ANEMIA IN THE PREMATURE INFANT
Saturday, August 16, 2008
General Considerations
In the premature infant, the hemoglobin reaches its nadir at approximately 8–12 weeks and is 2–3 g/dL lower than that in the term infant. The lower nadir in premature infants appears to be the result of a decreased erythropoietin response to the low red cell mass. Symptoms of anemia include poor feeding, lethargy, increased heart rate, poor weight gain, and perhaps apnea.
Treatment
The decision to transfuse is based on the presence of clinical symptoms. Transfusion is not indicated in an asymptomatic infant simply because of an arbitrary hematocrit number. Most infants become symptomatic if the hematocrit drops below 20%. With risks of transfusion, alternative therapies have been explored. Epoetin alfa, 150–250 units/kg subcutaneously three times per week, has been shown to increase hematocrit and reticulocyte count and to decrease the frequency and volume of transfused blood. This treatment should be reserved for the highest-risk infants (those born at less than 28–30 weeks’ gestation and below 1000–1200 g). For optimal effect, supplemental iron at a dosage of 4–8 mg/kg/d should be given. Treatment should start when infants are taking at least two thirds of their nutrition enterally and should continue through 36 weeks’ postconception.
In the premature infant, the hemoglobin reaches its nadir at approximately 8–12 weeks and is 2–3 g/dL lower than that in the term infant. The lower nadir in premature infants appears to be the result of a decreased erythropoietin response to the low red cell mass. Symptoms of anemia include poor feeding, lethargy, increased heart rate, poor weight gain, and perhaps apnea.
Treatment
The decision to transfuse is based on the presence of clinical symptoms. Transfusion is not indicated in an asymptomatic infant simply because of an arbitrary hematocrit number. Most infants become symptomatic if the hematocrit drops below 20%. With risks of transfusion, alternative therapies have been explored. Epoetin alfa, 150–250 units/kg subcutaneously three times per week, has been shown to increase hematocrit and reticulocyte count and to decrease the frequency and volume of transfused blood. This treatment should be reserved for the highest-risk infants (those born at less than 28–30 weeks’ gestation and below 1000–1200 g). For optimal effect, supplemental iron at a dosage of 4–8 mg/kg/d should be given. Treatment should start when infants are taking at least two thirds of their nutrition enterally and should continue through 36 weeks’ postconception.
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