Effects of partial plasma exchange transfusion on cerebral blood flow velocity in polycythaemic preterm,term and small for date newborn infants

Isovolemic haemodilution with plasma was performed in 36 newborn infants with polycythaemia 3 h after birth. Continuous wave Doppler ultrasonography was used to study the short and longer term influence of partial plasma exchange transfusion on cerebral blood flow velocity in both the anterior cerebral and mid cerebral arterial system up to 24 h after haemodilution. The study group consisted of 11 preterm infants, 12 term infants, and 13 small for date infants. After exchange transfusion peripheral venous haemotocrit decreased from 72.5% to 59.4%. In all experimental groups cerebral blood flow velocity (CBFV) before exchange transfution was significantly lower (18%–44%) than matched controls, and increased to control levels after exchange transfusion. CBFV improved most in preterm infants. After the transfusion the values were no different from the age-, weight-, sex-and parity-matched control groups, and they remained at this level during the next 24 h. No differences could be found between the anterior and mid-cerebral arterial system. When clinical symptoms were present, they subsided in all infants. In conclusion, partial plasma exchange transfusion has a favourable effect for at least 24 h on cerebral blood flow velocity in newborn infants with polycythaemia.Abbreviations AUC area under the curve (mean flow velocity) - CBFV cerebral blood flow velocity - EDFV end diastolic flow velocity - Hct haematocrit - PI pulsatility index according to Pourcelot - PRET partial plasma exchange transfusion - PSFV peak systolic flow velocity