Anemia in Newborns: Causes, Signs, Treatment and When to Worry

Quick Answer

Anemia in newborns means a baby has fewer red blood cells than normal, so less oxygen reaches the body. A mild, gradual drop in the first 2 to 3 months is normal and usually needs no treatment. Anemia caused by blood loss, blood group mismatch, prematurity or low iron is checked with a blood test and treated by your paediatrician.

Hearing the word “anemia” about your newborn can be frightening, especially if the doctor mentioned it in the NICU or after a routine blood test. The good news is that many babies with anemia need no treatment at all, and most of those who do recover well. This guide explains why it happens, which signs to watch for, how doctors treat it, and what you can do at home.

What is anemia in newborns?

Anemia (also spelt anaemia) is when a baby’s blood has too few red blood cells or too little haemoglobin, the protein that carries oxygen. In newborns it usually happens because red blood cells are made too slowly, broken down too fast, or lost through bleeding.

Cleveland Clinic notes that many babies with anemia do not need treatment. Whether your baby needs any depends on the cause, how low the blood count is, and how your baby is feeding and growing. For a general overview in adults and children, see our guide on what anemia is and how it is treated.

Is some anemia normal in newborns?

Yes. All babies have a slow, expected drop in red blood cells over the first 2 to 3 months, called physiologic anemia of infancy, according to the MSD Manual. It happens because a baby’s body slows red cell production after birth while the baby is growing quickly.

This normal dip does not cause symptoms in healthy, full-term babies and corrects on its own. Doctors only look further if the count falls lower or earlier than expected, or if your baby shows signs of illness.

What causes anemia in newborns?

Anemia in newborns has three main causes: the body makes too few red cells, red cells break down too quickly, or the baby loses blood. More than one cause can happen at the same time.

Sources: MSD Manual; Cleveland Clinic

Anemia of prematurity

Babies born early have fewer red blood cells, and those cells do not last as long. The drop in red cells is larger than in full-term babies, and it is most common in babies born before 32 weeks and those who stay in hospital for many days, says the MSD Manual. Frequent blood tests in the NICU can add to it.

Blood group mismatch (Rh and ABO)

If the mother’s blood group is Rh negative and the baby’s is Rh positive, the mother’s antibodies can attack the baby’s red cells. This is called haemolytic disease of the newborn, and it often causes jaundice as well as anemia. An injection called anti-D, offered to Rh-negative mothers carrying an Rh-positive baby, helps prevent the mother from making these antibodies. A milder version can happen when the mother’s and baby’s ABO blood groups do not match.

Low iron

Babies are born with stored iron that lasts the first few months. Premature and low birth weight babies have smaller iron stores, and early iron may also be considered if the mother had low iron, high blood pressure or diabetes in pregnancy, according to the Children’s Hospital of Philadelphia (CHOP). Iron deficiency anemia is most common later, between 9 and 24 months, as MedlinePlus explains.

What are the signs of anemia in a newborn?

Many babies with mild or moderate anemia have no symptoms at all, so it is often found on a routine blood test. When signs do appear, they can include:

• Pale skin, lips, gums or inner eyelids

• Low energy or being unusually sleepy

• Poor feeding, or getting tired during feeds

• Fast breathing or a fast heartbeat while resting

• Yellow skin or eyes (jaundice), when red cells are breaking down quickly

Sources: Cleveland Clinic; MSD Manual

On darker skin, paleness can be harder to see. Check the inside of the lower eyelid, the gums and the palms.

How do doctors diagnose newborn anemia?

Anemia is confirmed with a simple blood test. The main measurements are:

Depending on the likely cause, your doctor may also order tests to find the reason, such as blood groups, bilirubin (for jaundice), iron levels, or tests for inherited conditions such as G6PD deficiency. Ask your doctor to explain the results and what the numbers mean for your baby specifically.

How is anemia in newborns treated?

Treatment depends on the cause and how severe it is. Many babies only need watching and repeat blood tests, while others need iron, treatment of the underlying cause or, rarely, a blood transfusion.

Sources: MSD Manual; Cleveland Clinic

Never give iron drops or iron-containing tonics without your doctor’s advice. Too much iron can cause poisoning, and an iron overdose is a medical emergency. Keep all iron medicines out of reach of children.

Can newborn anemia be prevented?

Not every type can be prevented, but several simple steps lower the risk:

• Delayed cord clamping: WHO recommends clamping the cord no earlier than 1 minute after birth, which may improve a baby’s iron stores for up to six months. You can discuss this with your obstetrician before delivery.

• Anti-D for Rh-negative mothers: if you are Rh negative, make sure your blood group is on record and ask your doctor about anti-D injections.

• Treat anemia in pregnancy: good iron levels during pregnancy support the baby’s iron stores. Read more about anemia during pregnancy.

• Vitamin K at birth: the routine vitamin K injection helps prevent bleeding in newborns.

• Breast milk or iron-fortified formula: MedlinePlus advises no cow’s milk before 12 months, because it has little iron and makes iron harder to absorb. From about 6 months, add iron-rich foods such as iron-fortified cereals, mashed dal and well-cooked meat or egg if your family eats them.

• Follow-up for premature babies: keep every check-up and blood test your neonatologist schedules.

When should I call the doctor?

Call your paediatrician the same day if your baby:

• Looks pale, especially lips, gums, inner eyelids or palms

• Is feeding poorly or tiring quickly during feeds

• Seems more sleepy or less active than usual

• Has yellow skin or eyes, especially in the first 24 hours, or jaundice that is getting worse

• Is not gaining weight as expected

Get emergency help straight away if your baby is breathing very fast or with difficulty, is floppy or hard to wake, looks grey or very pale, or has any visible bleeding that does not stop. If you think your child has swallowed iron drops or tablets, go to the nearest hospital immediately.

For everyday care in the first month, including other newborn danger signs, see our newborn baby care guide.

Frequently asked questions

Is anemia serious in babies?

Most anemia in babies is mild and not serious. The normal dip in the first months corrects itself, and iron-related anemia usually responds well to treatment. Anemia caused by sudden blood loss, severe blood group mismatch or a serious infection can be serious and needs hospital care. Your paediatrician will tell you which type your baby has and how closely it needs watching.

How do you treat anemia in babies?

Treatment depends on the cause. Many babies only need monitoring. Babies with low iron are given iron drops prescribed by the doctor, babies with jaundice from blood group mismatch may need phototherapy or an exchange transfusion, and babies with severe anemia from blood loss or prematurity may need a blood transfusion. Never start iron on your own.

How can anemia be treated?

Anemia is treated by fixing the reason behind it. That can mean iron or other supplements for a nutritional deficiency, treating bleeding or an infection, medicines that help the body make red blood cells, or blood transfusions when the count is very low. For babies, all treatment should be guided by a paediatrician.

Can you live a normal life with anemia?

Yes, most babies and children with anemia go on to live normal, healthy lives. With treatment, iron deficiency anemia usually improves within about 2 months. Untreated iron deficiency can affect attention and learning, so follow-up matters. Inherited types such as thalassemia need long-term specialist care, so your doctor will guide you on follow-up.

Can my anemia in pregnancy make my baby anemic?

It can affect your baby’s iron stores. CHOP notes that doctors may consider early iron for babies whose mothers had low iron during pregnancy. Tell your paediatrician if you had anemia while pregnant.

Do breastfed babies need iron drops?

The iron in breast milk is absorbed well, but a baby’s stored iron runs low over the first months. CHOP advises daily iron for full-term, exclusively breastfed babies from 4 months until they eat iron-rich foods, and earlier iron for premature babies. Babies on iron-fortified formula usually do not need extra. Ask your paediatrician what is right for your baby, as practice varies.

Is physiologic anemia harmful to my baby?

No. Physiologic anemia is a normal stage of development in the first 2 to 3 months and does not harm healthy, full-term babies. It does not usually need tests or treatment unless your doctor finds the count lower than expected.

How long does anemia of prematurity last?

It varies from baby to baby. Most healthy premature babies with mild anemia need no treatment, while some need iron and a few need transfusions. Your neonatologist will plan follow-up blood tests until the count is stable.

References

1. MedlinePlus, US National Library of Medicine. Iron deficiency anemia in infants and toddlers.

2. Cleveland Clinic. Anemia in newborns.

3. MSD Manual Consumer Version. Anemia in the newborn.

4. World Health Organization, eLENA. Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes.

5. Children’s Hospital of Philadelphia. Iron supplementation in infants.

6. NHS. Rhesus disease: prevention.

Disclaimer: This article is for general information and does not replace advice from your paediatrician. If you are worried about your baby’s health, contact your doctor.

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