The human body is fuelled by the blood running through its circulatory system. Red blood cells (RBCs or erythrocytes) are an important component of blood responsible for the red colour associated with blood. RBCs also contain hemoglobin, which is responsible for the delivery of oxygen to every cell in the human body.
What is Anemia?
Under normal conditions, a hemoglobin count of 13.5 g/dl (gram per decilitre of blood) is ideal for men and 12 g/dl is the value ideal for women. During pregnancy the value may vary between 11-12 g/dl. A newborn has a slightly higher hemoglobin count of 14-24 g/dl. Children tend to have a count of about 11-16 g/dl.
When a person suffers from anemia, there is a hemoglobin deficiency in the body. The number of red blood cells decreases, leading to a low hemoglobin count. The person usually suffers from a deficiency of iron leading to this condition. If the count drops below 5 g/dl it is a critical value and there can be risk of heart failure.
What Causes Anemia in Newborns?
Newborns are said to be anemic if the central venous hemoglobin value is below 13 g/dl or the capillary hemoglobin is below 14.5 g/dl. They are usually born with an average hemoglobin count of 17 g/dl. The levels continue to decline after birth till the third week of life when they hit 11 g/dl. This process is a natural consequence of going from an oxygen deficit environment in the womb to an oxygen rich environment outside. Anemia in newborns results from three reasons:
- Loss of RBCs is the most common cause (Hemorrhagic Anemia)
- Increased destruction of RBCs (Hemolytic Anemia)
- Underproduction of RBCs (Hypoplastic Anemia)
Symptoms to Watch For in Preterm Babies
Anemia is common in babies born preterm. Mildly anemic infants may not display any signs of having the condition. In case of more severe anemia some of these symptoms may be indicative of the disorder.
- These infants will usually have a pale skin pallor.
- They are easy to tire and suffer from shortness of breath.
- They may be irritable all the time.
- They are fussy feeders who ingest less.
- They have a reduced attention span and may be less alert.
- They may develop a sore tongue.
- Nails may be brittle.
- A blue tinge may be found in the whites of the eyes.
Proper testing of the baby will be required to confirm that the infant actually has anemia. Just because the baby displays a couple of the symptoms mentioned does not means that it has developed this condition.
Tests to Diagnose Anemia in Newborns
There are a number of blood tests to check for anemia once the infant has been physically examined and found to show symptoms of the condition. These include hematocrit, serum ferritin, serum iron and total iron binding capacity (TIBC). Essentially the haemoglobin count is considered the first tool of diagnosis, but the health care provider will also look at the RBC indices, and the reticulocyte count.
If the anemia is being caused by hemorrhage or continuous loss of blood, the Kleihauer-Betke test may be performed on maternal blood to check for fetomaternal hemorrhage. A CXR may be performed for pulmonary hemorrhage. Ultrasound may be done to check for other internal bleeding possibilities. Blood smear tests may also be performed to diagnose the condition adequately.
Treatment Options for Newborns with Anemia
In case the anemia is severe, there may be a need for replacement transfusion for the infant to meet the ongoing deficit. This is critical so that the oxygen carrying capacity of the RBCs is maintained for the infant to survive. The blood transfusions may be continued till the infant is able to produce adequate red blood cells and push up the haemoglobin count.
For mild anemia, nutritional supplementation of iron, folate and Vitamin E may be prescribed for a period of time. Healthy foods that are rich in iron, such as apricots, beans, eggs, liver, oatmeal, prune juice, raisins, spinach, kale and lentils should be fed to the baby along with the supplements. It is not advisable to start supplements without informing the health care practitioner monitoring the baby’s health. it should also be known that not all supplements may suit the infant equally.
Prognosis after Treatment
Once diagnosed accurately, anemia is easily curable. In most cases with the right treatment, the newborn will have a normal blood count of hemoglobin within a couple of months. It is important to keep track of the reason why anemia was caused. Iron deficiency may plague the child for a while and parents must ensure that dietary supplements are continued until deemed no longer necessary by the health care provider.
Reviewed by Afsaneh Khetrapal, BSc (Hons)