Anemia of Newborn Infant - An Overview

Introduction:

The bone marrow in an infant produces few new red blood cells between birth and three weeks of age, making a steady drop in the red blood cell count, all this over the first couple of months of life (called physiologic anemia). Red blood cells get destroyed before time; anemia develops, and levels of bilirubin (end product of red blood cells) increase, resulting in jaundice where the newborn’s skin and the whites of the eyes can appear yellow. When a copious amount of blood is removed very rapidly, the newborn becomes seriously ill and develops shock, appears pale, has a rapid heart rate, and has low blood pressure along with rapid, shallow breathing. If there is less severe blood loss or a gradual loss of blood, the newborn may appear normal, but the skin will be paler.

What Is Anemia in Newborns?

Babies who have anemia at the very beginning of their life have a condition where they have less red blood cell count (below average), making their iron-binding capacity weaker and less oxygen circulation in the body.

What Are the Levels of Hemoglobin During and After Birth?

At birth, the hemoglobin levels are 14.9 g/dl-23.7 g/dl in term and 19.1 g/dl-22.1 g/dl in preterm babies. It decreases rapidly to 9.5-11 g/dl by nine to eleven weeks in term babies and 6.5-9 g/dl by four to eight weeks in preterm babies.

What Are the Causes for Anemia in Newborns?

A newborn can easily attain anemia. Some of the reasons include:

• The Baby’s Body Incapable of Producing Enough Red Blood Cells - Most babies are seen with anemia in the initial months of their life, known as physiologic anemia. The baby's body is growing rapidly, but red blood cell generation is slow and steady, hence the anemia. This is corrected as the production of RBCs catches up.

• The Body Losses Red Blood Cells Before Time - This happens when the mother’s and baby’s blood types do not match. This is called Rh/ABO incompatibility. These babies usually develop jaundice (hyperbilirubinemia-skin turns yellow). For some babies, anemia can result from infections or genetic (inherited) diseases.

• The Baby Loses Too Much Blood - Occurs as a result of frequent requirements for a blood test. These tests are needed to manage your baby’s condition. The blood, unfortunately, is not able to generate quickly, which causes anemia.

• The Baby Is Born Prematurely - Babies who are born premature (earlier than term) are deficient in red blood cells. Plus, these cells die prematurely, resulting in anemia or prematurity.

• The Influence of Cord Clamping - Important factors that affect hemoglobin levels at birth are the timing of the umbilical cord clamp and the position of the baby in the clamp.

  1. In term babies, the placental contains around 100 ml of potent blood at birth. It has been recorded that about 25 % of the placental blood is transferred within the first 10 to 15 seconds and 50% (equivalent to 50 ml in a term baby) in about the last 45 seconds.
  2. The difference is about 3g/dl of hemoglobin concentration in the baby between early and late cord clamping. Babies who are held below the level of the placenta receive placental blood until the cord is clamped and tend to have higher hemoglobin levels. And babies who are held above the level of the placenta lose blood into the placenta until the cord is clamped.

• Other Causes - Include internal bleeding and the blood transfusion between the baby and the mother while she was still caring for the fetus.

What Are the Symptoms Seen in Newborns Suffering From Anemia?

Symptoms can include:

• Having lighter skin.

• Having low energy.

• Getting tired and decreased feeding.

• Rapid resting heart rate and rapid breathing.

How Is Anemia in Newborns Diagnosed?

• A detailed medical history, including records of prenatal sociological reports, provides a great deal of information. Twin blood transfusions are easily diagnosed before birth. Details of labor, presentation, instrumental delivery, birth injury, cord accidents, and other details should be collected.

• Family history of anemia, cholelithiasis, splenectomy, and unexplained jaundice may point towards possible hemolytic anemia. All medication for the baby should be prescribed by a specialist doctor.

Anemia is diagnosed via blood test (CBC). Tests include:

• Hemoglobin - The iron-binding capacity in red blood cells that carries oxygen.

• Hematocrit - The percentage of blood that forms red blood cells.

• Reticulocytes - It estimates the immature red blood cells found in the given blood samples for further production of new RBCs.

Hemoglobin measuring less than 12 to 14 gms % seen in the first week after birth causes anemia in the newborn.

How Is Anemia in Newborns Treated?

The healthcare evaluates all data collected and only then comprehends a treatment plan that would be best for the baby. Premature babies or the ones who are getting sicker may require a blood transfusion to match the required number of red blood cells in the body. Most anemic babies are treated with medicine to help their bodies generate more red blood cells because the production of RBCs does not match the requirement. The right diet will also help the baby make red blood cells.

• Erythropoietin - (rHuEPO)- Many studies have shown that preterms treated with rHuEPO will require fewer transfusions. Although rHuEPO cannot help with the number of transfusions essential for preterm babies in early neonatal life, the future requirements of transfusions can be reduced significantly.

Conclusion:

During and after birth, all infants experience a downfall in hemoglobin (Hb) that causes them some form of anemia. The severity and longevity with which this anemia develops depend on the combination of multiple physiologic and non-physiologic processes. Preterm infants are more prone to such processes, as the severity of the developing postnatal loss in Hb is mostly seen with the least mature infants, placing them at a higher risk of developing serious anemias. Secondly, preterm infants are particularly prone to developing electrolyte and acid-base imbalance and infective illnesses. The diagnosis and management require frequent laboratory tests, resulting in significant blood loss.