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
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
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
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
- 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
- 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.
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
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.
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
- 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.