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Anemia of Prematurity



Anemia is a low level of red blood cells (RBCs). These cells are responsible for picking up oxygen in the lungs and delivering it to the rest of the body. Low levels of RBCs make it difficult for the body to get enough oxygen. If anemia is severe, it can lead to serious health problems.

Anemia of prematurity occurs in babies who are born earlier than expected.


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Causes    TOP

Anemia of prematurity may be caused by one or more of the following conditions:

  • Loss of blood due to:
    • Complications during labor and birth
    • Removal of blood for testing—regular blood tests are needed to monitor premature babies’ health
  • Decreased production of RBCs due to:
    • Nutrition problems
    • Certain infections like rubella or parvovirus that affect the bone marrow where RBCs are made
  • Destruction of RBCs may occur with medical conditions such as:
    • Incompatibility between mother’s and baby’s blood— Rh incompatibility
    • Hereditary disorders

Risk Factors    TOP

Infants are more prone to anemia because:

  • Production of RBCs temporarily slows down in all newborns right after birth—greater effect in premature babies
  • Blood volume can’t keep up with baby’s growth
  • RBCs have a shorter lifespan in infants compared to adults

Other factors that may increase the chances of anemia of prematurity include:

  • Family history of anemia
  • Complications during delivery
  • Blood loss during birth
  • Illness requiring a lot of blood work
  • Being a twin with twin-to-twin transfusion
  • Poor diet, particularly low in iron, vitamin B6 or B12 in
    • Mother during pregnancy
    • Infant after birth

Symptoms    TOP

Mild anemia may have no symptoms. Symptoms of moderate or severe anemia may include:

  • Pale appearance
  • Slow, dull activity
  • Fast or difficulty breathing
  • Difficulty during feeding
  • Fast heart rate
  • Slow weight gain
  • Period when breathing stops

Diagnosis    TOP

You will be asked about your baby’s symptoms and history. A physical exam will be done.

Your baby's blood will be tested. This can be done with blood tests.

A diagnosis will be made based on the blood test. The test results may also help find the cause of the anemia.


Treatment    TOP

Treatment will depend on the cause of anemia. Mild anemia may not need to be treated. The doctor will simply monitor your baby’s blood. As little blood as possible will be taken to keep the anemia from getting worse.

Treatment options for anemia of prematurity include:

Optimizing Nutrition

Nutrition plays a big role in the recovery from anemia. The right foods can help the baby’s body increase production of RBCs.

Lack of certain nutrients can also make it difficult for the body to make RBCs. Iron is important in making RBCs. When your baby is a few weeks old, supplemental iron may be added.

Blood Transfusion

Severe cases of anemia may need immediate treatment. A blood transfusion will quickly increase the level of RBCs in the infant.

More than 1 transfusion may be needed.


Prevention    TOP

To help reduce your child’s chance of getting anemia of prematurity:

  • Get proper prenatal care throughout your pregnancy
  • Take steps to prevent premature birth including:
    • Avoiding alcohol, smoking, and drugs
    • Eat a healthy, balanced diet with plenty of fruits and vegetables
    • Keep chronic disease under control
  • Optimize your baby’s nutrition

Healthy Children—American Academy of Pediatrics

Kids Health—Nemours Foundation


Health Canada

The Society of Obstetricians and Gynaecologists of Canada


Anemia of Prematurity. The Hospital for Sick Children website. Available at:
...(Click grey area to select URL)
Updated October 31, 2009. Accessed September 25, 2017.

Evaluation and management of the premature infant. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116613/Evaluation-and-management-of-the-premature-infant . Updated June 26, 2017. Accessed September 25, 2017.

Neonatal Anemia. UCSF Children’s Hospital website. Available at:
...(Click grey area to select URL)
Published 2004. Accessed September 25, 2017.

Trachtenbarg D, Golemon T. Office Care of the Premature Infant: Part II. Common Medical and Surgical Problems. Am Fam Physician. 1998 May 15;57(10):2383-2390. Available at:
...(Click grey area to select URL)
Accessed Sptember 25, 2017.

Last reviewed September 2018 by EBSCO Medical Review Board Kari Kassir, MD
Last Updated: 8/19/2014

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