• alternative name

• symptoms and signs

• laboratory findings

• about the disease

• treatment

• prognosis

Alternative name.  anemia at birth

Symptoms & signs.  the infant looks pale, may be sleepy or tired, may get tired when feeding, may have a fast heart rate and breathing rate when resting

Laboratory findings.  Blood examinations will show low red blood cell count (a normal newborn has an average hemoglobin value of 18 gm/100 ml, and a value less than 15 gm/100ml or 150g/L indicates anemia); may show low reticulocyte count which may indicate congenital hypoplastic, drug-induced suppression, or parvovirus 19 infection; a positive coomb’s test may indicate ABO incompatibility or Rh incompatibility; low MCV may be due to chronic intrauterine loss, twin-twin transfusion, fetomaternal abruption, or alpha-thalassemia; abnormal peripheral smear may be due to spherocytosis, eliptocytosis, stomatocytosis, pyknocytosis, disseminated intravascular coagulopathy, or microangiopathic disease; hemolysis may be due to several metabolic, infectious, or endocrine disorders

About the disease.  Anemia (a condition where there is not enough red blood cells to carry oxygen to the blood and deliver it to the rest of the body) at birth may be due to acute or chronic blood loss, destruction of red blood cells, or underproduction of red blood cells. It is usually caused by hemolytic disease of the the newborn (hydrops fetalis) but may also be a result of tearing or cutting of the umbilical cord during delivery, abnormal cord insertions, communicating placental vessels, placenta previa or abruptio, nuchal cord, incision into the placenta, internal hemorrhage (liver, spleen, or intracranial), alpha-thalassemia, congenital parvovirus infection or hypoplastic anemia, and twin-twin transfusion in monozygotic twins with arteriovenous placental connections. Acute blood loss usually results in severe distress at birth, initially with a normal hemoglobin level, no enlargement of the liver and the spleen (hepatosplenomegaly), and early onset of shock. In contrast, chronic blood loss while the fetus is still in the mother’s womb produces marked pallor, less distress, low hemoglobin level with microcytic indices, and if severe, heart failure. Premature babies are more frequently affected because they start out with fewer red blood cells.

Treatment.  asymptomatic full-term infants with a hemoglobin level of 10 g/dL may not be treated for anemia and is just observed; immediate blood transfusion may be needed by symptomatic infants with severe anemia; recombinant human erythropoietin (rHuEpo) has been used to prevent or treat chronic anemia associated with prematurity, chronic lung disease, and the hyporegenerative anemia of erythroblastosis fetalis; premature babies are also given iron supplements

Prognosis.  prognosis is good; all babies outgrow the anemia, the vast majority of babies who receive blood transfusions do not have any complications; the risk of transmission of communicable diseases is very low, with the advent of modern techniques to screen the blood