Anemia in the Newborn Infant
Joseph D. Dickerman MD1
1 Professor of Pediatrics, Given Medical Bldg, University of Vermont College of Medicine, Burlington, VT 05405
The proper management of anemia in the newborn period, as at any age, requires an accurate diagnosis. It is helpful to divide the many possible etiologies into three major categories: blood loss, increased destruction of red blood cells (hemolysis), and decreased production of red blood cells (bone marrow aplasia or hypoplasia).
DEFINITION
The first step in the diagnosis of neonatal anemia is to define it. Normal hematologic values during the first 2 weeks of life in the term infant are presented in Table 1. Similar values for infants of low birth weight have been published by Stockman and Oski. The more common anemias will be discussed in terms of findings on physical examination, history, ry, laboratory studies, and management with reference to groups of conditions (Tables 2 and 3) rather than to specific disease entities. The less common disorders will be either omitted or described only briefly. The anemia of prematurity will not be covered. A discussion of this topic can be found in the article by Stockman.
Approach to Diagnosis
The usual approach to diagnosis, taking a history and then performing a physical examination, has been reversed in this paper. In most cases, a physician is called to see a neonate suspected of being anemic because of signs and/or symptoms of shock, pallor, or a low hemoglobin concentration, and the physician examines the infant prior to obtaining a history.
