Question:medium
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 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?
Show Hint
A symptomatic SGA neonate with PCV greater than 65 percent needs partial exchange transfusion.
Updated On: Jun 24, 2026
- IV fluid
- Presumptive treatment of sepsis
- Exchange transfusion
- Repeat sepsis screen
Show Solution
The Correct Option is C
Solution and Explanation
The number to anchor on is the PCV of 70 percent. In a newborn a central haematocrit above 65 percent means polycythemia, so this baby is frankly polycythemic.
The setting reinforces this: a term infant weighing only 2.2 kg is small for gestational age, and growth-restricted babies are prone to polycythemia. When the blood becomes too thick, it leads to hyperviscosity, and one of its manifestations is poor feeding or feed intolerance, which is exactly what appeared on day two.
Because the sepsis workup is negative and the examination is otherwise normal, infection is effectively ruled out, so the feeding problem is being driven by the high haematocrit rather than by sepsis.
The definitive treatment for a symptomatic neonate whose haematocrit exceeds 65 percent is a partial exchange transfusion, which replaces some blood with fluid to bring the haematocrit down and relieve the hyperviscosity. Giving only IV fluid is insufficient, starting antibiotics is unjustified with a negative screen, and repeating the sepsis screen ignores the obvious abnormality.
Therefore the next step is exchange transfusion.
\[\boxed{\text{Exchange transfusion}}\]
The setting reinforces this: a term infant weighing only 2.2 kg is small for gestational age, and growth-restricted babies are prone to polycythemia. When the blood becomes too thick, it leads to hyperviscosity, and one of its manifestations is poor feeding or feed intolerance, which is exactly what appeared on day two.
Because the sepsis workup is negative and the examination is otherwise normal, infection is effectively ruled out, so the feeding problem is being driven by the high haematocrit rather than by sepsis.
The definitive treatment for a symptomatic neonate whose haematocrit exceeds 65 percent is a partial exchange transfusion, which replaces some blood with fluid to bring the haematocrit down and relieve the hyperviscosity. Giving only IV fluid is insufficient, starting antibiotics is unjustified with a negative screen, and repeating the sepsis screen ignores the obvious abnormality.
Therefore the next step is exchange transfusion.
\[\boxed{\text{Exchange transfusion}}\]
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