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Anemia in Premature Infants

Even as medicine is getting better at helping premature infants survive and thrive, these early arrivals often have initial challenges, one of which is called anemia of prematurity. Premature infants are those born at less than 37 weeks gestation.

Anemia refers to a reduced number of red blood cells in the baby’s body. Red blood cells (RBCs) are vital because they carry nutrients and oxygen to the organs of the body. Without enough RBCs, a baby’s cells cannot function properly. A number of factors can cause anemia in a premature baby. These include:

Insufficient RBC production, due to lack of erythropoietin (obtained during the third trimester), a hormone necessary to make RBCs.

Frequent blood draws and sticks for laboratory testing, resulting in blood loss.

Infant RBCs having a shorter-than-usual lifespan than adults.

In rare instances, anemia can indicate internal bleeding.

In addition to blood tests such as a complete blood count (CBC) that indicate anemia, a baby may show outward signs of reduced red blood cells. These include pale skin (pallor), rapid breathing (tachypnea), fast heart rate (tachycardia), poor weight gain (failure to thrive), and difficulty feeding.

Treatment for anemia in premature infants depends upon the severity. For example, some infants need time and observation to allow their bodies to develop enough to produce RBCs on their own. However, infants with extremely low blood counts may require blood transfusions. For example, an estimated 90 percent of extremely low birth weight infants (those weighing less than 1,000 grams) receive one or more red blood cell transfusions, according to the journal Blood Reviews.

Typically, there is no set laboratory value to determine when a blood transfusion is needed. Instead, an infant’s medical team will take the baby’s symptoms and lab values into account. Transfusions are typically given slowly and in very small volumes to prevent adverse effects.

Another treatment option is giving an infant recombinant erythropoietin (EPO), a medication that encourages RBC growth. Iron, vitamin E, folic acid, and dextran are other medications that also may encourage RBC growth.


  •  KidsHealth
  • A Primer on Preemies.
    March of Dimes
  • Your Premature Baby.
  • Anemia of Prematurity.
    Strauss, Dr
  • Ronald
  • Anaemia of Prematurity: Pathophysiology & Treatment
  • Blood Rev
  • November 2010; 24(6): 221-225.
    UCSF Children’s Hospital
  • Neonatal Anemia.

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