Abstract

Neonatal anaemia affects preterm and term infants globally and is marked by reduced erythrocyte count or haemoglobin. It presents a significant clinical challenge, arising from physiological and pathological factors, demanding careful management to prevent increased mortality and neuro developmental risks. Diagnosis employs a tiered approach, starting with a complete blood count and progressing to focused investigations like Coombs tests and advanced testing like haemoglobin electrophoresis. Management strategies are tailored to etiology and severity, emphasizing minimal blood loss, erythropoiesis-stimulating agents, Delayed cord clamping, disease-specific treatments, and nutritional support, which play crucial roles. Along with strategies, regular monitoring and long-term neuro developmental assessments are essential for positive outcomes. Future directions focus on optimizing transfusions, reducing iatrogenic blood loss, and improving prenatal screening, targeted management, and preventive strategies, which are vital for improved outcomes.

• 1.   Chaudhary, N., Jassar, R., & Singh, R. (2022). Neonatal anemia. Newborn, 1(3), 81–85. https://www.newbornjournal. o r g / a b s t r a c t A r t i c l e C o n t e n t B r o w s e / JNB/81/1/3/29902/abstractArticle/Article
• 2.   Maier, R. F., & Obladen, M. (2000). Neonatal anemia: Pathogenesis and treatment. Journal of Perinatal Medicine, 28(3), 221–238. https:// pmc.ncbi.nlm.nih.gov/articles/PMC2981681/
• 3.   Mukhopadhyay, K., & Yadav, R. K. (2021). Diagnosing anemia in neonates: An evidencebased approach. NeoReviews, 24(6), e343–e356. https://publications.aap.org/neoreviews/ article/24/6/e343/191331/DiagnosingAnemia-in-Neonates-An-Evidence-Based
• 4.   Dzierzak, E., & Philipsen, S. (2013). Erythropoiesis: development and differentiation. Cold Spring Harbor perspectives in medicine, 3(4), a011601. https://doi.org/10.1101/cshperspect.a011601
• 5.   Palis J. (2014). Primitive and definitive erythropoiesis in mammals. Frontiers in physiology, 5, 3. https://doi.org/10.3389/ fphys.2014.00003
• 6.   Widness J.A. (2008). Pathophysiology of Anemia During the Neonatal Period, Including Anemia of Prematurity. NeoReviews, 9(11), e520. https://doi.org/10.1542/neo.9-11-e520
• 7.   Walter, A.W. (2024, November 13). Perinatal anemia. MSD Manual Professional Edition. https://www.msdmanuals. com/professional/pediatrics/perinatalhematologic-disorders/perinatal-anemia
• 8.   Moritz, K.M., Lim, G.B., & Wintour, E.M. (1997). Developmental regulation of erythropoietin and erythropoiesis. AJP Regulatory Integrative and Comparative Physiology, 273(6), R1829–R1844. https://doi. org/10.1152/ajpregu.1997.273.6.r1829
• 9.   Stockman, J.A. (1984). Endogenous erythropoietin sensitivity to dissolved oxygen in premature infants. American Journal of Hematology, 17(2), 95-100.
• 10.   Steiner LA, Gallagher PG(2007). Erythrocyte disorders in the perinatal period. Semin Perinatol. (4): 254-61. doi: 10.1053/j. semperi.2007.05.003. PMID: 17825683; PMCID: PMC2098040.
• 11.   Sankaran VG, Orkin SH.(2013) The switch from fetal to adult hemoglobin. Cold Spring Harb Perspect Med. 1;3(1):a011643. doi: 10.1101/ cshperspect.a011643. PMID: 23209159; PMCID: PMC3530042.
• 12.   Solomonia N, Playforth K, Reynolds EW. Fetalmaternal hemorrhage: a case and literature review. AJP Rep. 2012 Nov;2(1):7-14. doi: 10.1055/s-0031-1296028. Epub 2011 Nov 25. PMID: 23946896; PMCID: PMC3653511.
• 13.   Counsilman, C.E., Heeger, L.E., Tan, R., Bekker, V., Zwaginga, J.J., Te Pas, A. B., & Lopriore, E. (2021). Iatrogenic blood loss in extreme preterm infants due to frequent laboratory tests and procedures. The journal of maternal-fetal& neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 34(16), 2660–2665. https://doi. org/10.1080/14767058.2019.1670800
• 14.   Dean L. Blood Groups and Red Cell Antigens [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2005. Chapter 4, Hemolytic disease of the newborn. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK2266/
• 15.   Song S.M., Bae K.W., Yoon HS, Im H.J., Seo JJ. (2010) A case of anemia caused by combined vitamin B12 and iron deficiency manifesting as short stature and delayed puberty. Korean J Pediatr. 2010 May; 53(5): 661-5. doi: 10.3345/ kjp.2010.53.5.661. PMID: 21189935; PMCID: PMC2994119.
• 16.   Strauss R.G. (2010)Anaemia of prematurity: pathophysiology and treatment. Blood Rev. Nov; 24(6): 221-5. doi: 10.1016/j. blre.2010.08.001. PMID: 20817366; PMCID: PMC2981681.
• 17.   Freeman A.M., Zubair M. Anemia Screening. (2025) In: StatPearls Treasure Island (FL): StatPearls Publishing; Available from: https:// www.ncbi.nlm.nih.gov/books/NBK499905/
• 18.   Santhosh Kumar Mondal, (2022) Laboratory Manual of Clinical Pathology and Hematology. CBS Publishers and Distributors Pvt Ltd.
• 19.   Dean L. (2005) Blood Groups and Red Cell Antigens [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); Chapter 4, Hemolytic disease of the newborn. Available from: https://www.ncbi.nlm.nih. gov/books/NBK2266/
• 20.   Bermejo F., García-López S. (2009) A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol. 15(37): 4638-43. doi: 10.3748/ wjg.15.4638. PMID: 19787826; PMCID: PMC2754511.
• 21.   Nassin M.L., Lapping-Carr G., de Jong J.L. (2015). Anemia in the Neonate: The Differential Diagnosis and Treatment. Pediatr Ann. 44(7): e159-63. doi: 10.3928/00904481-20150710-08. PMID: 26171704; PMCID: PMC6104389.
• 22.   Puia-Dumitrescu, M., Puia-Dumitrescu, M., Tanaka, D., Spears, T., etal.,(2019). Patterns of phlebotomy blood loss and transfusions in extremely low birth weight infants. Journal of Perinatology, 39. https://doi.org/10.1038/ s41372-019-0515-6
• 23.   Ohlsson A., Aher S.M. (2020)Early erythropoiesis-stimulating agents in preterm or low birth weight infants. Cochrane Database Syst Rev. 11; 2(2): CD004863. doi: 10.1002/14651858.CD004863.pub6. PMID: 32048730; PMCID: PMC7014351.
• 24.   McCarthy E.K., Dempsey E.M., Kiely M.E. Iron supplementation in preterm and lowbirth-weight infants: a systematic review of intervention studies. Nutr Rev. 2019 Dec 1; 7(12): 865-877. doi: 10.1093/nutrit/nuz051. PMID: 31532494; PMCID: PMC6888764.
• 25.   Marlies Bruckner, Anup C. Katheria, Georg M. Schmölzer, Delayed cord clamping in healthy term infants: More harm or good? Seminars in Fetal and Neonatal Medicine, Volume 26, Issue 2, 2021, 101221, ISSN 1744-165X, https://doi. org/10.1016/j.siny.2021.101221.
• 26.   Guidelines favor restrictive transfusion threshold for very preterm neonates. (2024, June 21). www.aabb.org. https://www.aabb.org/ news-resources/news/article/2024/06/21/ guidelines-favor-restrictive-transfusionthreshold-for-very-preterm-neonates
• 27.   Adane, Tiruneh & Worku, Minichil & Aynalem, Melak. (2022). Hematological Abnormalities in Culture Positive Neonatal Sepsis. Pediatric Health, Medicine and Therapeutics. 13. 217- 225. 10.2147/PHMT.S361188.
• 28.   Seko, Y., Kato, T., Morimoto, T., Yaku, H., (2021). Improved and new-onset anemia during follow-up in patients with acute decompensated heart failure. Medicine, 100(32), e26892. https://doi.org/10.1097/ md.0000000000026892
• 29.   Christensen, R.D., Bahr, T.M., Tweddell, S.M., Ohls, R.K., & Henry, E. (2023). Diagnosing Anemia in Neonates: An Evidence-Based Approach. NeoReviews, 24(6), e343–e355. https://doi.org/10.1542/neo.24-6-e343

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