Anemia of newborn can occur due to physiologic causes as red blood cell production declines and blood volume increases in the first few months of life, or due to pathological causes like hemolytic disease or prematurity. Premature infants are particularly at risk of anemia of prematurity, which can cause poor growth, breathing issues, and lethargy. Treatment may involve blood transfusions, erythropoietin, or ensuring adequate nutrition to support red blood cell production.
10. Physiologic Anemia of the Newborn
• At one week postnatal all RBC indices begin declining to a
minimum value reached at about 2 months of age.
– decreased RBC production
– plasma dilution associated with increasing blood volume
– shorter life span on neonatal RBCs (50-70 days)
– more fragile RBCs
– switch from HbF to HbA
• HbF decreases about 3% per week
• at 6 mo. HbF represents only 2% of total Hb
• switch to HbA provides for greater unloading of oxygen to tissues d/t
lower oxygen affinity of HbA relative to HbF.
– seldom produces symptoms
– not altered by nutritional supplements
11. Anemia at Birth
• Etiology: usually caused by congenital
hemolytic disease of the newborn.
• Other causes include:
– bleeding from umbilical cord
– internal hemorrhage
12.
13. Anemia of Prematurity
• Occurs in low birth weight infants w/ poor
erythropoietin response
– Protein content of breast milk may not be sufficient for
hematopoiesis in the premature infant.
– Hb level rapidly declines after birth to a low of 7-10 g/dl at
6 weeks of age.
– Signs and Symptoms
• apnea
• poor weight gain
• pallor
• decreased activity
• tachycardia
14. Background
• Anemia of prematurity (AOP) is an exaggerated, pathologic
response of the preterm infant. AOP is a normocytic,
normochromic anemia characterized by low serum EPO levels.
• Nutritional deficiencies of iron, vitamin E, vitamin B-12, and
folate may exaggerate the degree of anemia, as may blood
loss and/or a reduced red cell life span.
• The risk of anemia of prematurity (AOP) is inversely related to
gestational maturity and birthweight. As many as half of
infants of less than 32 weeks gestation develop AOP.
15. Etiology
• Three basic mechanisms for the development
of anemia of prematurity (AOP) include:
– inadequate RBC production
– shortened RBC life span
– blood loss.
16. Presentation
• Many clinical findings have been attributed to anemia of
prematurity (AOP), but they are neither specific nor
diagnostic. These symptoms may include the following:
– Poor weight gain despite adequate caloric intake
– Cardiorespiratory symptoms such as tachycardia, tachypnea, and flow
murmurs
– Decreased activity, lethargy, and difficulty with oral feeding
– Pallor
– Increase in apneic and bradycardic episodes, and worsened periodic
breathing
– Metabolic acidemia - Increased lactic acid secondary to increased
cellular anaerobic metabolism in relatively hypoxic tissues
18. Observation
• Observation may be the best course of action for
infants who are asymptomatic, not acutely ill, and
are receiving adequate nutrition.
• Adequate amounts of vitamin E, vitamin B-12, folate,
and iron are important to blunt the expected decline
in hemoglobin levels in the premature infant.
• Periodic measurements of the hematocrit level in
infants with AOP are necessary.
20. New Transfusion Guidelines
March 2010
Transfusion Threshold Clinical Situation
Hgb 10g/dL Critically ill neonate,
ventilated or significant
pressor support
Hgb 8g/dL Infant on stable respiratory
support (CPAP/stable vent,
HFHNC for CPAP effect, or
NC
Hgb ≤7g/dL Infant requiring no
support
