A neonate delivered at 38 weeks of gestation with a birth weight of 2.2 kg develops intolerance to feed/abdominal distension on the second day. Physical examination is unremarkable. Sepsis screen is negative. PCV is observed to be 72%. Which of the following represents the best management option –
PCV 72% in a neonate suggests the diagnosis of neonatal polycythemia.
Polycythemia is defined as central venous hematocrit  level of greater than 65%.
The neonate in question is also having an intolerance to feed and abdominal distension.
So, this neonate is having symptomatic neonatal polycythemia.

Treatment of neonatal polycythemia

Therapy in newborns with polycythemia is based on both the measured central venous hematocrit level and the presence or absence of symptoms.

(1) Symptomatic polycythemia

Partial exchange transfusion is the treatment of choice.

(2) Asymptomatic polycythemia

In asymptomatic polycythemia, treatment depends upon hematocrit level (PCV).

(i) PCV 65-75%

Perform cardiorespiratory monitoring and monitoring of hematocrit and glucose levels every 6-12 hours and observe the patients for symptoms
If hematocrit (PCV) becomes more than 75%, consider partial exchange transfusion (PET).

ii) PCV> 75%

Partial exchange transfusion (PET) is the treatment of choice.
Hydration with IV Fluids
Partial Exchange Transfusion
Presumptive treatment for sepsis
Medical Management for intestinal obstruction