Management and prevention of neonatal anemia: current evidence and guidelines

Abstract

Neonatal anemia is a common disorder, particularly in (very) preterm neonates. Management of neonatal anemia is based principally on red blood cell (RBC) transfusion. Although the use of blood products is nowadays widespread in neonatal medicine, evidence on the potential benefit is extremely limited. Recent studies suggest that RBC transfusions in newborns may be associated with an increased risk for necrotizing enterocolitis, transfer of infectious agents and negative effects on neurodevelopmental outcome. Whether the benefits of RBC transfusions outweigh the risks is controversial and requires further studies. In this review, we summarize the current evidence on the management of neonatal anemia and compare the various international guidelines. In addition, we discuss the various strategies to prevent neonatal anemia and reduce the need for RBC transfusions and discuss important trials currently enrolling patients to improve the management in neonatal anemia.

Keywords::

• anemia
• anemia of prematurity
• guideline
• neonate
• newborn
• preterm
• red blood cell transfusion
• transfusion threshold

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in this manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Restrictive transfusion guidelines do not appear to increase the risk of short-term morbidity in preterm infants.

• Further randomized controlled trials are urgently required to determine if the benefits of restrictive transfusion guidelines in preterm infants outweigh the risks (focusing in particular on neurodevelopmental impairment).

• Preventive measures including delayed cord clamping, reduction of iatrogenic blood loss, early iron supplementation and adherence to transfusion guidelines are important strategies to reduce the need for blood transfusion.