Why does hemoglobin drop more in premature babies?
The fetus receives its main supply of iron in the third trimester, so a child born earlier starts with small reserves. His red blood cells last less than those of an adult, and the production of erythropoietin, a hormone that stimulates the formation of new blood cells, temporarily decreases after birth. At the same time, the baby grows very quickly, and the blood volume increases, diluting the existing hemoglobin. Add to this regular blood draws for tests in the department, and it becomes clear why the decline is more pronounced and occurs earlier than in full-term infants.
- Low iron stores at premature birth
- Short lifespan of red blood cells
- Temporary decrease in erythropoietin production
- Rapid increase in blood volume with growth
- Blood loss during laboratory sampling
- Blood loss during childbirth and hemorrhage
How does it manifest itself?
Anemia is often detected during routine testing before complaints appear. With a more pronounced decrease, parents notice pallor of the skin and mucous membranes, especially noticeable on the palms and lips. The baby gets tired faster during feeding, pauses, sweats, breathes faster than usual, and the heartbeat quickens even at rest. Weight gain may slow down. In very premature infants, anemia sometimes manifests itself as increased episodes of respiratory arrest. Important: irritability and poor sleep in themselves are not signs of anemia.
- Pale skin and mucous membranes
- Fatigue when feeding
- Rapid breathing and heart rate
- Poor weight gain
- Lethargy and decreased activity
- Increased frequency of apnea episodes
Early and late anemia
Early anemia of prematurity is observed in the first weeks and a month or two of life; it is associated primarily with a decrease in erythropoietin production and blood loss, and not with iron deficiency, so iron supplements do not prevent it in the very first weeks. Late anemia develops later, closer to three to four months, and here it is the depletion of iron reserves against the backdrop of rapid growth that comes to the fore. It is important to distinguish between these options, because the tactics depend on it: observation and proper nutrition or targeted iron therapy.
- Early form - first weeks, physiological mechanism
- Late form - after 2–3 months, iron deficiency
- Ferritin helps assess iron stores
- Reticulocytes show hematopoietic activity
- Tactics depend on the shape and well-being of the child
Survey
The main analysis is a clinical blood test with determination of hemoglobin, hematocrit and erythrocyte parameters; For premature babies, it is repeated according to the schedule prescribed by the doctor. The reticulocyte count reflects how actively the bone marrow is producing new red blood cells. Ferritin and serum iron assess stores, and ferritin can be falsely elevated during inflammation, and this is taken into account. Bilirubin is checked to exclude increased breakdown of red blood cells. If the picture is unusual, severe anemia or poor response to treatment, the child is referred to a hematologist.
- Clinical blood test and hematocrit
- Reticulocytes
- Ferritin and serum iron
- Bilirubin to exclude hemolysis
- Assessing weight gain and nutrition
- Consultation with a hematologist for an atypical course
Treatment and prevention
In mild cases, observation and adequate nutrition are sufficient: breast milk with fortifier or a specialized formula for premature infants as prescribed by a doctor. Iron supplements are usually started from the second to fourth month and continue with the course, the dose is calculated by the pediatrician based on weight - you cannot give iron yourself, its excess is harmful. Measures to reduce unnecessary blood draws and delayed cord clamping at birth are helpful. Red blood cell transfusions are used only for severe anemia with obvious symptoms. Monitoring vitamin D and timely introduction of complementary foods rich in iron according to age are also important.
- Breast milk with fortifier or special formula
- Iron supplements as prescribed by a doctor
- Accurate dose calculation based on the child’s weight
- Delayed cord clamping at birth
- Reduce unnecessary blood draws
- Transfusion of red blood cells only for severe anemia
- Complementary feeding with iron-rich foods by age