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Clinical Reference Systems: Pediatric Advisor 10.0

Anemia of the Newborn


A baby who has anemia does not have enough red blood cells. The red blood cells carry oxygen in the blood and deliver it to the rest of the body.

A baby who is anemic:

  • looks pale
  • may be sleepy or tired
  • may get tired when feeding
  • may have a fast heart rate and breathing rate when resting.


Newborns may become anemic for several possible reasons. Sometimes the baby loses blood at the time of delivery, either into the mother's bloodstream or into the placenta. Sometimes, if the mother and baby do not have the same blood type, too many of the baby's red blood cells break down after birth.

Every baby becomes anemic 4 to 8 weeks after birth. This is called physiologic (or normal) anemia. In adults, red blood cells get old and break down but the body makes new red blood cells to keep the red blood cell count normal. Babies cannot make new red blood cells until they are 6 to 8 weeks old, and so they cannot replace the lost red blood cells and they become anemic. Once the baby starts making new red blood cells, the red blood cell count gradually returns to normal. Most babies do not have any symptoms from this natural process and do not need treatment.

Iron is a mineral that is important in making new red blood cells. Many children and adults do not get enough iron in their diet and are anemic because of the lack of iron. Babies are born with plenty of iron, but they need to have iron in their diet. Formula-fed babies should receive iron-supplemented formula. Breast milk contains some iron, so breast-fed babies do not normally need extra iron until the age of 4 to 6 months, when they can start eating iron-supplemented cereal.

Premature babies become anemic sooner than full-term infants because they start out with fewer red blood cells. They also lose blood from frequent blood tests. Many premature babies become anemic before their body can make red blood cells. They may need a transfusion of blood. The smaller a premature baby is, the more likely he will need one or more blood transfusions in the first 2 months of life.


Anemia is a normal process in the newborn period and does not need to be treated unless it causes a problem for the baby.

  1. Following for anemia

    Every baby in the special care nursery has a red blood cell count, or hematocrit, several times a week. It is expected that the blood count will gradually fall. A baby is not treated for anemia unless the baby develops symptoms of anemia or the hematocrit level drops too low.

  2. Iron supplementation

    Iron is needed to make red blood cells. Premature babies need iron added to their diet. When a baby is getting milk feedings and is 2 weeks old, the baby may be given iron drops by mouth twice a day.

  3. Transfusion

    A blood transfusion is a transfer of red blood cells to a baby through the veins. It increases the baby's red blood cell count.

    • Reasons for blood transfusion

      There are many different reasons for a blood transfusion. Sometimes a transfusion is needed as an emergency. If a baby rapidly loses a large amount of blood or if the blood count is so low that the heart and body are under stress from lack of oxygen, a blood transfusion may save the baby's life.

      At other times a transfusion is given to treat a specific symptom that is thought to be made worse by anemia. For example, a baby who is weak and tired and has a very low blood count may become stronger and eat better once the blood count is raised by a transfusion. Very premature babies may have low blood counts. Because of their age and prematurity, they are not expected to make blood for several weeks. In these cases a blood transfusion may be given to boost the blood count.

      If a transfusion is necessary, your baby's doctor will discuss the reasons with you.

    • Method

      Blood to be given to a baby is matched against the baby's blood to make sure it is compatible. The blood is also tested to make as sure as possible that it is free of any infection that could be passed through the blood.

      The blood is given to the baby into the veins with an intravenous (IV) line. The transfusion lasts about an hour. The baby is watched carefully during the transfusion but can be held during this time. The amount of blood given to the baby is relatively small. It is usually no more than a few tablespoons.

    • Sources of blood

      Blood for transfusion is obtained from the blood bank in two ways. Usually the blood is donated by volunteer donors; this is called blood bank blood. It is also possible for family members to donate blood specifically for the baby; this is called directed-donor blood. Your baby's doctor will tell you if a transfusion is needed and discuss with you your preferences for blood transfusion.

      Blood bank blood: All blood collected at the blood bank is donated by volunteers whose health is carefully screened. The blood is tested for infections that could be passed through blood. These infections include syphilis, hepatitis, HIV, and cytomegalovirus (CMV). CMV is a common virus which causes a mild cold in children and adults. However, CMV can be passed through blood transfusion and can cause more serious infections in premature babies. All blood used for premature infants is CMV negative; that is, it is donated by people who have not had CMV infections. HIV is the virus that causes AIDS. Because blood is now tested for HIV, the risk for getting AIDS through transfusion is very low, approximately 1 in 225,000. The risk for getting hepatitis is 1 in 3,300.

      Donor-specific blood: Family members can donate blood for their baby. However, mothers cannot donate for their baby until 6 to 8 weeks after delivery. The donor blood must be a compatible blood type. All donors are screened for syphilis, hepatitis, HIV, and CMV. The blood is available for transfusion 24 to 48 hours after the time of donation. If the transfusion needs to be done immediately, there may not be time for donor-specific blood donation. Research has shown that specific donors outside the immediate family unit (parents, grandparents) do not offer any greater protection from infection than volunteer donors from the blood bank.


All babies outgrow the anemia they may have during their first 2 months of life. The vast majority of babies who receive blood transfusions do not have any complications. With the advent of HIV testing for blood transfusion, follow-up HIV tests are not routinely done in babies who have received blood transfusions in the newborn period because the risk of transmission is very low.

Written by Patricia Bromberger, M.D., neonatologist, Kaiser Permamente, San Diego, CA
Copyright 1999 Clinical Reference Systems