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Anemia of Prematurity

  • Cynthia M. Johnson, MA
Publication Type:


Anemia of Prematurity


Anemia is a low level of red blood cells (RBCs). These cells pick up oxygen in the lungs and bring it to the rest of the body. Low levels make it hard for the body to get enough oxygen.

Anemia of prematurity is when this problem happens in babies who are born too early.


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Anemia of prematurity may be caused by one or more of the these problems:

  • Loss of blood due to:
    • Problems during labor and birth
    • Removal of blood for testing—regular blood tests are needed to monitor the health of babies born too early
  • Low production of RBCs due to:
    • Nutrition problems
    • Infections, such as rubella or parvovirus that affect the bone marrow where RBCs are made
  • Destruction of RBCs from health problems like:
    • Incompatibility between mother’s and baby’s blood—Rh incompatibility
    • Hereditary disorders

Risk Factors

Babies are likely to get anemia because:

  • Fewer RBCs are made right after birth
  • Blood volume cannot keep up with a baby’s growth
  • RBCs have a shorter lifespan in babies

Things that may raise the risk of this problem are:

  • A family history of anemia
  • Problems during delivery
  • Blood loss during birth
  • An illness that requires a lot of blood work
  • Being a twin with twin-to-twin transfusion
  • Poor diet that is low in iron, vitamin B6, or B12 in:
    • Mother during pregnancy
    • Baby after birth


Mild anemia may have no symptoms. Moderate or severe anemia may cause:

  • Pale skin
  • Low activity level
  • Fast or difficult breathing
  • Problems feeding
  • Fast heart rate
  • Slow weight gain
  • Periods when breathing stops


The doctor will ask about the baby’s symptoms and past health. A physical exam will be done.

The 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 will depend on the cause of anemia. Mild anemia may be monitored with blood tests. As little blood as possible will be taken to keep the anemia from getting worse.

Treatment options are:


To lower a child’s chance of getting anemia of prematurity:

  • Get proper prenatal care throughout pregnancy.
  • Mothers should take steps to prevent premature birth:
    • Avoid alcohol, smoking, and drugs.
    • Eat a healthy, balanced diet with plenty of fruits and vegetables.
    • Manage chronic health problems.
  • Provide proper nutrition to babies.

Better Nutrition

Nutrition can help with recovery by helping the body make more RBCs.

Iron is important in making RBCs. Some babies may be given supplemental iron.

Better Nutrition

Nutrition can help with recovery by helping the body make more RBCs.

Iron is important in making RBCs. Some babies may be given supplemental iron.

Blood Transfusion

Some babies with severe problems may need treatment right away. A blood transfusion can quickly raise the level of RBCs. It may need to be done more than once.





  • Treatment of other conditions in premature babies. The Hospital for Sick Children website. Available at: http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/OverviewofTreatment/TreatmentofOtherConditions/Pages/Treatment-of-Anemia-of-Prematurity.aspx.
  • Evaluation and management of the premature infant. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/evaluation-and-management-of-the-premature-infant.
  • Neonatal anemia. UCSF Children’s Hospital website. Available at: http://www.ucsfbenioffchildrens.org/pdf/manuals/37_Anemia.pdf.


  • Kari Kuenn, MD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.