Severe Anemia at Birth-Incidence and Implications

Area of Science:

• Neonatal Medicine
• Pediatric Hematology
• Clinical Epidemiology

Background:

• Severe anemia at birth, defined by hemoglobin or hematocrit below the 1st percentile, affects a significant number of neonates.
• Early recognition and accurate diagnosis of neonatal anemia are crucial for timely intervention and improved outcomes.

Purpose of the Study:

• To identify neonates with severe anemia at birth.
• To determine the rate of caregiver recognition of anemia within 24 hours.
• To investigate the probable causes and outcomes of severe neonatal anemia.

Main Methods:

• Retrospective cohort analysis of population-based data from 299,927 live births between 2011 and 2020.
• Identification of neonates with severe anemia based on hemoglobin/hematocrit values within 6 hours of birth.
• Retrospective review to determine anemia recognition, probable cause, and treatment.

Main Results:

• 344 neonates (0.11%) had severe anemia at birth; 55.5% were recognized within 24 hours.
• Hemorrhage was the most common cause of the lowest hemoglobin values.
• Mixed mechanisms, especially hemorrhagic plus hemolytic, were more common than initially recognized.

Conclusions:

• Severe anemia at birth is frequently unrecognized in the first day of life.
• Retrospective reviews identified causes not documented in medical records.
• An electronic medical record-associated nomogram could improve recognition and diagnosis.