Blood disorders in the neonate

Anemia

- Hemoglobin increases with gestational age. At term, cord blood hemoglobin is 16.8 g/dL (14-20)
- Those in VLBW infants are 1-2 lower than term
- Anemia is a hemoglobin value less than the normal range for birthweight and postnatal age
- There’s a physiologic decrease in Hg at 8-12 week in term (11 g/dL) and at 6 weeks in premature
(7-10)
- Infants born by cesarean section may have lower hematocrit than those born vaginally
- Anemia at birth manifests as pallor, heart failure or shock
- It may be caused by acute or chronic fetal blood loss, hemolysis or underproduction of
erythrocytes
- Transplacental hemorrhage with bleeding from the fetal into maternal circulation reported in 5-
15% pregnancies, but unless severe, doesn’t cause clinically apparent anemia at birth. The cause
is not clear, but it can be proven Kleihauer-Betke test or flow cytometry methods
- Acute blood loss usually causes severe distress at birth, initially with normal hemoglobin, no
HSM, early onset of shock. But chronic blood loss produces marked pallor, less distress, low
hemoglobin with microcytic indices, heart failure if severe
- Anemia appearing in the first few days is most frequently a result of hemolytic disease of the
newborn. Other causes are hemorrhagic disease of the newborn, bleeding from improperly tied
or clamped umbilical cord, large cephalhematoma, intracranial hemorrhage, subcapsular
bleeding from rupture of the liver, spleen, adrenals or kidneys. Rapid decrease in hemoglobin or
hematocrit during the first few days of life may be the initial clue to these conditions
- Later in the neonatal period, delayed anemia may result because of hemolytic disease of the
newborn, with or without exchange transfusion or phototherapy
- Repeated blood sampling
- Deficiency of minerals such as copper may cause anemia in infants maintained on total
parenteral nutrition
- Anemia of prematurity – LBW infants 1-3 months after birth, associated with hemoglobin levels
less than 7-10. Clinically manifested as pallor, weight gain, decreased activity, tachypnea,
tachycardia, feeding problems
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