Partial plasma exchange transfusion(XT) has been recommended as the treatment of choice in neonatal hyperviscosity although there remains no statistical proof that it prevents long-term CNS or other sequelae.
In order to study the long-term effect of XT, 24 infants found to have hyperviscosity of whole blood were assigned randomly to receive XT within 12 hrs of birth or to receive only supportive treatment. Twelve infants received XT with fresh frozen plasma while the other 12 received no XT. Gestational ages ranged between 36 and 40 weeks (x=37.6); all infants were appropriate-for-gestational age. All infants were seen in follow-up at 8 months of age at which time Bayley Scales of Infant Development were administered.
Infants in the XT group had higher scores than the non-XT group for both mental(MDI) and motor(PDI) indices (XT group: 111 and 105, non-XT: 96 and 93). The differences were not statistically significant for either index, but approached significance for the MDI(p<0.1; >.05).
Neuromuscular development also was assessed at 8 months by a physical therapist. One infant in the non-XT group was found to have a hemiparesis for which no cause other than the hyperviscosity could be identified.
Absolute benefit for partial plasma exchange transfusion in the treatment of neonatal hyperviscosity cannot be claimed from this study but therapeutic benefit is suggested.
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Hakanson, D., Oski, F. 58 NEONATAL HYPERVISCOSITY SYNDROME: LONG-TERM BENEFIT OF PARTIAL PLASMA EXCHANGE TRANSFUSION. Pediatr Res 15, 449 (1981). https://doi.org/10.1203/00006450-198104001-00067