Neonatal Anemia (Anemia in the Newborn)
Neonatal Anemia is a blood disorder characterized by the abnormal decrease of the red blood cells in the blood.
- Excessive breakdown of the red blood cells, severe blood loss, and nonproduction of red blood cells by the bone marrow, are the usual reasons of anemia in the newborn.
- When the anemia is due to excessive break down of red blood cells, yellowish discoloration of the skin as well as the whites of the infant’s eyes are the usual symptoms resulting from the high bilirubin levels in the blood.
- When severe blood loss is causing the anemia, symptoms of shock such as abnormally fast heart rate, very low blood pressure, fast but shallow breathing, and paleness are usually present.
- Intravenous administration of fluids and exchange blood transfusion are the treatments for anemia in the newborn.
The red blood cell production by the bone marrow temporarily stops for a period of 3 to 4 weeks following birth. It results in a condition called physiologic anemia lasting for about 2 or 3 months after birth. It is quite normal and usually mild, requiring no special treatment. In extremely premature infants the initial reduction of RBCs may be higher than it is in term babies. Neonatal anemia may be much more severe in certain situations which include rapid destruction of RBCs, severe blood loss during birth, and nonproduction of RBCs by the bone marrow. When the infant’s blood is drawn repeatedly for various tests in the initial days after birth, it may lead to anemia, especially in premature infants. Several of the above mentioned situations may occur together causing severe anemia.
Excessive breakdown of red blood cells raises the bilirubin levels in the blood resulting in a condition called hyperbilirubinemia. RBCs may be destroyed excessively and rapidly by the hemolytic disease occurring in the newborn infants. Certain hereditary disorders, if present, may lead to rapid destruction of red blood cells. For example, there is a blood disorder called hereditary spherocytosis characterized by an abnormal spherical shape of the red blood cells. A red blood cell enzyme called glucose-6-phosphate dehydrogenase [G6PD]) may be absent in some babies, though it is quite rare. When the mother uses certain medications such as sulfa drugs or aniline dyes it may affect the fetus and result in rapid destruction of RBCs in the newborn infant.
Many infections passed on to the fetus from the mother such as, syphilis, rubella, toxoplasmosis, herpes simplex and cytomegalovirus infections can be the reason for the destruction of RBCs in newborns. Bacterial infections contracted during birth, or afterwards, also may be responsible.
Severe blood loss resulting from fetal–maternal transfusion can result in neonatal anemia. This occurs towards the end of pregnancy and the beginning of labor. The fetal blood gets transfused into the maternal circulation through the placenta. Sometimes large amounts of blood may remain in the placenta at the time of delivery resulting in less blood in the infant. This may happen when the baby is held up to clamp and cut the umbilical cord, draining blood into the placenta. When twins have shared circulation, twin-to-twin transfusion may take place leaving one baby anemic, and the other with a condition called polycythemia or excess blood. Placental separation from the uterine wall during labor can result in severe fetal blood loss leading to anemia in the newborn.
In rare cases, the bone marrow of the fetus fails to produce red blood cells, causing anemia in infants. A genetic problem which cause anemia due to nonproduction of RBCs is called Diamond-Blackfan anemia. Fanconi’s anemia is another example. Certain infections, including syphilis, HIV and cytomegalovirus infection can prevent the production of RBCs by the bone marrow.
Symptoms and Diagnosis
Mild neonatal anemia is usually asymptomatic. If anemia is moderate, the infant may become lethargic. Poor feeding is another usual symptom of anemia. Some infants may not show any symptoms at all. Severe blood loss during labor, or at the time of delivery, may cause shock in the newborn. Abnormally fast heart rate, extremely low blood pressure, and fast but shallow breathing, are the usual symptoms of shock. The infant may look very pale too. Anemia can be caused when a large number of red blood cells breakdown. In such cases, the excess bilirubin released into the blood may make the skin as well as the whites of the infant’s eyes yellow. The typical symptoms often indicate anemia in infants, but blood tests are necessary to confirm the diagnosis.
Treatment
A mild form of neonatal anemia, which is usually present in most babies, does not need any specific treatment.
If heavy blood loss has been suffered by the infant, either during labor or at the time of delivery, fluids are administered intravenously and if necessary, blood transfusion is also done. Hemolytic disease is another condition which makes the infant extremely anemic and necessitates blood transfusion. Exchange blood transfusion is the preferred procedure for infants, as it serves the dual purpose of increasing the hemoglobin content and red blood cells, while decreasing the blood levels of bilirubin. In this procedure, one syringe of the infant’s blood is drawn out first and then the same amount of fresh blood from the blood bank is injected into the infant in exchange
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Yasser Elnahas
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