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by Jones P

Definition

Anemia is a low level of red blood cells (RBCs). These cells pick up oxygen in the lungs and bring it to the rest of the body. Low levels make it hard for the body to get enough oxygen.

Anemia of prematurity is when this problem happens in babies who are born too early.

Hemoglobin
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Causes

Anemia of prematurity may be caused by one or more of the these problems:

  • Loss of blood due to:
    • Problems during labor and birth
    • Removal of blood for testing—regular blood tests are needed to monitor the health of babies born too early
  • Low production of RBCs due to:
    • Nutrition problems
    • Infections such as rubella or parvovirus that affect the bone marrow where RBCs are made
  • Destruction of RBCs from health problems like:
    • Incompatibility between mother’s and baby’s blood— Rh incompatibility
    • Hereditary disorders

Risk Factors

Infants are likely to get anemia because:

  • Fewer RBCs are made in newborns right after birth
  • Blood volume cannot keep up with a baby’s growth
  • RBCs have a shorter lifespan in infants

Things that may raise the risk of this problem are:

  • Family history of anemia
  • Problems during delivery
  • Blood loss during birth
  • An illness that requires a lot of blood work
  • Being a twin with twin-to-twin transfusion
  • Poor diet that is low in iron, vitamin B6, or B12 in:
    • Mother during pregnancy
    • Infant after birth

Symptoms

Mild anemia may have no symptoms. Moderate or severe anemia may cause:

  • Pale skin
  • Low activity level
  • Fast or difficult breathing
  • Problems feeding
  • Fast heart rate
  • Slow weight gain
  • Periods when breathing stops

Diagnosis

You will be asked about your baby’s symptoms and health history. A physical exam will be done.

Your baby's blood will be tested. This can be done with blood tests.

A diagnosis will be made based on the blood test. The test results may also help find the cause of the anemia.

Treatment

Treatment will depend on the cause of anemia. Mild anemia may be monitored with blood tests. As little blood as possible will be taken to keep the anemia from getting worse.

Treatment options are:

Better Nutrition

Nutrition can help with recovery by helping the body make more RBCs.

Iron is important in making RBCs. Some babies may be given supplemental iron.

Blood Transfusion

Some babies with severe problems may need treatment right away. A blood transfusion can quickly raise the level of RBCs. It may need to be done more than one time.

Prevention

To lower a child’s chance of getting anemia of prematurity:

  • Get proper prenatal care throughout pregnancy.
  • Mothers should take steps to prevent premature birth:
    • Avoid alcohol, smoking, and drugs.
    • Eat a healthy, balanced diet with plenty of fruits and vegetables.
    • Manage chronic health problems.
  • Provide proper nutrition to babies.

RESOURCES

Healthy Children—American Academy of Pediatrics  http://www.healthychildren.org 

Kids Health—Nemours Foundation  http://kidshealth.org 

CANADIAN RESOURCES

Health Canada  https://www.canada.ca 

The Society of Obstetricians and Gynaecologists of Canada  http://www.sogc.org 

References

Treatment of other conditions in premature babies. The Hospital for Sick Children website. Available at: http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/OverviewofTreatment/TreatmentofOtherConditions/Pages/Treatment-of-Anemia-of-Prematurity.aspx. Updated October 31, 2009. Accessed December 31, 2019.

Evaluation and management of the premature infant. EBSCO DynaMed website. Available at:  https://www.dynamed.com/management/evaluation-and-management-of-the-premature-infant  . Updated December 4, 2019. Accessed December 31, 2019.

Gauer RL, Burket J, et al. Common questions about outpatient care of premature infants. Am Fam Physician. 2014 Aug 15;90(4):244-251.

Neonatal Anemia. UCSF Children’s Hospital website. Available at: http://www.ucsfbenioffchildrens.org/pdf/manuals/37%5FAnemia.pdf. Published 2004. Accessed December 31, 2019.

Trachtenbarg D, Golemon T. Office Care of the Premature Infant: Part II. Common Medical and Surgical Problems. Am Fam Physician. 1998 May 15;57(10):2383-2390. Available at: http://www.aafp.org/afp/1998/0515/p2383.html. Accessed December 31, 2019.

Revision Information

  • Reviewer: EBSCO Medical Review Board Kari Kassir, MD
  • Review Date: 09/2019
  • Update Date: 12/31/2019