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Anemia of Prematurity

Definition

Anemia is a low level of red blood cells. These cells are responsible for picking up oxygen in the lungs and delivering it to the rest of the body. Low levels of red blood cells make it difficult for the body to get enough oxygen. If anemia is severe, it can lead to serious health problems.
Anemia of prematurity occurs in babies who are born earlier than expected.
Anemia
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Causes

Anemia of prematurity may be caused by one or more of the following conditions:
  • Loss of blood due to:
    • Complications during labor and birth
    • Removal of blood for testing (regular blood tests are needed to monitor premature babies’ health)
  • Decreased production of red blood cells due to:
    • Nutrition problems
    • Certain infections like rubella or parvovirus that affect the bone marrow (where red blood cells are made)
  • Destruction of red blood cells may occur with medical conditions such as:
    • Incompatibility between mother’s and baby’s blood ( Rh incompatibility )
    • Hereditary disorders

Risk Factors

Infants are more prone to anemia because:
  • Production of red blood cells temporarily slows down in all newborns right after birth (greater effect in premature babies)
  • Blood volume can’t keep up with baby’s growth
  • Red blood cells have a shorter lifespan in infants compared to adults
Other factors that may increase the chances of anemia of prematurity include:
  • Family history of anemia
  • Complications during delivery
  • Blood loss during birth
  • Illness requiring a lot of blood work
  • Being a twin with twin-to-twin transfusion
  • Poor diet, particularly low in iron, vitamin B6 or B12 in
    • mother during pregnancy
    • infant after birth

Symptoms

Mild anemia may have no symptoms. Symptoms of moderate or severe anemia may include:
  • Pale appearance
  • Slow, dull activity
  • Fast or difficulty breathing
  • Difficulty during feeding
  • Fast heart rate
  • Slow weight gain
  • Period when breathing stops

Diagnosis

The doctor will ask about your baby’s symptoms and history and perform a physical exam. Blood tests to monitor your baby’s overall health may be needed to:
  • Count the number of red blood cells
  • Determine how fast red blood cells are being made
  • Look for signs of red blood cell destruction
  • Measure levels of iron and vitamin B in blood
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 not need to be treated. The doctor will simply monitor your baby’s blood. As little blood as possible will be taken to keep the anemia from getting worse.
Treatment options for anemia of prematurity include:

Optimizing Nutrition

Nutrition plays a big role in the recovery from anemia. The right foods can help the baby’s body increase production of red blood cells.
Lack of certain nutrients can also make it difficult for the body to make red blood cells. Iron is important in making red blood cells. Once the baby is a few weeks old, supplemental iron may be added.

Supplemental Erythropoietin

Erythropoietin is a hormone in the body. It encourages the body to make more red blood cells. Supplemental erythropoietin may be given to babies with or at risk for anemia. It will gradually help the body make more red blood cells.
This treatment is often given in addition to nutrition changes.

Blood Transfusion

Severe cases of anemia may need immediate treatment. A blood transfusion will quickly increase the level of red blood cells in the infant.
More than one transfusion may be needed.

Prevention

To help reduce your child’s chance of getting anemia of prematurity, take these steps:
  • Optimize your baby’s nutrition
  • Get proper prenatal care throughout your pregnancy
  • Take steps to prevent premature birth including:
    • Avoiding alcohol, smoking, and drugs
    • Eat a healthy, balanced diet with plenty of fruits and vegetables
    • Keep chronic disease under control

RESOURCES

American Academy of Pediatrics http://www.healthychildren.org

Kids Health http://kidshealth.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

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

References

Anemia of Prematurity. The Hospital for Sick Children website. Available at: http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/OverviewofTreatment/TreatmentofOtherConditions/Pages/Treatment-of-Anemia-of-Prematurity.aspx . Accessed December 5, 2012.

Neonatal Anemia. UCSF Children’s Hospital website. Available at: http://www.ucsfbenioffchildrens.org/pdf/manuals/37%5FAnemia.pdf . Accessed December 5, 2012.

Office Care of the Premature Infant: Part II. Common Medical and Surgical Problems. American Family Physician. Am Fam Physician. 1998 May 15;57(10):2383-2390. Accessed: http://www.aafp.org/afp/1998/0515/p2383.html .

What is Anemia of Prematurity? Greenwich Hospital website. Available at: http://www.greenhosp.org/upload/docs/FactSheets/English/pediatric%5Fanemia-premeturity.pdf . Accessed December 5, 2012.

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