***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The study of the developmental outcome of neonatal polycythemia was performed on 47 polycythemic and 21 controlled infants who were born at the same period of time . It was found that at the age of 1 1/2 to 2 years the number of infants with abnormal DQ was higher in the group of total polycythemic infants ( 47 % ) and in the group of asymptomatic polycythemic infants ( 45 % ) than that of the control groups ( 19 % and 5.6 % of the groups including twin sibs and excluding twin sibs respectively ) . There was no difference in the developmental test between the symptomatic and asymptomatic patients . In asymptomatic infants the benefit of partial plasma exchange transfusion on developmental outcome was not found and only low birthweight and small for gestational age infants are the risk factors for poor developmental outcome To determine the effect of partial plasma exchange transfusion , 20 newborn infants with neonatal hyperviscosity were r and omly assigned to observation or treatment with partial plasma exchange transfusion within the first eight hours after birth . They were studied for organ involvement by roentgenogram , blood count , coagulation studies , and neurologic behavior and were followed up using the Brazelton Neonatal Behavior Assessment scale at 8 , 24 , and 72 hours and 2 weeks of age ; in addition , ten control infants without hyperviscosity of similar birth weights and gestational ages were also studied . Exchange transfusion improved blood viscosity but both hyperviscous groups showed a higher proportion of abnormal results than did the control subjects . Infants receiving exchange transfusions subsequently improved during the period from 8 hours to 2 to 3 weeks of age , until they were indistinguishable from the control subjects . Neurologic improvement in hyperviscous infants who had not received exchange transfusions were significantly slower during this period . At 8 months of age , abnormal neurologic and developmental findings were impressive in both groups ; no significant differences in neurologic abnormalities were noted at that time . Developmental delays , tremors , spastic diplegia , and monoparesis were found in four of six untreated infants and five of ten infants who had received exchange transfusions . A fine tremor was present in one control child A prospect i ve study to evaluate efficacy and safety of partial exchange blood transfusion ( PEBT ) with normal saline or plasma was conducted in 30 symptomatic polycythemic newborns . Babies were r and omly assigned to receive PEBT either with normal saline or plasma . Both groups were comparable in terms of birth weight , gestational age , preexchange hematocrit and viscosity . A significant fall in hematocrit and viscosity was noticed at 6 hours following PEBT which persisted even at 24 hours ( P < 0.001 ) . Hematocrit and viscosity were comparable in the two groups at 6 and 24 hours ( p > 0.05 for both ) . Majority of babies became asymptomatic after 24 hours of PEBT , but one baby in the saline group remained polycythemic and symptomatic requiring repeat PEBT . No complications related to the procedure were encountered in the two groups . Partial exchange with normal saline was as effective and safe as plasma in symptomatic polycythemic newborns The use of partial plasma exchange transfusion in newborns with polycythemia and hyperviscosity was evaluated . Ninety-three infants with polycythemia and hyperviscosity were r and omly assigned to receive either partial plasma exchange transfusion or symptomatic treatment ; the infants were matched with control infants without polycythemia . Neonatal course and outcome at 1 and 2 years were evaluated for each of the three groups . Polycythemic infants had more fine motor and speech problems at 1 year of age than did control infants . At 2 years of age , polycythemic infants had more gross motor delays , neurologic diagnoses , fine motor abnormalities , and speech delays than did the control infants . There was no significant difference at 1 year between the polycythemic infants who had received partial plasma exchange transfusion and those given only symptomatic care . At 2 years , the group receiving partial plasma exchange transfusion had fewer neurologic diagnoses and fine motor abnormalities This r and omized controlled trial was conducted to determine the effect of partial exchange transfusion in polycythemic babies . Forty five asymptomatic polycythemic babies with birth weight < or = 2000 g were included and r and omly assigned to undergo either partial exchange transfusion using isotonic saline within 4 hours of screening or routine medical management . Outcome measures were neonatal morbidity ( especially hypoglycemia and neurological alterations ) and mortality ; developmental delays using DDST-II , neurological deficits , tone and DTR abnormalities over 18 months follow up period . The overall neonatal morbidity in this study was low and comparable in the two groups . Some of the polycythemic babies in the non-exchanged group found initially at 3 months age with " suspected development " grew out of their developmental delay at 18 months of age or later while those who underwent exchange transfusion and with retarded development at 3 months of age remained so even at 18 months of age We determined the cerebral hemodynamic changes in infants with asymptomatic polycythemic hyperviscosity syndrome and whether treatment with partial plasma exchange transfusion ( PPET )  would affect hemodynamics as well as outcome . From a routine cord blood hematocrit screening , 71 babies were identified as needing to be tested for polycythemic hyperviscosity . In addition to clinical evaluation , each infant had radial artery hematocrit and viscosity determinations , blood gas determinations , cerebral blood flow velocity studies , cranial ultrasonography , and noninvasive intracranial pressure determination .  Babies with symptomatic hyperviscosity ( n = 17 ) were treated by PPET , whereas those with asymptomatic hyperviscosity ( n = 28 ) were r and omly selected to have PPET ( n = 14 ) or to be observed ( n = 14 ) . The remaining babies ( n = 26 ) with normal viscosity served as control subjects . Both hematocrit and viscosity decreased after PPET but remained unchanged in babies with hyperviscosity who were merely observed . Reversal of cerebral blood flow velocity abnormalities was observed after PPET in the infants with symptomatic hyperviscosity , whereas those who had no symptoms had normal results on Doppler studies at the outset , and no significant changes occurred with either PPET or observation . There were two deaths in the group with symptoms . A total of 46 babies returned for follow-up evaluation at a mean age of 30 + /- 7.7 months . Outcome of the control group was no better than that of those who had hyperviscosity , and outcomes did not differ between the babies with symptomatic and those with asymptomatic hyperviscosity , nor between those treated with PPET and those who were only observed . Multivariate analysis revealed that other perinatal risk factors and race rather than polycythemia or PPET , significantly influenced long-term outcome BACKGROUND Neonatal polycythemia remains a significant clinical problem in Thail and .  Partial exchanges transfusion ( PET ) with fresh frozen plasma ( FFP ) has been the mainstay of management for this condition in Thail and . Since FFP is difficult to find in certain areas and can cause concerns of transfusion related diseases , this study was undertaken to investigate the possibility of using plasma substitute and normal saline ( NSS ) for PET in the newborn infant with polycythemia . OBJECTIVE 1 . To compare the rate and duration of decrease of venous hematocrit ( Hct ) before and after PET with FFP , Haemaccel and NSS . 2 . To compare any complications from using FFP , Haemaccel and NSS such as coagulation defect , electrolytes change , etc . in PET . METHODS AND SUBJECTS A r and omized prospect i ve trial was conducted in Neonatal Unit , Department of Pediatrics , Ramathibodi Hospital . The first phase of study : July 1 , 1993 to June 30 , 1994 : r and omized prospect i ve trial using FFP or Haemaccel for PET in 26 newborn infants with polycythemia . The second phase of study : July 1 , 1994 to June 30 , 1995 : consecutive enrollment trial using NSS for PET in 38 consecutive newborn infants with polycythemia . RESULTS There was significant decrease in Hct in both groups after PET but there was no statistically significant difference in the rate of decrease of Hct . There was no significant difference in biochemical profiles in both groups of infants 24 hours after PET . In the NSS group , there was significant decrease of Hct level after PET . There was no significant change of biochemical profiles and coagulation activity in these patients 24 hours after exchange transfusion . There were 2 patients with complications related to umbilical venous catheter and PET . CONCLUSION Haemaccel and NSS can be safely used for PET to treat neonatal polycythemia . However , the attending physician should be aware of possible complications related to umbilical venous catheterization and PET The neurologic outcome of 23 seven-year old children who had cord blood hyperviscosity was compared with that of children with normal cord blood viscosity in a r and omised , controlled and blinded study . Viscosity was measured using a coaxial narrow-gap couette viscometer . Sixteen ( 69.6 % ) of the children with hyperviscous cord blood had a disability ; this incidence being three times greater ( 22.7 % ) than in children whose cord blood was not hyperviscous ( P < 0.01 ) . In three children with cord-blood hyperviscosity , the disability was severe . No child had a severe disability with normal cord blood viscosity . Of the eight children whose cord blood was hyperviscous , but not polycythemic , six ( 75.0 % ) had a disability and in one child the disability was severe . These results demonstrate an association between cord blood hyperviscosity and later neurologic development . Cord studies are non-invasive and result in the rapid diagnosis of the neonatal hyperviscosity syndrome , so allowing earlier treatment . This may be crucial in altering the effects of hyperviscosity on the developing brain in the early neonatal period . Because the neurologic outcome of children was similar whether polycythemia was present or not , the prime factor was the viscosity and not the hematocrit level . We suggest it may be necessary to perform cord blood viscosity studies routinely We tested whether crystalliod solutions could be used instead of colloid solutions for  partial exchange transfusions ( PET ) in polycythaemic neonates because crystalloid solutions are cheap , carry no risk of anaphylactic reactions and can be sterilized . We r and omly assigned 20 term neonates with venous haematocrit (Hct)>0.65 l/l to PET  with either a serum preparation ( BISEKO ) or Ringer solution .  Plasma volume ( PV ) was measured with Evans blue dilution . Blood volume ( BV ) and red cell mass were calculated from PV and venous Hct . Before PET both serum and Ringer groups had the same Hct ( 0.69 ( 0.66–0.76 ) vs 0.69 ( 0.66–0.71 ) l/l ; median ( range ) ) and BV ( 108 ( 81–116 ) versus 96 ( 68–121 ) ml/kg . During PET an equivalent amount of blood was withdrawn stepwise ( 19 ( 14–26 ) versus 17 ( 13–25 ) ml/kg and replaced by either serum or Ringer solution . More of the Ringer solution ( median 77 % ) than of the serum ( median 36 % ) given left the intravascular space within 4 h after PET ( P=0.016 ) ; but there was no signficant difference in Hct after Ringer-PET compared to serum-PET ( median 0.58 vs 0.56 l/l ) . No infant required repeat PET . Ringer-PET  reduced BV from high to normal values ( from median 96 to 83 ml/kg;P=0.005 ) , whereas after serum-PET BV remained high ( from median 108 to 98 ml/kg ; not significant ) . Conclusion PET with Ringer solution result ed in a haemodilution comparable to PET with serum and a correction of hypervolaemia AIM To compare the efficacy of using isotonic saline ( crystalloid ) or 5 % albumin ( colloid ) as replacement fluid in partial exchange transfusion ( PET ) for the treatment of neonatal polycythaemia . METHODS One hundred and two polycythaemic full term infants were r and omly allocated to receive PET with either isotonic saline or 5 % albumin . The criteria for PET were : ( a ) venous haematocrit ⩾ 0.7 ; or ( b ) venous haematocrit 0.65 - 0.69 with symptoms or signs attributable to polycythaemia .  RESULTS PET with either saline ( n=53 ) or 5 % albumin ( n=50 ) result ed in a significant and sustained decline in haematocrit up to 24 hours after PET . Although the immediate haemodilution effect of isotonic saline was statistically smaller than that of 5 % albumin ( decline in haematocrit 19.3 % vs22.8 % of pre-PET value ) , the difference was too small to be of any clinical significance , and the haematocrit at 4 or 24 hours after PET did not differ significantly between the two groups . PET with either replacement fluid was not associated with any complication . The serum sodium and potassium concentrations were not significantly affected by the PET in either group . CONCLUSIONS 
    Output:
    
There are no proven clinical ly significant short or long-term benefits of PET in polycythemic newborn infants who are clinical ly well or who have minor symptoms related to hyperviscosity .
PET may lead to an increase in the risk of NEC .