PCV 72% in a neonate suggests the diagnosis of neonatal polycythemia. Polycythemia is defined as central venous hematocrit level of greater than 65%. The neonate in question is also having an intolerance to feed and abdominal distension. So, this neonate is having symptomatic neonatal polycythemia.Treatment of neonatal polycythemiaTherapy in newborns with polycythemia is based on both the measured central venous hematocrit level and the presence or absence of symptoms.(1) Symptomatic polycythemiaPartial exchange transfusion is the treatment of choice.(2) Asymptomatic polycythemiaIn asymptomatic polycythemia, treatment depends upon hematocrit level (PCV).(i) PCV 65-75%Perform cardiorespiratory monitoring and monitoring of hematocrit and glucose levels every 6-12 hours and observe the patients for symptoms If hematocrit (PCV) becomes more than 75%, consider partial exchange transfusion (PET).ii) PCV> 75%Partial exchange transfusion (PET) is the treatment of choice.