The etiology of neonatal hyperviscosity syndrome include increased intrauterine erythropoiesis and placental hypertransfusion (Table 4.26). Increased intrauterine erythropoiesis may be caused by placental insufficiency in infants small or large for gestational age, by postmaturity, by toxemia of pregnancy, and by placenta previa.
It may also be caused by metabolic disorders such as congenital adrenal hyperplasia or neonatal thyrotoxicosis, by endocrine disorders such as maternal diabetes, hypoglycemia, or hypocalcemia, by chromosomal abnormalities such as Down syndrome, or by drugs such as during maternal propranolol therapy.
Placental hypertransfusion, the most common cause, may result from delayed cord clamping, cord milking, holding the newborn below the level of the placenta while the cord is pulsating, and the administration of oxytocic drugs. It may also result from twin-to-twin transfusion, causing polycythemia in one and anemia in the other.
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