Neonatal anemia is when the number of red blood cells in an infant's body is lower than normal. This condition can occur for several reasons, including the infant being born prematurely, the red blood cells breaking down too quickly, the body not producing enough red blood cells, or the infant losing too much blood.
What is neonatal anemia?
Anemia, defined as a hemoglobin level two standard deviations below the mean for age, is prevalent in infants and children worldwide. The evaluation of a child with anemia should begin with a thorough history and risk assessment. Characterizing the anemia as microcytic, normocytic, or macrocytic based on the mean corpuscular volume will aid in the workup and management. Microcytic anemia due to iron deficiency is the most common type of anemia in children. The American Academy of Pediatrics and the World Health Organization recommend routine screening for anemia at 12 months of age; the U.S. Preventive Services Task Force found insufficient evidence to assess the benefits vs. harms of screening. Iron deficiency anemia, which can be associated with cognitive issues, is prevented and treated with iron supplements or increased intake of dietary iron. The U.S. Preventive Services Task Force found insufficient evidence to recommend screening or treating pregnant women for iron deficiency anemia to improve maternal or neonatal outcomes. Delayed cord clamping can improve iron status in infancy, especially for at-risk populations, such as those who are preterm or small for gestational age. Normocytic anemia may be caused by congenital membranopathies, hemoglobinopathies, enzymopathies, metabolic defects, and immune-mediated destruction. An initial reticulocyte count is needed to determine bone marrow function. Macrocytic anemia, which is uncommon in children, warrants subsequent evaluation for vitamin B12 and folate deficiencies, hypothyroidism, hepatic disease, and bone marrow disorders.
Worldwide, anemia affects up to one-half of children younger than five years. Anemia is defined as a hemoglobin level that is two standard deviations below the mean for age. After children reach 12 years of age, the hemoglobin norm can be further divided into gender-specific ranges. Table 1 lists age-based hemoglobin levels. Anemia can be categorized as microcytic, normocytic, or macrocytic. Microcytic iron deficiency anemia is a common cause of childhood anemia, whereas macrocytic anemia is rare in children. Table 2 summarizes the causes of anemia.
What causes anemia in neonatal?
There are several reasons why anemia occurs in neonatal. These causes may include:
- The infant's body does not produce enough red blood cells. Most infants have anemia in the first few months of life. This is called physiologic anemia. This anemia occurs because your baby's body is growing so fast that red blood cell production takes time to catch up.
- The body's red blood cells break down too quickly. This problem is common when the blood types of the mother and baby do not match. This is called an Rh/ABO blood type mismatch. These babies often suffer from jaundice (hyperbilirubinemia), which causes their skin to turn yellow. In a small number of infants, anemia can also be caused by infection or genetic disorders.
- Infants lose too much blood. Blood loss in the neonatal intensive care unit (NICU) is usually due to frequent blood tests by health care workers. These tests are needed to help the health care team manage your infant's condition. The blood drawn is not replenished quickly enough, resulting in anemia.
- This baby was born prematurely. Premature babies have fewer red blood cells. The life span of red blood cells is also shorter than that of a full-term infant. This is called anemia of prematurity.
Other causes include internal bleeding and the transfer of blood between mother and baby while the fetus is in the womb.
What are the symptoms of anemia in neonatal?
Many infants with anemia do not have any symptoms at all. When symptoms do appear, they may include:
- Poor feeding or fatigue during feeding.
- Rapid heartbeat and shortness of breath at rest.
- Pale skin.
- Listlessness feeling lethargic.
What is the treatment for neonatal anemia?
Your baby's health care provider will determine what is the best treatment. Many infants with anemia do not need any treatment. However, infants born prematurely or with severe conditions may need blood transfusions to increase the number of red blood cells in their bodies.
Other infants will receive medications to help their bodies make more red blood cells. All anemic infants should have their feedings checked, as a proper diet will help the infant make red blood cells.
References
1. Iron Deficiency and Other Types of Anemia in Infants and Children
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