PEDIATRICS Vol. 83 No. 5 May 1989, pp. 662-667
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Neonatal Hyperviscosity Association With Lower Achievement and IQ Scores at School Age

Virginia Delaney-Black MD1, Bonnie W. Camp PhD, MD1, Lula O. Lubchenco MD1, Carol Swanson MD1, Loretta Roberts MD1, Patricia Gaherty MD1, and Barbara Swanson MD1

1 The Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, and the Department of Pediatrics, University of Colorado Health Sciences Center, Denver

A longitudinal study was conducted to determine whether the early neurologic and motor impairment observed in children with neonatal polycythemia and hyperviscosity persisted into school age. Forty-nine children who had neonatal polycythemia and hyperviscosity were evaluated at a mean age of 7 years. Of these, 21 (group 1) received a partial plasma exchange transfusion, whereas 28 (group 2) received symptomatic care. Forty control children (group 3) with a normal neonatal hematocrit were also evaluated. Testing consisted of a battery of measures to evaluate IQ, achievement, neuromotor function, and gross and fine motor skills. Maternal education and IQ were also assessed to avoid potential confounding by differences in the home environment. The neonatal course of the children with polycythemia and hyperviscosity was characterized by an increased number of problems, including hypoglycemia and cyanosis. At 7 years of age, the 49 children who had hyperviscosity (groups 1 and 2) had significantly lower "spelling" and arithmetic achievement test results and gross motor skill scores. Scores for reading, visual motor integration, and neurologic signs did not differ significantly from group 3. Maternal IQ scores were similar for both groups. Left-hand preference was seen in 14% of group 1 and 2 children and 7% of group 3 children (not significant). The scores for IQ, achievement, neuromotor function, and visual motor integration were compared for the hyperviscosity group (groups 1 and 2) and the control group (group 3) by multivariate analysis of variance with sex and hyperviscous group as independent variables and maternal education and maternal IQ as covariates (P = .040). Univariate F tests were significant for IQ (P = .002), arithmetic achievement (P = .026), and reading achievement (P = .034). Two of group 1, and 5 of 28 group 2 children were left-handed (not significant). Better left-hand skills were shown in the fine motor scores for group 1, however (P < .02). Additionally, although both groups were examined at a comparable age, the school grade achieved by group 1 was significantly higher (P < .005). These results suggest that the sequelae associated with neonatal polycythemia and hyperviscosity, although subtle, persist into school age. The etiology of these abnormalities is not clear. The small differences previously observed between the group that received an exchange transfusion and the group that did not persisted.

Key Words: polycythemia • hematocrit • hyperviscosity • partial plasma exchange transfusion

Submitted on April 4, 1988
Accepted on June 10, 1988




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