as a conservative treatment for polycythemia, along with phototherapy for hyperbilirubinemia. On the third day of life, hemoglobin and hematocrit values further increased (Hgb 24.6 g/dL, Hct 74%), accompanied by total bilirubin levels of 281.9 µmol/L. Partial exchange transfusion was considered but withheld due to clinical stability. In the following days, laboratory findings demonstrated gradual correction (Hgb 19.4 g/dL, Hct 65%, total bilirubin 215 µmol/L). On the sixth day of life, the infant developed clinical deterioration with fever, respiratory insufficiency, and septic appearance. Endotracheal intubation, mechanical ventilation, and dual broad-spectrum antimicrobial therapy were initiated. Blood culture revealed Klebsiella pneumoniae, while tracheal aspirate culture identified Enterobacter hormaechei, indicating a nosocomial infection. Therapy was adjusted according to the antibiogram and protocol for late-onset neonatal sepsis. After five days in the neonatal intensive care unit, the infant was transferred to standard care, gradually recovered, and was discharged home on the twentieth day of life.

Conclusion: This case highlights the complex course of neonatal polycythemia, evolving from initial plethora and hyperbilirubinemia to late-onset neonatal sepsis with respiratory insufficiency, classified as a nosocomial infection. Timely monitoring, conservative management, and appropriate treatment of complications contributed to a favorable outcome.