Anemia of 1 degree in a newborn that. Symptoms and treatment of anemia in infants. The severity of the disease

Low hemoglobin in an infant, the symptoms of which are the reason for the diagnosis of iron deficiency anemia, is often presented to parents as an unpleasant “surprise”. How to recognize characteristic anemic conditions right away so as not to allow pathological iron deficiency to affect the development of the child? Is it enough to just monitor his health, or do you need to immediately consult a doctor?

The answer to these questions will be unambiguous.- parents must definitely know how the disease manifests itself, pay attention to the primary symptoms and worry about obvious signs of acute pathology.

WHAT IS LOW HEMOGLOBIN (ANEMIC SYNDROMES) IN A NEWBORN

Breast anemia is a pathological condition that manifests itself in a sharp decrease in the level of hemoglobin in the blood and is complicated by iron deficiency.

Red blood cells, called erythrocytes, supply oxygen to all tissues of the body and are 98% hemoglobin (a complex iron-containing protein). That is, hemoglobin is essentially a symbiosis of iron and protein. Therefore, a decrease in its quantitative indicators affects the state of organs and systems, general oxygen starvation develops, and, as a result, the child will be diagnosed with "iron deficiency anemic syndrome".

Low hemoglobin in an infant (symptoms for different clinical stages, stages and forms of the disease will be described below), most often characteristic of children who are exclusively breastfed (without the introduction of complementary foods at the age of 3 months). And also for those babies who have inherited "maternal" chronic diseases in the prenatal period.

REDUCED HEMOGLOBIN IN A NEWBORN: SYMPTOMS OF THE STAGE-BY-STEP DEVELOPMENT OF THE DISEASE

In the process of development, anemia of newborns goes through three main stages. Typical signs of the disease vary depending on the severity of iron deficiency:

• Prelate iron deficiency: characterized by depletion of iron stores in the tissues of the vital organs. But at the same time, hemoglobin indicators to peripheral blood remain within normal values. Quantitatively, the iron in the tissues is constantly decreasing, and what comes with food is not absorbed, which leads to a cyclic closed process: hemoglobin begins to fall. Iron cannot be absorbed due to decreased intestinal fermentation activity.
• Latent iron deficiency: the child's body begins to lose the deposited reserves of the element. At this stage, signs of anemia in infants: a sharp decrease in the amount of iron in the blood serum.
• Acute iron deficiency: This is the most dangerous stage of iron deficiency. Hemoglobin drops to the minimum critical level. The number of red blood cells in the blood decreases. From this moment on, the child is diagnosed with iron deficiency anemia.

ANEMIA AT BREAST: SYMPTOMS

Astheno-neurotic syndrome can be considered a characteristic sign of iron deficiency anemia in children under the age of 1 year. How is it expressed? The child becomes irritable, overly excitable, emotionally unstable. Constant nervous activity leads to a lag in terms of physical development, psychomotor functions fade away, the speech part disappears, the baby stops gurgling. Over time, the patient becomes lethargic, gets tired quickly and sleeps most of the time.

Decreased hemoglobin in an infant, whose symptoms are perceived by doctors as anemic signs, leads to the development of epithelial syndromes. Outwardly, it looks like lightening and paleness of the mucous membranes and skin. A clearly visible nasolabial triangle appears, the auricles become cyanotic. On the skin of the face and body of the child, depigmented areas appear, they flake off and may itch. There is visible dryness of the skin, hair and nails are brittle.

In children over 6 months of age, a decrease in the hemoglobin level is characterized by low-symptom caries, changes in taste preferences, a non-standard reaction to habitual odors, loss of appetite and various disorders in the gastrointestinal tract. Without proper treatment, anemia leads to intestinal bleeding.

The disease transforms and begins to affect the physiological functions of the body. Signs of low hemoglobin in infants: pronounced muscle syndromes. In addition to delays in physical development, arising as a result of psychomotor retardation, the child suffers from weakness of the sphincters. This usually manifests itself as enuresis. This is very dangerous, since the parents of the baby do not give this fact due attention, taking the manifestation of iron deficiency for an adequate physiological process of emptying the bladder.

Cardiovascular syndromes: increased heart rate, shortness of breath, progressive hypotension. The ECG shows functional systolic murmurs. The local immune defense is reduced, and the barrier tissues no longer function adequately. The baby is prone to colds, prone to infectious pneumonia.

There is an increase in the size of some organs of the hematopoietic system: the spleen and liver.

LOW HEMOGLOBIN IN BREAST: CLINICAL SYMPTOMS.

Diagnostically important signs of anemicity can be detected using several laboratory tests. The presence of the disease is indicated, first of all, by indicators of the level of hemoglobin and erythrocytes contained in the blood. To establish the correct diagnosis, focusing on external symptoms, the doctor must know what type of blood was taken from the baby for analysis.

Anemia in newborns (symptoms of characteristic conditions) is assessed based on the age of the child. It is important: the indicators of arterial hemoglobin will be slightly higher than venous even in completely healthy children - and this is not considered a pathology.

In clinical practice, blood from a vein is used to monitor for signs of iron deficiency anemia. But a decrease in the level of hemoglobin is not regarded as the only sure sign of the disease. Such indicators as the threshold value of the average concentration of hemoglobin per erythrocyte, color markers, erythrocyte volume, and the amount of iron contained in the blood serum must be taken into account.

To establish the pathology, preliminary treatment is required. The baby is given iron supplements and then the tests are repeated. If anemia in an infant, the symptoms of which are described above, continues to progress, then the baby is placed on a hematological dispensary registration and receives a referral for more accurate analyzes necessary to establish the type, degree and form of the disease based on the available clinical signs.

How is low hemoglobin manifested in infants and what should parents do to identify iron deficiency? There is one simple test, but it is only suitable for children from 7 to 12 months, after they have introduced vegetable complementary foods into their diet. It is enough to give the child a small amount of freshly grated beets and see the result when emptying the bladder.

In anemic children, urine will certainly turn red and this will be a clear indication of iron deficiency. In healthy children, the liver, which receives enough iron from the blood, will make the natural beetroot dye colorless, so it will not be visible in the urine.

ANEMIA IN NEWBORNS: CAUSE AND EFFECTIVE SIGNS

To differentiate the condition of the baby based on the external signs of iron deficiency, it is imperative to establish the cause of anemia in each individual case. Why is it important? Focusing on nosological diagnostics makes it possible not only to eliminate the main symptoms of the disease, but also to influence the main pathological process.

IDA (iron deficiency anemia in infants) has symptoms in common with many third-party diseases. Even the classic signs of a lack of hemoglobin, such as cyanosis and pallor of the skin, conjunctivitis and rhinitis, cannot serve as a sufficient basis for a diagnosis without laboratory evidence. In addition, attentive parents may notice atypical manifestations of anemicity in their baby.

Low hemoglobin in a newborn, atypical symptoms:

• Excessive sweating, even during a night's sleep.
• Superficial sleep, upon awakening, the child looks sluggish, moody and excitable.
• Frequent regurgitation, regardless of time, abundance and type of feeding.
• Vomiting after eating.
• Loss of vision function.
• Inability to hold even a light toy in your hands. Refusal to play.
• Regression of motor skills - the symptom is observed only in children under the age of 12 months.

By the second half of life in anemic children, in the absence of proper treatment and hematological control, the condition worsens, and the spectrum of symptoms of iron deficiency becomes wider. First, angular stomatitis develops, which is characterized by the appearance of painful and weeping cracks in the corners of the mouth. After the disease progresses to the stage of glossitis and atrophy of the mucous membranes in the oral cavity.

Critically low hemoglobin in infants, symptoms:

• Roughness of the skin, outwardly it looks like cutis anserina, that is, a chronic condition of "goose bumps".
• Nails and hair become dull, and against the background of general discoloration of the skin, this is a very important diagnostic criterion.
• Not only teeth affected by low-symptom caries are destroyed, but also healthy ones. Their growth slows down, and the gums can swell and bleed.

The nervous system is also involved in the process: the baby suffers from headache, dizziness, disorientation, short-term loss of consciousness. In acute iron deficiency, the condition may be complicated by orthostatic hypotension. Acute anemia is expressed in a violation of the swallowing processes, constipation, a perversion of taste, in which a grown-up child seeks to eat inedible things, for example, earth.

Decreased hemoglobin in infants (the symptoms are multifaceted and still not fully typified) is taken by parents for granted and often signs of anemicity are simply not regarded as a disease.

The pallor and cyanosis of the skin is attributed to the fragility of the infant organism, altered states of internal organs - to normal deformation during development, and low red blood cell and hemoglobin counts - to poor appetite, hyperactivity or the cold season. But the disease is extremely dangerous and can cause severe chronic conditions.

Deficiency conditions in newborns and in children under one year old are quite dangerous. Anemic syndrome can be the beginning of the development of persistent disorders in the internal organs. With an untimely start of treatment, such conditions lead to the development of dangerous adverse consequences in the future.

What it is?

Hemoglobin plays an important role in the child's body. With its help, nutrients and oxygen are transferred to the cells of the body. Violation of the transport function as a result of a decrease in the amount of hemoglobin leads to the appearance of tissue oxygen starvation or hypoxia. This condition is dangerous because after some time persistent destructive changes begin to occur in the internal organs.

Causes

Various factors lead to the appearance of anemic syndrome. They can be either congenital or acquired in the first months after birth. Various reasons cause a decrease in hemoglobin, which leads to an anemic state in the baby.

Anemia can be caused by the following reasons:

Increased destruction of hemoglobin. It arises as a result of pathologies in the hematopoietic organs. It is most common in diseases of the liver, spleen and bone marrow, which are severe and require urgent treatment.

Heredity. As a result of genetic abnormalities, the process of formation of red blood cells - hematopoiesis - is disrupted. The number of newly formed erythrocytes is too small. They are not enough to perform basic oxygen transport functions. This leads to the development of persistent tissue hypoxia and oxygen starvation of internal organs.

Prematurity. In prematurely born babies, due to incompletely formed hematopoietic organs, an impaired synthesis of erythrocytes is observed. This leads to the fact that the child's body does not produce the required amount of red blood cells. An insufficient content of red blood cells leads to a low concentration of hemoglobin, which means it provokes the development of anemia.

Multiple pregnancy. Twins or triplets may have lower hemoglobin levels after birth. The more body weight in future babies during intrauterine development, the higher the risk of developing an anemic state in the first days after their birth.

Eating disorders. If a child has chronic diseases of the gastrointestinal tract or the development of individual intolerance to certain foods during complementary foods, the first anemic manifestations may develop.

Fast refusal of breastfeeding and transition to artificial formula. Scientists have proven that breast milk contains a sufficient amount of all substances necessary for the growth and development of a baby, including iron. With a quick refusal from breastfeeding and the wrong selection of adapted formulas, the baby may experience various deficiencies, which ultimately lead to the development of anemic syndrome.

Congenital tumors. In the presence of such formations, a rapid and persistent development of anemic syndrome occurs. Quite often, only a decrease in the level of hemoglobin or red blood cells makes it possible to suspect the presence of a tumor in a baby.

Congenital pathologies of the digestive system. The presence of anatomical defects in the structure of the stomach or intestines can lead to impaired absorption of iron, folic acid and vitamins from the incoming food. Ultimately, this condition leads to the development of anemia.

A different Rh factor in a baby and a mother. In this case, hemolytic anemia develops. As a result of the immune response, damage to the red blood cell occurs. Its outer shell breaks through and the whole structure of the red blood cell is disrupted. This leads to a strong decrease in hemoglobin in the blood.

Severity classification

The quantitative determination of hemoglobin is used by doctors to establish the prognosis of the course of the disease. A level above 110 g / liter is considered a normal indicator. A decrease in hemoglobin below this indicator should cause fear in parents and force them to see a doctor.

In terms of severity, all anemic conditions in infants can be divided into:

Decrease of 1 degree. The hemoglobin level is above 90 g / liter, but below 110.

Reduction of the 2nd degree. Hemoglobin level from 70 to 90 g / liter.

Reduction of 3 degrees. The hemoglobin level is between 50 and 70 g / liter.

Reduction of the 4th degree. Hemoglobin level below 50 / liter.

Views

Taking into account the various reasons that provoke the development of anemias, several options can be distinguished:

Iron deficient. Associated with insufficient intake of iron into the body from the outside. Most often it occurs due to the refusal of breastfeeding and the use of improperly selected mixtures, as well as the presence of chronic diseases of the digestive system in the baby. Most often it is hypochromic, that is, with a reduced color index.

Hemolytic. They arise as a result of exposure to various causes that lead to the death of red blood cells. Most often found with different Rh factors in mothers and children during pregnancy, as well as during intrauterine infection with various viral infections.

Folic acid deficiency. They arise as a result of insufficient intake of folic acid. Can be congenital or acquired. Quite often, they proceed in a latent form and are difficult to diagnose.

B12 is in short supply. Associated with an insufficient content of vitamin B12 in the blood. They are found in the presence of diseases of the digestive system, as well as during helminthic invasions. Eliminated by parenteral administration of drugs.

In premature babies, doctors distinguish several types of anemic conditions. With the development of anemic symptoms at 3-4 months of life, such anemia is called late, at an earlier age - early. This division allows the diagnosis to be made as accurately as possible.

Symptoms

It is quite difficult to suspect an anemic condition in a baby with a mild course of the disease. The most specific signs appear only when the hemoglobin content is significantly lower than the age norm.

The most common symptoms of anemia are:

Lagging in physical development. Poor weight gain can be noticed in babies as early as 3 months. The child develops more slowly, does not gain weight well and looks different than his peers.

Decrease in blood pressure.

Exposure to frequent colds. The presence in the medical card of a 9-month-old baby of information about 5-6 transferred infectious diseases should alert the attending physician.

Decreased appetite, distortion of eating habits. Toddlers can skip certain foods entirely. In some cases, they may like combinations of products that are absolutely incompatible at first glance.

Pale skin. With a severe course of the disease, the lips of the child acquire a blue tint. The skin becomes transparent and pale, veins are well translucent.

Severe dryness of the skin. Even despite the use of various moisturizing and nourishing products, the child's skin remains very dry and easily injured.

Small cracks in the corners of the mouth.

General weakness, decreased activity, increased drowsiness.

Behavior change. Babies become more restless, fall asleep poorly, and may refuse breastfeeding.

Stool disorders. Most often - a tendency to constipation. However, with some forms of anemia, diarrhea can also occur.

Consequences

Anemia is dangerous by the development of distant manifestations. With prolonged oxygen starvation, many internal organs do not receive the required amount of oxygen they need to perform all the necessary vital functions. This leads to the appearance of persistent and pronounced violations.

Oxygen starvation is most dangerous for the heart and brain. Prolonged anemia leads to the development of myocarditis. This condition is manifested by the appearance of various cardiac arrhythmias. Most often, babies experience severe tachycardia or arrhythmias.

Treatment

Various drugs are used to treat anemic conditions. If the process is caused by iron deficiency, then iron-containing drugs are used. They can be administered as tablets, syrups, and suspensions. In some cases, if the baby has erosive processes in the stomach or intestines, such drugs are prescribed in the form of injections.

Treatment of anemia is long-term. It takes several months to normalize the hemoglobin level to normal. The first result of the treatment can be assessed only after 2-3 months. For this, a general blood test is performed. The appearance of reticulocytes indicates the activation of the process of hematopoiesis and is a favorable symptom of improving well-being.

If the cause of anemia is a congenital defect in the bone marrow or spleen, then in many cases surgery is required. Usually, operations are performed at an older age. However, if the baby has cancer and a bone marrow transplant from a donor is required, then it may need to be performed immediately.

Prophylaxis

Compliance with preventive measures should begin already during the pregnancy of the expectant mother. Often, babies are born with signs of anemic conditions that have arisen as a result of various pathologies of the mother in the process of gestation. Controlling the correct and healthy course of pregnancy helps prevent various congenital pathologies of the hematopoietic organs.

After the baby is born, it is important to try to keep breastfeeding for as long as possible. Mother's milk contains all the essential nutrients in the right concentrations.

The introduction of the first complementary foods should be carried out taking into account the age of the baby. By the age of one year, a child's diet must include most of the animal and plant foods. Buckwheat, beef, poultry, various cereals, vegetables and fruits should become daily components of the children's menu.

Preventing the development of anemia in a baby in the first year of life is a very important task. A child needs a normal hemoglobin level for proper growth and development.

Why is there a lack of iron in the baby's body? Kapitonova Eleonora Kuzminichna, Doctor of Medical Sciences, talks about this reason.

Anemia in infants is not uncommon, however, as a rule, such a diagnosis scares his parents.

Decreased hemoglobin and a decrease in the number of red blood cells in human blood is called "anemia". This concept is quite capacious, since it includes various in nature, reason for the occurrence and severity of the state of hematopoiesis disorders, namely the production of red blood cells.

Types of anemia in children of the first year of life

In medical science, anemia is divided into three degrees, depending on the severity of the disease, that is, on the number of red blood cells and hemoglobin per unit volume of blood.

1. Light degree - more than 90 g / l.
2. Average degree - 70.0 to 90.0 g / l.
3. Severe degree - less than 70 g / l.

The so-called iron deficiency anemia of newborns is also distinguished, which, first of all, occurs due to improper nutrition of the expectant mother during the period of gestation, which leads to a weak supply of iron in the newborn.

Hemolytic anemia of newborns occurs against the background of Rh-conflict incompatibility between the maternal organism and the fetus.

Also, the cause can be intrauterine infection with toxoplasmosis, rubella, herpesvirus infection.

What are the reasons

Most often, young children are diagnosed with anemia caused by iron deficiency, it is also called hypochromic anemia.

The main reasons for the occurrence of such a violation include the following:

• Violation of the principles of a balanced diet.
• Inappropriate nutrition of the mother during the period of gestation, which led to an insufficient supply of iron in the baby after his birth.
• Immaturity of systems and organs as a result of prematurity.
• Early abandonment of the breast and the transition to artificial nutrition.
• Acute inflammatory processes.
• Diseases of the gastrointestinal tract.
• Infectious diseases in acute form.

Symptoms

Anemia in babies has its own characteristic signs due to the fact that there is a violation of oxygen access to the tissues of the body.

1. The baby's skin acquires a characteristic pallor and dryness.
2. Babies with anemia often suffer from stomatitis, and cracks appear in the corners of their lips.
3. Frequent constipation is also one of the symptoms, since with anemia, indigestion is more a pattern than a coincidence.
4. In a child suffering from anemia, you may notice inactivity and fatigue.

These symptoms should at least alert parents. They are a reason to contact the attending doctor for advice, he will give a referral for a general blood test of the child to confirm or exclude this diagnosis.

Do I need to treat

The deviation of the number of red blood cells in the blood from the norm must be treated. The thing is that erythrocytes and hemoglobin perform an essential function in the human body - they transport oxygen to all cells and, accordingly, body tissues. Lack of oxygen affects the functionality of cells in the most negative way.

Treatment and prevention

1. The treatment of this ailment should be carried out under the supervision of an experienced doctor, who, first of all, will prescribe the necessary examination of the child, on the basis of which he will write a treatment regimen, prescribe medications to correct the iron level.
2. Iron supplements are recommended to be taken between feedings. They should not be given to the baby with milk, since milk protein interferes with the absorption of iron.
3. When treating infants, the best option is to administer iron in its liquid form. Most often, the dose is calculated according to the formula 3 mg per 1 kg of the child's weight. This will be the daily dose.
4. Such therapy, as a rule, allows you to quickly bring hemoglobin to the desired parameters. But with all this, the course of treatment is from 2 to 6 months (at the discretion of the treating doctor). This is necessary in order for the child's body to be able to make the necessary supply of iron.
5. If the baby is diagnosed with severe anemia, the doctor may prescribe iron injections.

What to feed

A balanced child's diet is one of the keys to successful treatment.

D50 Iron deficiency anemia

P55 Hemolytic disease of fetus and newborn

Epidemiology

The statistics on the prevalence of anemia suggests that about 5% of newborn babies encounter this problem in the first month of life, and more than 40% of cases of anemia are etiologically associated with problems of pregnancy and childbirth. The prevalence of iron deficiency anemia ranges from 0.9% to 4.4%, depending on race, ethnicity and socioeconomic status, but accounts for only about 40% of the total number of anemias in young children. The remaining 60% are hemolytic and aplastic anemias.

Causes of anemia in a newborn

Most of the anemias encountered today are iron deficiency anemias. Other anemias are congenital aplastic, hemolytic anemias also occur, but much less often and with a brighter clinical picture.

To understand the causes of anemia in newborn babies, you need to consider the role of iron in the blood. To simplify the scheme, we can imagine that iron is in the center of the heme molecule, which is externally surrounded by a protein called globin. This is how hemoglobin itself is built, which is the basis for the erythrocyte. It is hemoglobin that is responsible for binding oxygen molecules in the lungs and transporting such a complex throughout the body, to every cell that requires oxygen. With a decrease in the level of iron, the level of heme also decreases, so red blood cells cannot bind oxygen, which is the basis for the development of anemia and its manifestations. This is why it is so important for a newborn baby that the mother, and then he has a sufficient amount of iron.

Adequate iron is a condition in which the iron content is sufficient to maintain normal physiological functions, in which case a pregnant woman should take into account the double need for it.

Iron deficiency is a condition in which the iron content is insufficient to maintain normal physiological functions. Iron deficiency is the result of insufficient iron absorption to meet the increased needs of the mother during pregnancy, or is the result of prolonged negative iron balance. Either situation leads to a decrease in iron stores, which is determined by measuring the concentration of ferritin in the blood serum or the iron content in the bone marrow. Therefore, iron deficiency in a mother during pregnancy is the first and main cause of iron deficiency anemia in a newborn, regardless of the gestational age.

The deficiency of total iron in the body in premature infants is the greater, the younger the gestational age. It is exacerbated by the rapid postnatal growth seen in many children and by frequent phlebotomies without adequate blood replacement.

Of the iron in the newborn's body, 80% accumulates during the third trimester of pregnancy. Babies who are born prematurely lose this period of rapid growth and are deficient in total body iron. A number of maternal conditions, such as anemia, hypertension with intrauterine growth restriction, or diabetes during pregnancy, can also lead to a decrease in fetal iron stores in both term and premature infants.

The concept of breastfeeding is very related to this, since breast milk contains as much iron as the baby needs in his first five months of life. And if a child does not breastfeed immediately after birth, then this may be one of the main reasons for the development of anemia in him.

Among other reasons for the development of anemia in a newborn, which may be associated with pregnancy and childbirth, pathology of the intranatal period can be attributed. Fetoplacental transfusion and intrapartum bleeding due to birth trauma and abnormal development of blood vessels of the placenta and umbilical cord can lead to significant blood loss in the mother. This continuously affects the formation of red blood cells in the child.

Anemia can also develop for other reasons, which are more serious and associated with the pathology of iron intake in the newborn's body due to organic pathology. Impaired absorption of iron can be observed with malabsorption syndrome, congenital intestinal obstruction, short bowel syndrome. All this leads to the secondary development of anemia. Iron loss in significant amounts can be observed with bleeding of various etiologies. In newborns, this is most often bleeding from the navel or intestinal bleeding with hemorrhagic disease.

Although iron deficiency is the main cause of anemia, there are other anemias that a newborn may have. These include congenital aplastic anemias and hemolytic anemias.

Aplastic anemia is a condition characterized by a decrease in hemoglobin levels due to a disruption in the formation of red blood cells in the bone marrow. In newborns, aplastic anemias are more often congenital. The main cause of congenital aplastic anemia can never be pinpointed. Children are born already with pathology, and the reason cannot be precisely determined. Risk factors include ionizing radiation, genetic mutations, medicines, viral and bacterial agents, and more.

The pathogenesis of the development of aplastic anemia is based on a violation of the development of the stem cell, which gives rise to all blood cells. And depending on which germ is involved, there may be a decrease in the level of other blood cells.

Hemolytic anemia occurs in a child more often due to hereditary causes. This is due to a mutation in a gene that is responsible for the structure of the erythrocyte cell. Therefore, its membrane cannot function normally and periodically it collapses, which is called hemolysis. The most common Minkowski-Shoffard anemia in newborns. This anemia occurs due to a genetic mutation of the erythrocyte membrane proteins spectrin and ankyrin. Therefore, the main cause of anemia in this disease is a violation of the cell membrane due to a lack of these proteins.

Anemias in newborns have similar clinical manifestations, but it is imperative to know the cause and understand the pathogenesis of development for the correct treatment tactics.

Symptoms of anemia in a newborn

Speaking about the clinical manifestations of anemia, you need to understand the stages of its development. If we are talking about iron deficiency anemia, then it has its own stages of development. At first, the baby is born absolutely healthy, because immediately after birth, he has a physiological increase in the level of red blood cells. But at this time, the number of red blood cells that should be formed in the bone marrow decreases due to a lack of iron. This corresponds to the latent or latent stage of anemia. At the same time, there are no clinical manifestations yet, but the lack of iron leads to a critical decrease in hemoglobin and erythrocytes.

The next stage - long-term iron deficiency leads to the appearance of clinical symptoms, so this is an obvious stage of anemia.

It is very difficult to identify the symptoms of anemia in a newborn baby, especially for a mother. Since the child is still very young and he sleeps most of the time, the mother does not notice any signs. It also often happens that the child develops physiological jaundice, which can make it difficult to see the symptoms. This proves the importance of preventive examinations of the child during this period.

The first signs of anemia differ depending on the etiology. Iron deficiency anemia in newborns is the most common, and its first symptom is the pallor of the skin and mucous membranes of the child. All newborn babies are usually red at first, and then pink, and with anemia they are a little pale. This symptom is highly subjective, but it can be the first sign of anemia.

Other clinical manifestations may already be associated with severe hypoxia caused by a lack of oxygen. This can be the appearance of cyanosis of the skin and shortness of breath during feeding, anxiety for the baby.

All the symptoms of anemia can be generalized and distinguished into several groups. The main syndromes for anemia in newborns are anemic-hypoxic and sideropenic, and speaking of hemolytic anemia, hyperbilirubinemia syndrome is also added.

The first syndrome occurs due to a lack of oxygen and is manifested by pallor, especially mucous membranes, poor health, decreased appetite, and lack of strength. All this in a child is manifested by the fact that he eats poorly and does not gain weight. Sideropenic syndrome occurs due to a malfunction of enzymes that depend on oxygen. This disrupts the work of all cells and is manifested by dry skin against a background of pallor, in newborns the fontanelle is poorly overgrown, there is no muscle hypertonicity inherent in them, but on the contrary, hypotension occurs.

Hemolysis syndrome occurs due to increased breakdown of red blood cells in the vascular bed, which causes the release of bilirubin and an increase in its concentration. Then, against the background of anemia and all of the above symptoms, a yellow coloration of the child's skin and sclera occurs. Hemolytic anemia in a newborn is most often of a genetic nature. One of the types of such pathology is Minkowski-Shoffard anemia. Some of the family members have this disease, which makes the diagnosis a little easier. All syndromes are the same, and it is important not to confuse jaundice with physiological anemia with such hemolytic anemia.

Congenital anemia in newborns is more often aplastic in nature and is the most severe type of anemia. There are several types. One of them is Blackfan-Diamond anemia. With this pathology, it is the number of red blood cells that decreases due to the defeat of this growth in the red bone marrow. In the first month of life, it rarely spills, clinical signs are more visible closer to the sixth month of life.

Congenital Estren-Damesek anemia is a decrease in the level of all bone marrow cells. Therefore, in addition to anemia and hypoxia, there will be bleeding and early infectious lesions. Another type of aplastic congenital anemia is Fanconi's anemia. Symptoms of this disease, in addition to anemic, are congenital malformations in the form of microcephaly, other malformations of the skull, underdevelopment of fingers, underdevelopment of internal organs.

It is also necessary to highlight conditions in which a decrease in the amount of hemoglobin can also be observed - this is anemia in premature newborns. This is caused by the immaturity of the bone marrow and unpreparedness for breathing through the lungs. This is considered normal and such anemia can resolve on its own without treatment. Physiological anemia of a newborn can also occur in a full-term baby, and the exact cause has not been established. This may be due to the destruction of fetal hemoglobin and low dynamics of the growth of hemoglobin type A, as in an adult. This condition should also not cause concern and is transient.

The consequences of anemia in a newborn can be very serious if the pathology was not noticed in time. After all, constant hypoxia leads not only to a lack of body weight, but also a lack of oxygen affects the brain. It is known that iron is essential for the normal development of the nervous system. Iron deficiency anemia affects neuronal energy metabolism, neurotransmitter metabolism, myelination, and memory function. Therefore, anemia in the neonatal period can cause irreversible memory dysfunctions, delayed psycho-motor development, behavioral abnormalities and speech delays in the future. For other complications, anemia increases the risk of other infectious diseases. The consequence of not timely diagnosed hemolytic anemia may be brain damage and the development of bilirubin encephalopathy.

Stages

Tests also allow you to classify anemia by severity:

1. the first degree - the level of hemoglobin within 120 (110) - 91 T / L;
2. second degree of anemia - 90 - 71 T / L;
3. third degree - hemoglobin level 70-51 T / L;
4. fourth degree - hemoglobin level less than 50 T / L.

Grade 1 anemia in a newborn is considered mild and may be a sign of physiological processes, but it definitely requires monitoring and observation. Mild anemia in a newborn premature baby can also be regarded as transient and requires monitoring.

Diagnosis of anemia in a newborn

The main criterion for anemia is undoubtedly laboratory confirmation of a decrease in the level of hemoglobin and red blood cells. But the main task of the mother and the doctor is the timely diagnosis of anemia, so it should begin with general clinical signs. The pallor of the skin and mucous membranes should already suggest a possible anemia. If the child is not gaining weight well, then you also need to look for the cause and think about the anemia. It is important to ask the mother about pregnancy and childbirth, whether she took vitamins and whether there was massive blood loss. All these thoughts can lead to a diagnosis. Even if the baby is premature, then, in most cases, he has a latent iron deficiency and this is potentially dangerous for the development of anemia in the future.

On examination, in addition to pallor, there may be a systolic murmur at the apex of the heart on auscultation, which also requires attention. This is due to the turbulence of the blood flow at a low concentration of red blood cells relative to the liquid part of the blood. There are practically no other objective symptoms.

Laboratory diagnosis of anemia is the most accurate and necessary for an accurate diagnosis. A general blood test allows you to establish a decrease in the level of red blood cells and hemoglobin. And such a diagnostic number is:

1. a decrease in hemoglobin levels below 145 T / L in children during the first two weeks of life;
2. hemoglobin level less than 120 T / L in newborns after the second week of life;
3. in children under five years old, less than 110 T / L;
4. in children after five years - less than 120 T / L.

In a general blood test, if anemia is suspected, it is also necessary to determine the level of reticulocytes. These cells are responsible for the formation of red blood cells in the red bone marrow and are their precursors. The reticulocyte count is further required to assess the response to treatment.

To establish the diagnosis of iron deficiency anemia, one or more tests should be added to the determination of the hemoglobin concentration. The three parameters that provide summary information on iron status are ferritin, chromium and transferrin concentrations. Ferritin concentration is a sensitive indicator for assessing iron stores in healthy individuals. Measurement of ferritin concentration is widely used in clinical practice and is available abroad. But in Ukraine, of these indicators, only the transferin level is used.

Today, most blood tests are performed on special analyzers, which allow, in addition to the formula, to assess the size of red blood cells and their structure. In anemia, the average content of hemoglobin in an erythrocyte is reduced, the average size of erythrocytes is reduced, and the average concentration of hemoglobin in an erythrocyte is also below normal.

Among other tests, a microscopic examination of a smear is also carried out, which in case of anemia has characteristic changes in the form of anisocytosis, inclusions and granules in erythrocytes.

If a child has jaundice combined with anemia, then a study of total bilirubin and its value by fractions is mandatory. It is also necessary to exclude hemolytic anemia or differentiation from hemolytic disease of the newborn. The total bilirubin level should be in the range of 8.5 - 20.5 micromolar.

These are the main laboratory parameters that can confirm the diagnosis of anemia and establish the etiology.

Instrumental diagnostics for iron deficiency anemia is not used, but if hereditary hemolytic anemia is suspected, an ultrasound examination is possible. It shows the condition of the spleen, which affects the condition of the child with this pathology and indicates the options for treatment.

Differential diagnosis

Differential diagnosis of anemia should be carried out primarily according to the etiological principle. It is necessary to distinguish between the symptoms of anemia in a child with physiological jaundice and the manifestation of hemolytic anemia. In the first case, a decrease in the level of hemoglobin will be accompanied by an increase in bilirubin below the critical values ​​- this is below 100 micromoles. If we are talking about congenital hemolytic anemia, then bilirubin will be above 100, even up to 250 and above. There will also be blood hyperchromia (an increase in the color index above 1.05).

Treatment of anemia in a newborn

Of course, the approach to the treatment of anemias of different etiology is different. That is why it is so important to know the cause of this or that type of pathology. If we are talking about iron deficiency anemia, which has arisen after prolonged bleeding in a child or as a result of a congenital pathology of impaired iron absorption, then the first step towards treatment is to exclude the cause of the anemia.

Regarding iron deficiency anemia as the most common problem, it should be noted that the main element of treatment for such anemia is the replenishment of iron stores. Therefore, the medications used in treatment are iron preparations. Iron is absorbed most easily from the trivalent form, so iron supplements, especially for newborns, should be in this form. Preparations based on ferric iron are better absorbed, better absorbed and have fewer negative and side effects.

Treatment of anemia begins not with the calculation of the drug, but with the calculation of the dose of iron that the child needs. After all, each drug contains a certain amount of iron, which must also be taken into account when choosing this drug. The therapeutic dose of iron is 3-5 milligrams per kilogram of the child's body weight, which must be taken per day. The minimum treatment period for anemia is one month. Further, if the blood counts are within normal limits, then they give a prophylactic dose for another six months. The prophylactic dose is half of the therapeutic dose, and it is given ten days each month for six months. The medications that are used to treat iron deficiency anemia are as follows:

1. Aktiferin Is an iron preparation, which also contains the amino acid serine, which ensures its better absorption. The drug acts when it enters the intestines and bloodstream by binding to the transferrin protein. So iron is transported to the liver, bone marrow, where it is released and takes part in the synthesis of hemoglobin and in the formation of new red blood cells. The drug is available in the form of drops, syrup and capsules. For newborns, use the form of drops. One milliliter of medicine in this form contains 9.8 milligrams of iron, which corresponds to 20 drops. Therefore, the dosage is calculated first 3-5 milligrams per child's weight, and then the drug itself. Side effects can be in babies in the form of colic, increased gas production, diarrhea or constipation. These are the first signs that indicate the need to reduce the dose of the drug. Precautions - Do not use the drug for hemolytic anemia.
2. Hemoferon- it is also an iron preparation, which additionally contains other vitamins - folic acid and cyanocobalamin. The medicine contains citric acid, which helps the iron molecule to be better absorbed. One milliliter of the drug contains 8.2 milligrams of iron. The dosage of the drug is standard, but for newborns, on average, it is 2.5 milliliters daily. Side effects can be vomiting, digestive and stool disorders, and dark stool staining. Precautions - do not use the drug in case of liver damage in a child or if hepatitis is suspected.
3. Hemofer Is a preparation that contains a ferrous molecule and citric acid. It is most suitable for treatment in which you need to quickly achieve the results of an increase in hemoglobin levels, followed by a switch to trivalent drugs. The dosage of the drug - 1 drop contains 1.6 milligrams of iron, and for newborns about 1 drop per kilogram of body weight. Side effects - decreased appetite and breast refusal, diarrhea.
4. Ferramine-Vita Is a ferric iron preparation that works by the principle of slow restoration of the iron level in the child's body. The drug is available in the form of a solution and its dosage is one to three drops per day for newborns. Side effects are less common than with ferrous iron and may be limited to dyspepsia.
5. Maltofer- This is a preparation of ferric iron, which has a slow absorption in the intestine, and due to this, its physiological concentration in the blood serum is established. The dosage of the drug is 1 drop per kilogram for newborns. The drug in the form of drops can be used by newborns, including premature babies. Side effects can include allergies and stool staining.

Such treatment of anemia with iron preparations is carried out for a month, then preventive therapy is given. It is very important during this period if a mother is breastfeeding a child, then her nutrition should contain the maximum amount of iron and all useful microelements. If the baby is bottle-fed, then it is necessary that the formula also be fortified with iron. It should be said that in the presence of anemia, the cause of which is in the violation of iron absorption, it is necessary to use its injectable forms. The same applies when the child has had stomach or intestinal surgery and oral iron cannot be used.

It is necessary to evaluate the effectiveness of treatment 7-10 days after the start, when it is necessary to repeat the blood test. At the same time, an increase in the number of reticulocytes will be evidence of a positive dynamics of treatment. An increase in hemoglobin will be observed by the end of the course of treatment in the third or fourth week.

Nursing care for neonatal anemia is very important if the anemia is congenital. If we are talking about hemolytic anemia or congenital aplastic anemia, then it is very important to properly organize the child's day regimen, his nutrition. Considering that complications can be caused by the influence of bilirubin on the central nervous system, it is important that it is the medical personnel who monitor the child. After all, there may be symptoms that threaten the life of the child, and the mother may simply not notice them due to inexperience. Therefore, the issue of inpatient treatment of congenital anemia is so important.

Speaking of the surgical treatment of anemia, it should be noted that severe anemias, in which the hemoglobin level is less than 70, require blood transfusions. This is considered an intervention on a par with a surgical one. Determination of the child's blood group and the Rh factor is mandatory.

Surgical treatment of congenital hemolytic anemia is carried out for children at an older age, closer to five years. It is performed for severe anemia with frequent hemolytic crises. The essence of the operation is to remove the spleen. The spleen is an immunocompetent organ in which the destruction of red blood cells occurs and in hemolytic anemia it is permanent. Therefore, splenectomy results in fewer flare-ups as fewer red blood cells are destroyed. But before such an operation, the child must be vaccinated outside the plan, since such an operation violates the normal immune status.

Vitamins for a child with anemia are considered a must, as it increases the absorption of iron and has a good effect on appetite. For newborns, vitamins from the carnitine group can be used, which contribute to weight gain, which is important in case of anemia. One of these drugs is Steatel.

Steatel is a vitamin containing the metabolically active substance levocarnitine. It promotes the assimilation of biologically useful substances and accelerates metabolism in cells, which especially affects the synthesis of new erythrocytes. The drug is available in the form of a syrup. One milliliter of syrup contains 100 milligrams of the substance, and the dosage is 50 milligrams per kilogram. The drug can be used even in premature babies. Side effects can be in the form of stool disorders, colic, convulsive syndrome.

Physiotherapy treatment of anemia in the acute period in newborns is not used.

Alternative treatment of anemia

Of course, a newborn cannot take anything except mother's milk and medicines, because any herbs or traditional medicine can be allergic. Therefore, all folk remedies are aimed at ensuring that a young mother who feeds a child follows the advice of traditional medicine, taking certain remedies.

1. The main thing for the treatment of anemia is to eat right for the mother in order to improve hematopoiesis for both herself and the child. Therefore, if a newborn has iron deficiency anemia, then the mother should include in her diet the maximum amount of foods that contain iron. These products include: red meat, fish, buckwheat porridge, parsley and spinach, legumes, pomegranate. These foods must be included in the diet.
2. Pomegranate is known for its beneficial effect not only on blood vessels, but also on the heart and on the formation of shaped elements. Therefore, to stimulate erythropoiesis, it is necessary to take 150 grams of fresh pomegranate juice, add 50 grams of beet juice and the same amount of carrot juice. You need to take such a vitamin mix four times a day. These foods are very allergenic, so you need to start with a small amount - ten to twenty grams. You can drink for a month.
3. Another folk remedy is the use of blueberry extract. To do this, you need to take two hundred grams of fresh berries and pour 50 grams of water. You need to insist for two hours, and then beat with a blender. Mom needs to take a tablespoon five times a day in the intervals between feedings.

Herbal treatment for anemia is also widely used:

1. Hellebore and yarrow herb should be taken in equal proportions and covered with hot water. This tincture should be allowed to stand for two days, and then you can take a teaspoon in the morning and evening, adding a little lemon juice.
2. Rosehip fruits must be poured with hot water from the top and insisted for ten to twenty minutes. Mom should take a glass throughout the day instead of tea. This tea not only accelerates the synthesis of red blood cells, but also speeds up the liver, which synthesizes proteins, including transferrin. Such a complex action brings recovery closer.
3. Birch leaves must be dried in the oven and made into a decoction. To do this, take thirty grams of dry leaves and pour a liter of hot water. After insisting, two hours later, you can take a tablespoon of decoction twice a day.

Homeopathic remedies can also be used by mom:

1. Natrium chloratum is a homeopathic medicine based on organic elements. It is produced in the form of a monopreparation in granules or in combination with succinic acid, which better affects the absorption of iron. The dosage of the drug for the mother depends on the severity of the anemia - for the first degree, two granules three times, and for more severe ones, the dose is doubled. There may be side effects in the form of pallor of the skin and mucous membranes of the child, which is caused by the action of the drug and will disappear after a few days.
2. Poets is a multicomponent preparation, which mainly consists of different types of antibodies to erythropoietin in homeopathic concentrations. The effect of the drug is to stimulate the work of cells, which are precursors of erythrocytes. The dosage of the drug is 1 tablet per day or six drops once a day. Side effects - an increase in body temperature to subfebrile numbers.
3. Cuprum metalicum is a homeopathic remedy that contains copper molecules that accelerate the maturation of red blood cells in the red bone marrow. The drug is used for the mother in a dose of one grain six times a day. Side effects can only be if the mother is intolerant, and the newborn may have problems with stool.
4. Galium-Hel is a combined homeopathic remedy that is used to treat anemia, which is accompanied by a child's weight loss, poor appetite, and stool disorders in the form of diarrhea. The drug is dosed in five drops three times a day for the mother, since the child is not recommended in the acute period. For the first three days, you can take five drops every three hours. No side effects were found.

Both indicators change rapidly with the maturation of the newborn, so the lower limits of the norm also change. Variables such as gestational age, sampling sites (capillaries or veins), and the position of the newborn relative to the placenta prior to cord clamping (in the lower position, blood enters the newborn; a higher position causes blood to drain from the newborn) also affect test results.

Causes of anemia in newborns

Causes of anemia in newborns include:

• physiological processes,
• loss of blood
• decreased production of red blood cells,
• increased destruction of red blood cells (hemolysis).

Physiological anemia... Normal physiological processes often cause normocytic-normochromic anemia in term and preterm infants. Physiological anemia usually does not require careful evaluation or treatment.

In term infants, the increase in oxygenation that occurs with normal respiration after birth results in a dramatic rise in tissue O 2 levels, resulting in negative feedback for erythropoietin production and erythropoiesis. This decrease in erythropoiesis, as well as the shorter life span of red blood cells in newborns (60-70 days versus 120 in adults), causes a decrease in hemoglobin concentration during the first 2-3 months of life, usually not lower than 9.4 g / dL. The Hb level remains stable over the next few weeks, and then slowly rises until 4-6 months in response to renewed erythropoietin stimulation.

The same mechanism leads to anemia in premature infants in the first 4-12 weeks, but lower erythropoietin production, shorter life span of erythrocytes (35-50 days), rapid growth and more frequent bloodletting contribute to a faster and stronger decrease in Hb. Babies<32 нед гестации страдают сильнее всего.

Blood loss... Anemia can develop due to prenatal, perinatal (during labor), or postpartum bleeding. In newborns, the absolute blood volume is low (for example, in premature babies - 90-105 ml / kg, in full-term babies - 78-86 ml / kg), therefore, an acute loss of only 15-20 ml of blood can lead to anemia. Infants with chronic blood loss can be compensated physiologically and are generally more clinically stable than infants with acute blood loss.

Prenatal hemorrhages can be caused by:

• hemorrhage from the fetus to the mother,
• transfusion between twins (fetal-fetal),
• malformations of the umbilical cord,
• placental disorders
• diagnostic techniques.

Fetal-to-maternal hemorrhages occur spontaneously or as a result of maternal trauma, amniocentesis, cephalic rotation, or placental tumor. They occur in about 50% of pregnancies, although in most cases the amount of blood lost is extremely small (about 2 ml); massive blood loss, defined as> 30 ml, occurs in 3/1000 pregnancies.

Feto-fetal transfusion is an unequal distribution of blood between twins, which affects 13-33% of monozygotic monochorionic twin pregnancies. When a significant portion of the blood is transferred, the twin donor can become very anemic with the development of heart failure, while the recipient can become polycythemic with the development of hyperviscosity syndrome.

Umbilical cord malformations include velamentous inserts in the umbilical cord, vascular presentation or placental insertion in the abdominal cavity; the mechanism of bleeding, which is often massive and rapid, is due to a shift or rupture of the vessels of the umbilical cord.

Two important placental defects that cause hemorrhage are placenta previa and premature placental abruption.

Diagnostic procedures that cause hemorrhage include amniocentesis, chorionic biopsy, and cord blood sampling.

Perinatal hemorrhages can be caused by:

• rapid labor (i.e., rapid, spontaneous labor during<3 ч после начала родов, что вызывает кровотечение из-за разрыва пуповины);
• obstetric complications (eg, incision of the placenta during caesarean section, birth injury);
• coagulopathies.

Cephalohematomas resulting from the application of, for example, vacuum or forceps are generally relatively harmless, but subgaleal bleeding can spread to soft tissue, and large blood volume loss leads to anemia, hypotension, shock, and death. Much less often, internal bleeding can result from rupture of the liver, spleen, or adrenal glands during childbirth. Intraventricular hemorrhage, which is most common in premature babies, and subarachnoid and subdural bleeding can also lead to a significant decrease in hematocrit.

Hemorrhagic disease of newborns - bleeding for several days after normal delivery, caused by a transient physiological deficiency of vitamin-K-dependent blood coagulation factors. Other possible causes: hemorrhages in the first few days of life and other coagulopathies (eg, hemophilia), disseminated intravascular coagulation syndrome caused by sepsis, vascular malformations, or prenatal maternal use of vitamin K antagonists (eg phenytoin, warfarin, isoniazid).

Decreased production of red blood cells... Defects in red blood cell production can be:

• congenital
• acquired.

Birth defects are extremely rare, but Diamond-Blackfan anemia and Fanconi anemia are the most common.

Diamond-Blackfan anemia is characterized by the absence of precursors of red blood cells in the bone marrow, macrocytic red blood cells, the absence of reticulocytes in the peripheral blood, and the lack of involvement of other blood cell lines. It is often part of a syndrome of congenital anomalies, including microcephaly, cleft palate, eye defects, thumb deformities, and pterygoid neck. Up to 25% of affected children are anemic at birth, and low birth weight occurs in about 10% of cases. This anemia is thought to be caused by defective stem cell differentiation.

Fanconi anemia is an autosomal recessive disease of bone marrow progenitor cells that causes macrocytosis and reticulocytopenia with progressive defect in all hematopoietic cell lines. It is usually diagnosed after the neonatal period. The cause is a genetic defect that interferes with the repair of damaged DNA or the removal of toxic free radicals that damage cells.

Other congenital anemias include Pearson's syndrome, a rare, multisystem disorder involving mitochondrial defects that causes refractory sideroblastic anemia, pancytopenia, various dysfunctions and insufficiency

liver, kidney, pancreas; Congenital dyserythropoietin anemias, in which chronic anemia (usually macrocytic) results from ineffective or abnormal production of red blood cells and hemolysis caused by abnormalities in red blood cells.

Acquired defects are those that occur after birth. The most common reasons are:

• infections,
• nutritional deficiencies.

Infections (eg, malaria, rubella, syphilis, HIV, cytomegalovirus, adenovirus, bacterial sepsis) can impair the production of red blood cells in the bone marrow. Congenital parvovirus B 19 infection can result in a lack of red blood cell production.

Nutritional deficiencies in iron, copper, folate (folic acid), and vitamins E and B 12 can lead to anemia in the first months of life, but usually not at birth. Iron deficiency anemia is the most common nutritional deficiency. Its incidence is higher in less developed countries, where it is the result of poor nutrition and exclusive and prolonged breastfeeding. Iron deficiency is common in infants whose mothers are themselves iron deficient and in preterm infants who have not received blood transfusions and whose formula is not supplemented with iron; in premature infants without nutritional supplements, iron stores are depleted by 10-14 weeks.

Hemolysis... Hemolysis can be caused by:

• immune disorders
• defects in the membrane of erythrocytes,
• enzyme deficiency
• hemoglobinopathies,
• infections.

All of the above also causes hyperbilirubinemia, which can lead to jaundice and bilirubin encephalopathy.

Immune-mediated hemolysis can occur when fetal red blood cells with surface antigens (most often Rh and ABO blood antigens, but also Kell, Duffy, and other minor antigens) that differ from maternal red blood cell antigens enter the maternal bloodstream and stimulate the production of antibodies IgG directed against fetal red blood cells. The most common severe scenario is when an Rh (O antigen) negative mother became D antigen sensitive during a previous pregnancy with an Rh positive fetus; a second Rh-positive pregnancy can then trigger an IgG response that can lead to fetal and neonatal hemolysis. Intrauterine hemolysis can be severe enough to cause swelling or death; postpartum there may be significant anemia and hyperbilirubinemia with pre-existing hemolysis secondary to persistent maternal IgG (half-life about 28 days). With the widespread prophylactic use of anti-MO antibodies to prevent sensitization, lesions develop when<0,11% беременностей у резус-отрицательных женщин. АВО-несовместимость может вызвать гемолиз по аналогичной схеме. АВО-несовместимость обычно происходит у матерей с 0-й группой крови. Матери с группой крови А, В или АВ вырабатывают анти-А и анти-В антитела, которые являются преимущественно IgM и не способны проникать через плаценту. Гемолиз, вызванный АВО-несовместимостью, может происходить при первой беременности, потому что матери часто сенсибилизированы антигенами пищевых продуктов или бактерий.

Defects in the membranes of red blood cells change the shape and deformability of red blood cells, which leads to their premature removal from the circulation. The most common disorders are hereditary spherocytosis and hereditary ovalocytosis.

G6PD and pyruvate kinase enzyme deficiencies are the most common hemolysis-causing enzyme deficiencies.

Hemoglobinopathies are caused by deficiency and structural abnormalities of globin chains. At birth, 55-90% of a newborn's hemoglobin consists of 2α- and 2γ-globin chains (fetal hemoglobin or hemoglobin F). After birth, γ-chain production decreases and β-chain production increases until adult hemoglobin becomes predominant. Alpha thalassemia is a genetically inherited disorder caused by depression of globin α-chain production and is the most common hemoglobinopathy, causing anemia in the neonatal period. β-thalassemia is a congenital disorder of β-chain production. Since the amount of β-globin is normal at birth is negligible, β-thalassemia and structural abnormalities (Globin chains are rare at birth and symptoms do not appear until the fetal hemoglobin level is low enough by 3-4 months.

Intrauterine infection with certain bacteria, viruses, fungi and protozoa (primarily toxoplasmosis and malaria) can also cause hemolytic anemia. In malaria, Plasmodium enters the red blood cells and destroys them. Immune-mediated destruction of infected red blood cells and excessive removal of uninfected cells occurs. Associated bone marrow dyserythropoiesis results in inadequate compensatory erythropoiesis. Intravascular hemolysis, extravascular phagocytosis, and dyserythropoiesis can lead to anemia.

Symptoms and signs of anemia in newborn babies

Symptoms and signs are similar regardless of cause, but vary with the severity and rate of onset of the anemia. Newborns are usually pale and, if the anemia is severe, have tachypnea, tachycardia, and sometimes flow murmur; hypotension with acute blood loss is characteristic. Jaundice with hemolysis may be present.

Diagnosis of anemia in newborns

Anamnesis... Anamnesis should be directed to maternal factors (eg, hemorrhagic diathesis, hereditary erythrocyte defects, nutritional deficiencies, medications), family history of hereditary diseases that cause hemolytic disease of the newborn (eg, hemoglobinopathies, enzyme deficiencies, erythrocyte membrane defects, erythrocytic aplasias) obstetric factors (eg, infections, vaginal bleeding, obstetric interventions, mode of delivery, blood loss, treatment and appearance of the umbilical cord, placental pathology, fetal distress, number of fetuses).

Nonspecific maternal factors provide additional information. Splenectomy indicates a history of possible hemolysis, defects in the cell membrane of erythrocytes, or autoimmune anemia; cholecystectomy - for a history of hemolysis induced by gallstones. Important factors include gestational age at delivery, age at symptom onset, gender, race, and ethnicity.

Medical checkup... Tachycardia and hypotension suggest significant blood loss. Jaundice is hemolysis, either systemic (caused by ABO incompatibility or G6PD deficiency) or localized (caused by the decomposition of blood in cephalohematomas). Hepatosplenomegaly suggests hemolysis, congenital infections, or heart failure. Hematomas or petechiae - hemorrhagic diathesis. Congenital abnormalities can indicate bone marrow failure syndrome.

Testing... Anemia may be suspected if prenatal ultrasound detects fetal dropsy, which is defined as abnormal, excessive fluid in two or more parts of the body (eg, pleura, peritoneum, pericardium); enlargement of the heart, liver, spleen may be present.

After delivery, if anemia is suspected, initial testing consists of:

• from counting reticulocytes,
• peripheral smear studies.

• titers or PCR studies for congenital infection (rubella, syphilis, HIV, cytomegalovirus, adenovirus, parvovirus);
• folate and vitamin B ^ levels;
• levels of iron and copper.

If these tests do not determine the cause of the anemia, a bone marrow biopsy, genetic testing for congenital abnormalities in red blood cell production, or both, may be necessary.

If the reticulocyte count is high or normal (reflecting the corresponding bone marrow response), the anemia is due to blood loss or hemolysis. If there is no apparent blood loss or if signs of hemolysis are noted in the peripheral smear, a direct antiglobulin test (DAT [Coombs' test]) should be performed.

If Coombs' test is positive, the anemia is likely secondary to an incompatibility of Rh, ABO, or other systems.

If Coombs' test is negative, determination of the mean corpuscular volume of the red blood cell (MCV) may be helpful. A severely reduced MCV suggests a-thalassemia or chronic intrauterine blood loss. With normal or high MCV, a peripheral blood smear may reveal abnormal red blood cell morphology consistent with membrane abnormalities, microangiopathy, disseminated intravascular coagulation, vitamin E deficiency, or hemoglobinopathy. If the smear is normal, the cause may be blood loss, enzyme deficiency, or infection, and appropriate testing should be done, incl. testing for fetomaterine hemorrhage.

Fetomaterine hemorrhages can be diagnosed by testing for the presence of fetal red blood cells in the mother's blood. The Kleihauer-Vetke acid elution technique is the most commonly used test, but other approaches include immunofluorescence techniques and a differential or mixed agglutination test. With the Kleihauer-Vetka technique, citrate-phosphate buffer pH 3.5 elutes hemoglobin from adult, but not fetal erythrocytes; thus, fetal red blood cells are stained with eosin and are visible on microscopy, while adult red blood cells are displayed as red cell shadows. The Kleihauer-Vetke technique is ineffective if the mother has hemoglobinopathies.

Treatment of anemia in newborns

The need for treatment depends on the severity of the anemia and associated medical conditions. Mild anemia in otherwise healthy term and preterm infants usually does not require special treatment; treatment is determined by the underlying diagnosis. Some patients require transfusion or exchange transfusion of red blood cells.

Transfusion... Transfusion is indicated in the treatment of severe anemia. Blood transfusion should be performed if symptoms of anemia are present or if a decrease in tissue O 2 supply is suspected. The decision to transfuse should be based on symptoms, the age of the patient, and the severity of the disease. The hematocrit itself should not be a deciding factor because some children may be asymptomatic with a lower hematocrit, and others may have symptoms of anemia with a higher hematocrit.

Before the first transfusion, if it has not yet been done, the blood of the mother and fetus should be tested for belonging to the ABO and Rh groups and for the presence of atypical antibodies to red blood cells, a direct antiglobulin test for the child's red blood cells must be performed.

Blood for transfusion must be the same or compatible in the ABO and Rh systems of the newborn to any anti-ABO or anti-erythrocyte antibodies present in the serum of the mother or newborn. Anti-erythrocyte antibodies are rarely produced in newborns, therefore, in cases where the need for blood transfusion persists, re-screening of antibodies is usually not required until 4 months.

The erythrocyte mass used for transfusion must be filtered (leukocyte-free), irradiated and poured into aliquots of 10-20 ml / kg obtained from one donor blood; sequential transfusions of the same blood will minimize the impact on the recipient and the complications of the transfusion. Blood from cytomegalovirus-negative donors should be considered as a therapy for very premature infants.

Exchange transfusion... Exchange transfusion, in which blood from newborns is taken in aliquots with subsequent transfusion of erythrocyte mass, is indicated for some cases of hemolytic anemia with an increase in serum bilirubin and some cases of severe anemia with heart failure. This procedure reduces plasma antibody titers and bilirubin levels and minimizes fluid overload. Serious side effects (eg, thrombocytopenia; necrotizing enterocolitis; hypoglycemia; hypocalcemia; shock, pulmonary edema, or both [caused by fluid balance changes]) are common and should be performed by experienced personnel. Guidelines for exchange transfusion vary and are inconclusive.

Other treatments... Recombinant human erythropoietin is generally discouraged, in part because it has not been shown to reduce transfusion requirements in the first 2 weeks of life.

Iron therapy is limited to cases of repeated blood loss (eg, hemorrhagic diathesis, gastrointestinal bleeding, frequent bleeding). Oral iron preparations are preferred; parenteral iron supplementation sometimes leads to anaphylaxis, so a hematologist should administer therapy.

Treatment for more unusual causes of anemia is disease-specific (eg, corticosteroids for Diamond-Blackfan anemia and vitamin B12 for B12 deficiency).