Snapshot A 2-day-old newborn presents with cyanosis and irritability. His mother had gestational diabetes, which resulted in a difficult delivery due to the baby’s large size. Delivery was further complicated by delayed clamping of the umbilical cord. On physical exam, the patient has plethora and ruddiness of his face. Heelstick hematocrit was found to be 71%. Venous sampling of hematocrit was found to be 68%. Introduction Venoushematocrit exceeding normal values for gestational and postnatal age login to view 1 more bullet Most babies are asymptomatic Distinct from adult polycythemia vera, a myeloproliferative neoplastic disorder EPIDEMIOLOGY Risk factors login to view 8 more bullets Hyperviscosity thought to play a role in symptoms, if any Presentation Majority are asymptomatic Symptoms/physical exam login to view 8 more bullets studies Venous hematocrit > 65% Glucose for hypoglycemia Bilirubin level login to view 1 more bullet Observe closely for neurologic and cardiovascularsymptoms login to view 1 more bullet Differential Other causes of polycythemia vera login to view 1 more bullet Treatment Asymptomatic login to view 2 more bullets Symptomatic login to view 6 more bullets Complications Hypoglycemia Prognosis Unclear effect on long-term outcome