Overview

Anemia in newborns refers to a condition in which there is a decrease in the number or concentration of red blood cells or hemoglobin in the blood. This can occur for a variety of reasons, including physiologic anemia of the newborn, which is caused by the rapid expansion of blood volume during the first few days of life, as well as more serious causes such as bleeding or inherited blood disorders. Symptoms of anemia in newborns can include pallor, fatigue, and difficulty breathing. Treatment for anemia in newborns will depend on the underlying cause and may include blood transfusions, iron supplements, or other supportive care. Regular monitoring of the newborn's blood counts is crucial in order to identify and treat anemia as soon as possible.

 

What is Anemia?

Anemia is a condition in which the body does not have enough red blood cells or hemoglobin, a protein that carries oxygen from the lungs to the body's tissues. This can lead to symptoms such as fatigue, weakness, and shortness of breath. There are many different types of anemia, caused by a variety of factors including nutritional deficiencies, chronic diseases, and inherited disorders. Treatment for anemia typically involves addressing the underlying cause and may include taking supplements or medications to increase the number of red blood cells and hemoglobin in the body.

 

Developmental Erythropoiesis

Developmental erythropoiesis refers to the process of red blood cell (RBC) formation during embryonic development. Erythropoiesis is the process of producing RBCs and occurs primarily in the fetal liver and spleen during embryonic development and in the bone marrow after birth. This process is controlled by a variety of hormones and growth factors, including erythropoietin (EPO), which is produced by the kidneys and regulates the production of RBCs in response to changes in oxygen levels in the body.

During embryonic development, RBCs are formed in large numbers to support the rapid growth and development of the fetus. The process of erythropoiesis in the fetus is different from that in the adult and is characterized by the formation of nucleated RBCs which are larger and have a shorter lifespan than mature RBCs. After birth, erythropoiesis shifts to the bone marrow and the nuclei of RBCs are lost, resulting in the formation of mature, non-nucleated RBCs which have a longer lifespan.

Abnormalities in developmental erythropoiesis can lead to various forms of anemia. These can be caused by genetic mutations or environmental factors that disrupt the normal process of RBC formation during embryonic development.

 

What is Anemia in newborns?

Anemia in newborns is a condition in which the baby's body does not have enough red blood cells to carry oxygen to the body's tissues. There are several types of anemia that can occur in newborns, the most common of which is iron-deficiency anemia, which results from a lack of iron in the baby's diet. Other causes can be inherited anemia such as sickle cell anemia, or anemia caused by other blood disorders or infections.

 

What causes Anemia in newborns?

Anemia in newborns can be caused by a variety of factors, including:

1. Iron-deficiency anemia: This is the most common cause of anemia in newborns and results from a lack of iron in the baby's diet.
2. Inherited anemia: Some babies are born with inherited anemia, such as sickle cell anemia, thalassemia or other genetic blood disorders.
3. Blood loss: Some newborns may experience blood loss during delivery or due to other medical conditions such as bleeding in the brain, gastrointestinal bleeding or hemolytic anemia caused by Rh or ABO incompatibility.
4. Prematurity: Premature babies are more susceptible to anemia due to their immature red blood cells and lower iron stores.
5. Malnutrition: Poor nutrition in the mother during pregnancy can also lead to anemia in the newborn.
6. Infections: Some infectious diseases such as congenital cytomegalovirus (CMV) or parvovirus B19 infections can cause anemia in newborns.

It's important to note that early diagnosis and treatment of anemia in newborns is important to prevent complications and ensure the health of the baby. Regular follow up with a pediatrician is important to monitor the progress of treatment and the health of the baby.

 

Physiologic Anemia of the newborn

Physiologic anemia of the newborn is a common condition that occurs due to the rapid expansion of blood volume during the first few days of life. This results in a decrease in the concentration of hemoglobin, the protein in red blood cells that carries oxygen, in the newborn's blood. The condition is not harmful and typically resolves on its own within a few weeks without any treatment.

 

Anemia in preterm infants

Anemia is a common complication in preterm infants, who are born before 37 weeks of gestation. Preterm infants have a higher risk of anemia due to their immaturity, as they have not yet developed the ability to produce enough red blood cells to support their growth and development.

In preterm infants, anemia is often caused by a combination of factors, including blood loss from invasive procedures, inadequate iron stores, and a lack of erythropoietin, a hormone that regulates the production of red blood cells.

 

There are several strategies that can be used to prevent and treat anemia in preterm infants. These include:

1. Maternal blood donation: Preterm infants may receive a transfusion of red blood cells from their mother's blood to help boost their iron stores and prevent anemia.
2. Iron supplementation: Preterm infants may be given iron supplements to increase the number of red blood cells and hemoglobin in their blood.
3. Erythropoietin therapy: Erythropoietin therapy can be used to stimulate the production of red blood cells in preterm infants.
4. Blood conservation: Preterm infants may be at risk of blood loss due to invasive procedures such as heel sticks and intubation. Blood conservation techniques, such as using smaller gauge needles and minimizing the number of procedures can help to reduce blood loss and prevent anemia.
5. Monitoring: Regular monitoring of hemoglobin levels is important to detect anemia early and to make sure that the treatment is effective.

 

What are the symptoms of Anemia in newborns?

Symptoms of anemia in newborns can include:

1. Pale or yellowish skin: Anemia can cause a lack of oxygen in the baby's body, which can lead to paleness or yellowing of the skin.
2. Fatigue and weakness: Anemia can cause fatigue and weakness in the baby, which can make it difficult for the baby to feed and stay awake.
3. Difficulty feeding: Anemia can cause a lack of energy, which can make it difficult for the baby to feed and stay awake.
4. Jaundice: Anemia can cause a yellowing of the skin and whites of the eyes (jaundice) due to the breakdown of red blood cells.
5. Rapid breathing or heart rate: Anemia can cause a lack of oxygen in the baby's body, which can lead to rapid breathing or a fast heart rate.
6. Irritability or poor sleeping habits: Anemia can cause discomfort and fussiness, which can affect the baby's sleep patterns.

It's important to note that these symptoms can be caused by other conditions and that it's important to consult a pediatrician if you suspect your baby has anemia or any other health concerns. A pediatrician can conduct a physical examination and run blood tests to confirm the diagnosis and provide appropriate treatment.

 

How is Anemia in newborns diagnosed?

Anemia in newborns is typically diagnosed through a combination of physical examination, blood tests, and patient history.

1. Physical examination: 

A pediatrician will examine the baby for physical signs of anemia, such as pale skin, jaundice, and a fast heart rate. They may also take the baby's pulse and blood pressure, as well as check for other signs of poor health.

    2. Blood tests:

 Blood tests are used to confirm the diagnosis of anemia and to determine the specific type of anemia. A complete blood count (CBC) is typically the first test ordered, which measures the number of red blood cells, white blood cells, and platelets in the blood. Hemoglobin and hematocrit levels are also measured, which indicate the amount of oxygen-carrying protein in the blood.

Iron studies such as serum iron, ferritin, and total iron binding capacity (TIBC) are also done to evaluate iron status. Genetic blood disorder tests may be done if inherited anemia is suspected.

    3. Patient history: 

Your pediatrician may also ask about the baby's birth history, any recent blood loss, and any other health conditions to help identify the cause of the anemia.

Based on the results of the physical examination, blood tests, and patient history, a diagnosis of anemia in newborns can be made and appropriate treatment can be started. It's important to note that anemia treatment in newborns should be done under the guidance of a pediatrician, as the treatment and dosages may vary depending on the cause and severity of anemia. Regular follow up with the pediatrician is important to monitor the progress of treatment and the health of the baby.

 

What Are the Levels of Hemoglobin During and After Birth?

During pregnancy, the levels of hemoglobin in a woman's blood tend to be slightly higher than normal due to the increased volume of blood in her body. After delivery, the newborn's hemoglobin levels will depend on several factors, including whether the baby was born prematurely or at term, and whether the baby is breastfed or formula-fed.

• Hemoglobin levels in a full-term newborn are typically around 17-22 g/dL.
• Premature infants tend to have lower hemoglobin levels, around 14-20 g/dL
• Hemoglobin levels may drop slightly in the first few days after birth due to the physiologic anemia of the newborn, as the blood volume expands rapidly.
• Hemoglobin levels in breastfed infants tend to be lower than in formula-fed infants.
• Infants who are not getting enough iron from their diet may develop iron-deficiency anemia, which can cause their hemoglobin levels to be lower than normal.
• It is important to note that these values may vary depending on the lab and population, and it's always good to consult with a healthcare professional for more specific and accurate information.

 

What treatments are used for Anemia in newborns?

Treatment for anemia in newborns will depend on the cause and severity of the anemia, as well as the overall health of the baby.

• Iron Supplements: If the anemia is caused by iron deficiency, iron supplements are typically prescribed. Iron supplements come in several forms, such as oral tablets, capsules, or liquids. It's important to take iron supplements exactly as directed by the pediatrician.
• Blood Transfusions: If the anemia is severe or caused by blood loss, blood transfusions may be necessary to increase the baby's red blood cell count. Blood transfusions can be given through an IV line, and the blood is typically matched to the baby's blood type to reduce the risk of complications.
• Medication: If the anemia is caused by other underlying conditions such as inherited anemia or infections, medication may be prescribed to treat the underlying condition.
• Dietary Changes: If the anemia is caused by poor nutrition, the pediatrician may recommend a change in the baby's diet to include more iron-rich foods.

 

How Do You Prevent Anemia in Babies?

Preventing anemia in babies can be achieved through a combination of maternal and infant nutrition and supplementation, as well as prompt identification and treatment of any underlying medical conditions that could contribute to anemia.

For pregnant women, it is important to ensure that they are getting enough iron, folic acid, and other essential nutrients in their diet. This can be achieved through a healthy diet that includes a variety of foods high in these nutrients, such as leafy greens, lean red meats, and fortified cereals. Prenatal vitamins that contain these nutrients can also be helpful.

For babies, it is important to ensure that they are getting enough iron in their diet, especially during the first 6 months of life. Infants should be breastfed exclusively for the first 6 months, as breastmilk is a good source of iron. After 6 months, babies can be introduced to iron-rich solid foods such as pureed meats, beans, and leafy greens. If a baby is not breastfeeding or not getting enough iron in their diet, a pediatrician may recommend iron supplements.

If there is a family history of anemia or if the baby is at risk for anemia, a pediatrician may recommend regular blood tests to monitor the baby's hemoglobin levels. If anemia is detected, the pediatrician will work with the parents to develop a treatment plan that may include iron supplements and dietary changes.

It is important to note that if anemia is caused by underlying medical condition, such as thalassemia, a genetic blood disorder, it will require further treatment and management.

 

Conclusion 

All infants have a drop in hemoglobin (Hb) during and after birth, resulting in some type of anemia. The severity and duration of this anemia are determined by a mix of physiologic and non-physiologic mechanisms. Preterm newborns are especially vulnerable to such processes since the severity of developing postnatal Hb loss is most common in the youngest infants, putting them at a higher risk of having major anemias. Second, preterm newborns are more likely to develop electrolyte and acid-base imbalances, as well as infectious infections. Frequent laboratory tests are required for diagnosis and management, resulting in substantial blood loss.