SOP 22: NCU

Anaemia
Anaemia is a condition characterized by a decreased number of red blood cells or
decreased haemoglobin concentration. It is the most common haematological
abnormality in neonates, especially in premature and LBW infants.
Hb levels change with the age of the infant.

Risk Factors Investigations

- Prematurity ✓ Hb level / Full Blood Picture
- Acute blood loss ✓ Blood grouping and crossmatching
- Haemolysis ✓ Coombs test
- Infection ✓ Reticulocyte count
- Frequent blood sampling ✓ Septic screening (FBP, CRP, urine
- Physiological analysis, LP, blood culture)

Clinical Presentation Management

✓ Transfuse symptomatic infants
- Pallor
according to haemoglobin (Hb) level
- Tachypnoea, increased oxygen
and age
requirement
✓ Transfuse over 4 hours
- Increased apnoea or bradycardia
✓ Transfuse with packed cells (10
- Persistent tachycardia
ml/kg). If packed cells are not
(HR > 160 /minute)
available whole blood (20 ml/kg) can
- Low blood pressure (CRT > 3 sec)
be given
- Poor feeding
✓ Furosemide is NOT given routinely!
- Poor weight gain
✓ Give iron prophylaxis and
- Decreased activity
multivitamins to all LBW and
- Features of heart failure
prematures from 3rd week of life

Transfusion Table
Week of life Severe condition Mild to moderate condition

1st week Hb < 10.0 g/dl Hb < 10.0 g/dl

2nd week Hb < 10.0 g/dl Hb < 8.5 g/dl

≥ 3rd week Hb < 8.5 g/dl Hb < 7.5 g/dl

“Severe condition” if ≥ 1 of the following is present:

- Need of oxygen - Fever > 39.0 °C - No weight gain
- Lethargy - Feeding problems - Jaundice
- Irritability
MoHCDGEC (2019) National Guideline for Neonatal Care and Establishment of Neonatal Care Unit, p 70-72