• Anemia of Prematurity


    Anemia is a low level of red blood cells (RBCs). These cells are responsible for picking up oxygen in the lungs and delivering it to the rest of the body. Low levels of RBCs make it difficult for the body to get enough oxygen. If anemia is severe, it can lead to serious health problems.
    Anemia of prematurity occurs in babies who are born earlier than expected.
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    Anemia of prematurity may be caused by one or more of the following conditions:
      Loss of blood due to:
      • Complications during labor and birth
      • Removal of blood for testing—regular blood tests are needed to monitor premature babies’ health
      Decreased production of RBCs due to:
      • Nutrition problems
      • Certain infections like rubella or parvovirus that affect the bone marrow where RBCs are made
      Destruction of RBCs may occur with medical conditions such as:
      • Incompatibility between mother’s and baby’s blood—Rh incompatibility
      • Hereditary disorders

    Risk Factors

    Infants are more prone to anemia because:
    • Production of RBCs temporarily slows down in all newborns right after birth—greater effect in premature babies
    • Blood volume can’t keep up with baby’s growth
    • RBCs have a shorter lifespan in infants compared to adults
    Other factors that may increase the chances of anemia of prematurity include:
    • Family history of anemia
    • Complications during delivery
    • Blood loss during birth
    • Illness requiring a lot of blood work
    • Being a twin with twin-to-twin transfusion
    • Poor diet, particularly low in iron, vitamin B6 or B12 in
      • Mother during pregnancy
      • Infant after birth


    Mild anemia may have no symptoms. Symptoms of moderate or severe anemia may include:
    • Pale appearance
    • Slow, dull activity
    • Fast or difficulty breathing
    • Difficulty during feeding
    • Fast heart rate
    • Slow weight gain
    • Period when breathing stops


    You will be asked about your baby’s symptoms and history. A physical exam will be done.
    Your baby's blood will be tested. This can be done with blood tests.
    A diagnosis will be made based on the blood test. The test results may also help find the cause of the anemia.


    Treatment will depend on the cause of anemia. Mild anemia may not need to be treated. The doctor will simply monitor your baby’s blood. As little blood as possible will be taken to keep the anemia from getting worse.
    Treatment options for anemia of prematurity include:

    Optimizing Nutrition

    Nutrition plays a big role in the recovery from anemia. The right foods can help the baby’s body increase production of RBCs.
    Lack of certain nutrients can also make it difficult for the body to make RBCs. Iron is important in making RBCs. When your baby is a few weeks old, supplemental iron may be added.

    Supplemental Erythropoietin

    Erythropoietin is a hormone in the body. It encourages the body to make more RBCs. Supplemental erythropoietin may be given to babies with or at risk for anemia. It will gradually help the body make more RBCs.
    This treatment is often given in addition to nutrition changes.

    Blood Transfusion

    Severe cases of anemia may need immediate treatment. A blood transfusion will quickly increase the level of RBCs in the infant.
    More than 1 transfusion may be needed.


    To help reduce your child’s chance of getting anemia of prematurity, take these steps:
    • Get proper prenatal care throughout your pregnancy
    • Take steps to prevent premature birth including:
      • Avoiding alcohol, smoking, and drugs
      • Eat a healthy, balanced diet with plenty of fruits and vegetables
      • Keep chronic disease under control
    • Optimize your baby’s nutrition


    Healthy Children—American Academy of Pediatrics http://www.healthychildren.org

    Kids Health—Nemours Foundation http://kidshealth.org


    Health Canada http://www.hc-sc.gc.ca

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org


    Anemia of Prematurity. The Hospital for Sick Children website. Available at: http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/OverviewofTreatment/TreatmentofOtherConditions/Pages/Treatment-of-Anemia-of-Prematurity.aspx. Updated October 31, 2009. Accessed September 16, 2015.

    Neonatal Anemia. UCSF Children’s Hospital website. Available at: http://www.ucsfbenioffchildrens.org/pdf/manuals/37%5FAnemia.pdf. Published 2004. Accessed September 16, 2015.

    Trachtenbarg D, Golemon T. Office Care of the Premature Infant: Part II. Common Medical and Surgical Problems. Am Fam Physician. 1998 May 15;57(10):2383-2390. Available at: http://www.aafp.org/afp/1998/0515/p2383.html. Accessed Sptember 16, 2015.

    What is Anemia of Prematurity? Greenwich Hospital website. Available at: http://www.greenhosp.org/upload/docs/FactSheets/English/pediatric%5Fanemia-premeturity.pdf. Updated April 2006. Accessed September 16, 2015.

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