Anemia - what is it and why is it dangerous in newborns?
With a low level of hemoglobin in the blood, which is the building material for red blood cells, anemia develops. Red blood cells, or erythrocytes, transport oxygen to all cells of the human body. Almost 98% of their composition is protein (globin) and iron.
The lack of this element in the body of newborns leads to a delay in the development of brain structures and severe immunodeficiency. At the first signs of anemia, you should immediately contact your pediatrician, since at the initial stage anemia can be corrected quite easily. Moderate and severe degrees of this disease require careful adherence to the pediatrician’s recommendations.
Types of anemia in babies under one year of age
When breastfeeding, anemia in a baby occurs extremely rarely. And all because breast milk gives the baby everything he needs for health and proper development. However, even breastfed babies sometimes develop anemia, which occurs:
iron deficiency. It occurs due to the fact that an insufficient amount of iron enters the body, as a result of which the bone marrow begins to produce a small amount of red blood cells;
acute. This type of anemia develops due to chronic blood loss, which can occur due to injury or frequent nosebleeds;
hemolytic. It is diagnosed if enough glandular compounds enter the body and the bone marrow produces a normal number of red blood cells, but red blood cells are destroyed due to malfunctions in the hematopoietic system.
"Important information! Most often, infants are diagnosed with iron deficiency anemia. It accounts for 70% of all diagnostically confirmed anemias. In premature babies, this pathology can develop by four months. For this reason, pediatricians refer the child for a repeat general blood test at three months.”
Cause of anemia in an infant
In the first 6 months of life, the child uses the iron reserves stored in his body during the prenatal period. If there is a lack of iron in the infant’s diet, after this period he or she develops anemia. The consequences are even more complex if a deficiency of a valuable microelement occurs in the perinatal period.
Causes of iron deficiency in the fetus:
- Deficiency of copper, folic acid, vitamin B12 in the body of a pregnant woman, additional medications are required;
- Bleeding during pregnancy;
- Iron deficiency in the body of a woman expecting a child; to replenish it, you need to adjust your diet and take medications with a high content of the microelement;
- Poor diet of a pregnant woman;
- Abnormalities of placental development;
- Trauma suffered during pregnancy;
- Premature birth;
- Delayed ligation of the umbilical cord;
- Rhesus conflict;
- Infections suffered by a woman during pregnancy.
That is why, for timely monitoring of the health status of the pregnant woman and the fetus, it is important to register with the antenatal clinic on time. It is advisable to do this until the pregnancy has reached 12 weeks. Collaboration with a gynecologist is very important throughout the gestational period.
What can cause acquired anemia in an infant:
- Using an adapted milk formula;
- Introduction of whole cow's milk into the diet;
- Bleeding due to an infectious disease;
- Gastrointestinal pathologies;
- Burdened heredity;
- Lead toxicity;
- Upper respiratory tract infections;
- Disorders of the blood formation process;
- Disturbed diet of a nursing mother.
All of the above reasons change the shape of red blood cells and their color, the blood cells become lighter and acquire an oval shape.
Causes of anemia.
In order for the process of blood formation in a child to proceed normally, during the period of intrauterine development, his body needs to receive and accumulate a sufficient amount of iron from the mother. At 28-32 weeks of intrauterine development, the most intense transfer of iron from the mother and its accumulation in the child’s body occurs.
Disruption of the normal course of pregnancy during this important period leads to a disruption in the exchange of iron between mother and child and, as a consequence, to its insufficient accumulation in the body.
Maternal anemia and premature birth are the reasons why anemia is detected in all children from birth or from about the 3rd month of life. Multiple pregnancies also lead to the development of anemia.
After birth, anemia can be caused by damage to red blood cells due to hemolytic disease of the newborn and impaired hemoglobin formation.
Most often, anemia is caused by nutritional reasons. In children of the first year of life, anemia develops most often due to monotonous milk feeding, with a poor iron content in breast milk; early transfer of the child to artificial or mixed feeding; using unadapted formulas, cow's or goat's milk for feeding; not timely introduction of complementary foods into the child’s diet.
Premature babies and children born with increased body weight especially need an increased intake of iron into the body.
Therefore, a discrepancy between the intake of iron into the body and its consumption in children of the first year of life can also cause anemia.
Anemia can occur due to blood loss, for example, with frequent nosebleeds. In children with neurodermatitis, food allergies, and exudative diathesis, there is an increased loss of iron from the skin epithelium, so children suffering from such diseases are at risk for developing iron deficiency anemia.
In addition to the direct loss of iron, disturbances in its absorption and metabolism lead to the development of anemia. This can occur, for example: with rickets or lactase deficiency.
The deficiency of B vitamins and microelements is of great importance, which is why a complete and balanced diet is so important.
Any infectious or chronic somatic disease can cause anemia.
Symptoms of anemia in newborns
In infants, anemia may not show any obvious signs. The disease can only be indicated by the results of a blood test when the hemoglobin content in them is below 110 units.
Symptoms of anemia noticeable to parents of infants:
- Restless sleep, daytime drowsiness;
- Lethargy and moodiness;
- Desire to eat inedible objects (clay, sand, earth);
- Complete lack of appetite;
- Hair loss, poor growth;
- Spitting up for no reason;
- Cracks in the corners of the lips;
- Frequent colds;
- Dyspeptic manifestations, disruption of the gastrointestinal tract;
- Stomatitis;
- Brittle nails;
- Increased sweating.
If a child exhibits similar symptoms, the doctor will order a general blood test. The norm of hemoglobin in a newborn child is 200 g/l, in a child up to six months old – 100 g/l, over 6 months – 140 g/l.
If the child's test results are noticeably behind the norm, a pediatrician should be consulted.
Types of anemia in children under one year old
Slow or stopped production of red blood cells causes anemia in the infant.
Types of anemia in infants:
- Anemia of premature babies
– recorded in every child born prematurely, determined in the maternity hospital;
- Iron deficiency, or hypochromic
– recorded in 80% of all cases;
- Hemolytic
– occurs when there is a Rh conflict between mother and child, as well as when a pregnant woman is infected with toxoplasmosis, rubella, or herpes;
- Nutritional
– is formed against the background of a monotonous diet, poor in vitamins and microelements;
- Anemia as a result of infection
– may be a symptom of pathology;
- Autoimmune
– irregularly shaped red blood cells in this type of anemia lead to oxygen starvation;
- Yaksha-gayema anemia
– characterized by an enlarged liver, hyperthermia, pale skin, the appearance of shortness of breath and heart murmurs, a sharp decrease in hemoglobin, although the number of red blood cells remains within normal limits;
- Hypoplastic anemia
, which has a high percentage of deaths, and
hemoblastosis
(leukemia) - occurs due to suppression of the activity of red blood cells by leukocytes due to impaired immunity, or due to impaired synthesis of red blood cells.
Degrees of anemia in infants
The severity of the condition with anemia in an infant is divided according to the level of hemoglobin and the concentration of red blood cells:
- Mild degree
. Laboratory parameters: red blood cells – 3 million/l, hemoglobin – 90-110 g/l. The condition does not require treatment; it is corrected by introducing a more varied diet into the diet of a woman in a state of lactation. In case of transient anemia, the pediatrician monitors the child’s condition and prescribes special medications.
- Average degree
. Laboratory indicators: red blood cells – 2.5 – 3 million/l, hemoglobin – 70-90 g/l. With this degree of anemia, the child lags behind the age norm in his physical and mental development, and the functioning of the gastrointestinal tract and cardiovascular system is disrupted. The child feels dizzy, suffers from shortness of breath, often suffers from colds and infectious diseases; children with anemia of this degree are usually lethargic and weak. This degree of pathology most often requires medical supervision in a hospital setting and treatment with iron supplements.
- Severe degree
. Laboratory indicators: red blood cells - less than 2.5 million/l, hemoglobin - below 70 g/l. In an infant with this degree of anemia, the kidneys and intestines, the hematopoietic system, the respiratory and circulatory systems are affected, and dystrophy appears.
Treatment of anemia in infants
Anemia therapy is carried out only after a thorough diagnosis, identification of the type and form of the disease. If newborns or infants are diagnosed with “iron deficiency anemia of the 1st degree,” correction of this condition can be carried out outside the hospital, only by making changes to the baby’s diet and daily routine.
Complex treatment - necessary measures:
- Impact on the causes of anemia (replacement of formula, correction of the mother’s diet).
- Taking vitamins and medications with a high iron content, for better absorption they are given between feedings, possibly mixed with fruit juice, although they are already available in the form of syrup.
- Making changes to the diet, following a diet that includes buckwheat porridge, egg yolk, apple puree, liver, meat, cheese, fruit juices, vegetable puree, giving up semolina, rice cereal, oatmeal.
- Correction of the daily routine: long walks, massage, games with elements of physical education, gymnastics, extra sleep.
The minimum duration of treatment for anemia in an infant is 1 month or more.
When a child is born with hypoxia, prematurely, with large blood loss, he is given a mass with a high content of red blood cells (30%).
Treatment for grade 2 anemia
: prescribing drugs with a high iron content (Aktiferrin, Maltofer, Hemoferon), selected in accordance with the individual characteristics and needs of the infant. Most often they are produced in the form of oil and water-soluble drops.
Treatment for grade 3 anemia
: if the hemoglobin level in an infant is below 70 g/l, an urgent blood transfusion is performed in a hospital setting.
If breastfeeding is maintained, the child must be given breast milk, rich in easily digestible iron, on demand.
Medications
Iron preparations also differ from each other in their form. In addition, they can be composed of substances that help this element to be absorbed. There are quite a lot of medications belonging to this group, and they also have certain side effects. Therefore, their treatment is strictly prescribed by a doctor. It should be noted that the prescription of iron supplements occurs only after tests have been carried out to determine the amount of different forms of iron in the blood, as well as factors associated with it.
Dosages are selected individually, depending on the patient’s age and the severity of anemia. Infants are prescribed drugs in liquid form to make them easier to use. If the manifestations of IDA are quite serious, doctors prescribe intravenous administration of the drug to enhance the effect. The child may also be prescribed a red blood cell transfusion.
It is important for mothers to know some rules that will ensure a full recovery for their children:
- If the hemoglobin level has recovered, this does not mean that you can stop taking the drug. Remember that during illness, tissue iron reserves and depots are depleted. Therefore, treatment of iron deficiency anemia in children is usually long-term.
- It is necessary to take the medicine regularly, without interruptions. Otherwise, the effect of taking it will be significantly reduced.
- If your baby has signs indicating intolerance to the drug (nausea, change in bowel habits), consult your doctor. You may be prescribed a different medicine.
- Dairy products reduce iron absorption, so it is prescribed to infants between feedings, and older children are advised to take the medicine with drinks rich in vitamin C (for example, orange juice).
- Just because you have included enough iron-rich foods in your child's diet does not mean that such foods will cure anemia. To compensate for the amount of iron at the tissue level, you cannot do without medications. Nutrition only maintains the amount of this element in the body at the proper level.
- Don't be alarmed if you see the stool color change (dark green or black). Iron preparations can stain it, and this is completely normal.
- You should not give your child iron supplements if he is sick. Especially when there is a rise in temperature. Be sure to discuss this with your pediatrician.
Efficacy of therapy in infants
Treatment of anemia in infants should be accompanied by a gentle regimen:
- Frequent walks in the fresh air;
- Temporary refusal to visit children's preschool rooms;
- Limiting physical activity;
- Correction of diet, early introduction of complementary foods (2-4 weeks earlier).
After correcting these factors, treatment with medications begins. After 1-2 weeks of complex treatment, if all conditions are fully met, hemoglobin levels increase and reticulocytes increase. Hemoglobin can rise to normal levels within 3-5 weeks, and even after this, treatment should continue for at least 3 months.
The reason for the lack of positive dynamics after 3-4 weeks of treatment:
- Incorrectly calculated dosage of an iron-containing drug;
- History of neoplasms and inflammation;
- Infection with parasites;
- Misdiagnosis;
- Lack of vitamin B12.
After analyzing the causes, the pediatrician adjusts the treatment of the disease.
Low hemoglobin – School of Dr. Komarovsky:
Iron deficiency anemia in a child
Iron deficiency anemia in a child is treated with a complex of medications. Main 4 principles of treatment:
- possible correction of the cause of iron deficiency
- normalization of the child’s lifestyle and diet
- concomitant therapy (symptomatic)
- taking iron supplements
To correct iron deficiency, proper nutrition is important. For babies this is breastfeeding. Breast milk contains iron, and it also has a positive effect on the absorption of iron from other foods that the baby eats. But in infants, active metabolic processes occur, therefore, at the age of 5-6 months, antenatal iron reserves are depleted in all children. Therefore, it is important to consume iron in foods.
A large amount of iron is contained in such products:
- beef tongue
- pork liver
- egg yolk
- veal kidneys
- beans
- oysters
- seaweed
- sesame
- buckwheat
- wheat bran
- Turkish walnut
- pistachios
- peach
- cereals
- hazelnuts
- spinach
The absorption of iron by the body is slowed down by such substances:
- oxalates,
- tannins found in tea
- ethylenediaminetetraacetic acid (preservative),
- phosphates,
- tetracyclines,
- antacid drugs.
Such substances enhance iron absorption:
- lemon acid
- ascorbic acid
- malic, succinic acids
- cysteine
- fructose
- nicotinamide
Treatment for iron deficiency anemia includes:
- normalization of sleep-wake patterns
- walks in the open air
— prevention of acute respiratory viral infections
- favorable psychological climate in the family, kindergarten and school
- limiting physical activity
If a child suffers from the disease in question, he is introduced to complementary foods 2-4 weeks earlier than healthy children. Meat complementary foods are introduced at the age of six months. It is better not to feed your child semolina, oatmeal, or rice porridge. Barley, buckwheat and millet porridge are recommended.
The basis of therapy is still considered to be taking iron supplements :
- hydroxide-polymaltose complex
- maltofer foul
- maltofer
- iron-protein complex
- ferrum lek
- ferroplex
- actiferrin
- hemopher
- tardiferon
- ferrous fumarate
- totem
- ferronate
First, the drugs are taken orally (by mouth). If the child has poor tolerance, symptoms such as vomiting and nausea or stool disorders occur, then iron supplements are administered parenterally. Among oral forms, the most effective are nonionic iron compounds: protein and hydroxide-polymaltose complexes Fe3+. They do not interact with food. Side effects are rare.
Syrups and drops are used for infants. This makes it easier to dose the medications, and taking them does not cause negative emotions in the child. The dose of the drug for people of any age is individual and should be calculated by a doctor. The use of parenteral iron supplements is necessary when there is a goal to quickly normalize the condition of a child with severe anemia, nonspecific ulcerative colitis, pathology of the gastrointestinal tract combined with malabsorption, severe intolerance to oral forms of drugs, chronic enterocolitis.
In the CIS countries, venofer is administered intravenously, and ferrum lek is administered intramuscularly. Infants and preschool children cannot have iron deficiency on their own. It occurs together with a deficiency of vitamins C, A, B12, B6, E, PP, zinc, folic acid, copper and other elements. Therefore, therapy for such conditions includes taking multivitamin preparations.
After 7-10 days, the effectiveness of therapy for iron deficiency conditions in a child should already appear. An increase in reticulocytes and an increase in hemoglobin are assessed. The rate of increase in hemoglobin is 10 g/l or more per week. The course of treatment with iron supplements is at least 3 months to replenish the depot, and not just normalize hemoglobin levels.
If hemoglobin does not return to normal within 3-4 weeks, then the reasons for the ineffectiveness of therapy are determined. Often the cause is ongoing or unidentified blood loss, incorrect dose of iron supplement, concomitant vitamin B12 deficiency, the presence of chronic inflammatory diseases or neoplasms, helminthic infestation and other parasitic infections. It may also be misdiagnosed.
Contraindications to the administration of iron supplements to children:
- sideroachrestic anemias
- lack of laboratory confirmation of iron deficiency
- hemosiderosis and hemochromatosis
- hemolytic anemia
- infection caused by gram-negative flora
Severe anemia is treated with recombinant human erythropoietin preparations. A- and b-epoetins are used. This allows blood transfusions, which have a high likelihood of complications. RhEPO preparations are mainly administered subcutaneously. The advantage compared to intravenous administration is the use of smaller doses. Since 2004, subcutaneous administration of a-erythropoietins has been permitted in European countries. In our country, such drugs include Eprex (Jansen-Silag) and Epocrine.
