Low hemoglobin in a newborn: symptoms, what to do, treatment

Low hemoglobin in a newborn is always a cause for concern, since hemoglobin performs an important function in the baby's body. Lack of oxygen may not have a very good effect on the development of brain cells and internal organs. Therefore, it is important not only to know about the clinical manifestations of this syndrome, but also to find the cause.

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Epidemiology

Statistics on the prevalence of low hemoglobin in newborns emphasize that this problem is common at almost all times and does not depend so much on the standard of living of the family. In terms of frequency and significance among all the causes that cause anemia in newborns, hemolysis should be put in first place, which depletes hemoglobin reserves. In second place, one can note the insufficient iron supply in the baby from the mother, and in third place, blood loss.

Causes low hemoglobin in a newborn.

To understand which indicators for a newborn are considered reduced, you need to know about the standards for hemoglobin indicators in a newborn. The peculiarity of the child's circulatory system at the time when it develops in the mother's belly is that only the large circle of blood circulation works. This determines the need for blood cells to work more efficiently. Therefore, the hemoglobin of a child who is in the womb is not the same as that of adults. Hemoglobin is called "fetal", and its functionality is slightly higher. It is able to attach more oxygen than normal hemoglobin, which allows the entire child's body to be provided with a sufficient amount of oxygen. Therefore, the hemoglobin content in the body of a newborn child is 180-220 grams per liter. These are the standard values for a child during the first month of life. Therefore, a hemoglobin level of less than 180 is considered low.

The hemoglobin level can decrease in the so-called deficiency states, when the formation of hemoglobin is disrupted or there is excessive destruction. There are different types of deficiency states, which include iron deficiency, folic and B12 acid deficiency, and hemolytic states. This is where the main reasons for the development of low hemoglobin come from.

The child's body contains 2000-3000 mg of iron. The main mass - about 2/3 of its total amount - is part of hemoglobin, 200-300 mg - in cytochromes and cytochrome oxidase, myoglobin; from 100 to 1000 mg of iron is deposited in the liver, bone marrow, spleen in the form of ferritin and hemosiderin. Iron reserves are created during the period of intrauterine development of the fetus mainly due to the maternal fund, and are subsequently accumulated by absorbing iron from food. Iron metabolism is closely related to the processes of its intake and excretion from the body.

Iron is constantly excreted from the child's body with sweat, urine, exfoliated cells of the integumentary tissues - skin and mucous membrane of the digestive tract. The daily loss of iron is 1-2 mg. To maintain iron reserves at a physiological level, it is necessary to ensure that at least 1-2 mg of iron enters the body every day. Its absorption is ensured by enzymes and biologically active substances that are found in the duodenum and in the initial section of the small intestine. Iron is contained in food products mainly in the trivalent form. The condition for its absorption is the transition of trivalent iron to divalent, that is, to a soluble reduced form. This process occurs in the stomach in the presence of hydrochloric acid.

In the cells of the intestinal mucosa, iron forms a complex with a protein, apoferritin, and then passes into ferritin, from which iron is separated in the form of divalent iron, enters the blood, and binds to transferrin, which transports iron to the sites of use or deposition.

There is a specific mechanism for regulating iron absorption. Absorption increases in the presence of even latent, hidden iron deficiency and decreases when iron reserves reach the norm. Thus, iron absorption increases after blood loss due to operations in newborns. Iron absorption is affected by the composition of the food of a pregnant woman and later a nursing mother. Iron absorption improves with sufficient protein and ascorbic acid in the mother's diet. Iron absorption decreases when dairy products and strong tea are consumed - with milk, iron forms insoluble albuminates, and with tannin it also forms insoluble complexes.

The main reasons for the development of low hemoglobin in newborns are the following:

1. blood loss;
2. impaired iron absorption in a newborn with nonspecific ulcerative colitis or other pathologies;
3. increased iron consumption may occur in newborns with chronic diseases or congenital heart defects;
4. iron fixation by macrophages in some pathological processes.

Repeated blood loss increases iron deficiency, first manifested by latent, and then by overt anemia. The source of blood loss is most often the digestive tract - in newborns the cause is diaphragmatic hernia, ulcerative colitis, hemorrhagic disease of the newborn, hemorrhages in the brain or ventricles.

Pathologies of iron absorption are observed after resection of significant sections of the small intestine, which may be due to the ineffectiveness of conservative treatment.

Redistribution of iron occurs in some chronic infections (sepsis), diseases of connective tissue, when iron is used not for the needs of erythropoiesis, but to fight infection, being fixed in the cells of the phagocytic mononuclear system.

Alimentary iron deficiency anemia develops mainly in newborns who are on artificial or irrational feeding. There may also be problems in children whose mothers did not have a rational diet during pregnancy, and thus the baby's iron reserves were not formed.

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Risk factors

Risk factors for developing low hemoglobin are:

1. a premature baby or a twin baby initially has low iron and hemoglobin reserves;
2. inadequate nutrition of the mother during pregnancy;
3. feeding a child with cow's or goat's milk;
4. concomitant diseases in the baby;
5. congenital defects;
6. hemolytic disease in relatives.

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Pathogenesis

The pathogenesis of low hemoglobin development lies precisely in the lack of iron, which reduces the formation of red blood cells. If we are talking about blood loss due to the destruction of red blood cells, for example, in hemolytic disease of the newborn, then the pathogenesis in this case lies in a decrease in the number of active red blood cells during their decay and a decrease in hemoglobin, respectively.

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Symptoms low hemoglobin in a newborn.

The clinical picture of low hemoglobin in a newborn depends on the level of iron deficiency. The deeper the iron deficiency, the more pronounced the clinical symptoms and the more severe the patient's condition.

The mother may notice the first signs of pathology immediately after discharge home. A newborn baby should be pink, plump, eat well, cry and sleep. If the baby has a poor appetite, sleeps a lot at night and practically does not wake up to eat, then this may be one of the signs that something is wrong with the baby. With low hemoglobin, the child does not have enough strength to be active and therefore the appetite decreases, because feeding requires a lot of energy, and the cells are "starving" from lack of oxygen. But this is a non-specific symptom.

Pale skin, when the baby should be pink, is considered a more specific symptom.

Symptoms of low hemoglobin in a newborn with a pronounced deficiency are manifested by symptoms from the internal organs. Cardiac syndrome is manifested by pain in the heart area, increased heart rate, decreased strength of heart sounds, systolic murmur over the apex or base of the heart, "whirring top" murmur over the jugular veins, expansion of the heart borders, relative insufficiency of the valves resulting from deterioration of the myocardium's oxygen supply and blood thinning. With severe anemia, signs of heart failure may occur, which may be manifested by the child's pastosity, swelling of the legs against the background of its low weight. With a long "anemic history", manifestations of cerebral hypoxia may occur. The child may be a little delayed in reaction, be drowsy or inhibited.

Endocrine syndrome develops against the background of insufficient oxygen supply to the thyroid gland and disruption of thyroid hormone synthesis. Therefore, secondary hypothyroidism may develop. Clinically, signs of hypothyroidism are revealed: the symptom of dirty elbows, dry skin, hair loss, chilliness, swelling, poor closure of the fontanelle, large tongue.

Dyspeptic syndrome is manifested by a decrease in the secretory function of the stomach, liver, and pancreas. This can be revealed by constipation or diarrhea. On the part of the respiratory organs, respiratory failure occurs, which is symptomatically revealed by an increase in the respiratory rate, a decrease in the vital capacity and other reserve standards. This disorder is associated with a decrease in the tone of the respiratory muscles due to insufficient oxygen supply.

If we are talking about a decrease in hemoglobin in a newborn due to congenital hemolytic anemia, then one of the most important symptoms will also be yellowing of the skin and mucous membranes. Along with a decrease in hemoglobin levels against the background of anemia, hyperbilirubinemia will be determined. The child will be pale yellow, and against this background, there may be disturbances in the general condition.

When talking about the symptoms of anemia, it is important to know that there are successive stages of hemoglobin deficiency development. If we are talking about iron deficiency, then the manifestation of symptoms depends on the level of this deficiency. There is a latent and obvious iron deficiency. With latent deficiency, there may not yet be any visual symptoms of low hemoglobin, although there are already changes in the analysis. Obvious iron deficiency is characterized by its deep deficiency, while there are already clearly visible symptoms and changes in the internal organs.

Complications and consequences

The consequences of low hemoglobin are more common with long-term untreated anemia. Impaired oxygen delivery to cells can lead to their starvation, which can be critical for some organs. If we talk about the brain, then in a newborn baby, its cells begin to actively function under the influence of environmental factors. And with a lack of oxygen, they are the first to suffer, which can cause further disorders and developmental delays. Against the background of low hemoglobin, the body is considered vulnerable to the action of pathogenic factors, so such babies can get sick more often. Complications of low hemoglobin can be if it is caused by a hemolytic disease of a congenital or acquired nature. In this case, the level of bilirubin in the blood increases significantly, which is very toxic to the brain. This can lead to the accumulation of bilirubin in the cells and the development of nuclear encephalopathy. This is a serious disease with a delay in development and cognitive functions.

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Diagnostics low hemoglobin in a newborn.

Diagnosis of low hemoglobin in a newborn should begin with a visual assessment of its condition. Pale skin and mucous membranes may be one of the signs for further examination of the baby. A specific symptom of such a pathology can be noticed when looking at the baby's palm in a semi-bent position and comparing the color of the skin of the palm with the color of the mother's palm. With a hemoglobin deficiency in the baby, the palm will be pale.

Further, during an objective examination, a systolic murmur in the heart at the apex will be noted, which must be immediately differentiated from the functional murmur.

Diagnosis of low hemoglobin in a newborn is based on a peripheral blood test and determination of various iron level indicators. Clinical data and the presence of signs of sideropenia are taken into account. Bone marrow testing is extremely rare.

Tests are very important to confirm the diagnosis and determine the severity. A simple blood test is informative, and if there are changes, further examinations of the serum blood are carried out. Changes in the blood: the hemoglobin level is reduced, the number of red blood cells in the early stages of iron deficiency may be normal, then decreases. The color index is reduced (0.8 and below), which indicates a decrease in the hemoglobin content in each individual red blood cell. Hypochromia of red blood cells and a decrease in their volume are noted. The number of reticulocytes is normal, but after blood loss it may increase. The number of leukocytes and the leukocyte formula are not changed, however, in the case of long-term uncompensated iron deficiency, leukopenia is possible. The number of platelets is normal and may increase due to bleeding.

The serum iron level is below normal (<11 μmol/l), free blood transferrin is elevated (>35 μmol/l). The transferrin saturation level is reduced (<25%). The desferal test is positive. With prolonged chronic iron deficiency anemia, symptoms of bone marrow hyporegeneration appear.

Diagnosis criteria:

1. hemoglobin level less than 180 in the neonatal period.
2. decrease in color index less than 0.85;
3. microcytosis (more than 20% of red blood cells with a diameter of <6), decreased MCV less than 80.0 fetometers, decreased MCH less than 30.4 picograms, decreased MCHC less than 34.4%.

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Differential diagnosis

Low hemoglobin should be differentiated from anemia caused by pathology of synthesis and utilization of porphyrins - sideroblastic conditions. These conditions develop with hereditary defects of enzymes participating in the formation of porphyrins and heme, or in the case of such a defect, for example, due to lead poisoning. These conditions are also characterized by hypochromia of erythrocytes, however, the normal iron index is preserved, and the content of sideroblasts rich in ferritin granules is increased in the bone marrow. In individuals with lead intoxication, basophilic puncturation of erythrocytes is detected, in the bone marrow - an increased number of sideroblasts with a ring arrangement of ferritin, in the urine - lead and an increase in the level of 5-amino-levulinic acid. Hypochromia of erythrocytes is also found in patients with thalassemia. Thalassemia is characterized by clinical symptoms of hemolysis: anemia, jaundice, splenomegaly, the presence of target-like erythrocytes in the blood, bilirubinemia, and, with hemoglobin electrophoresis, an increased content of hemoglobin F.

If low hemoglobin is caused by a hemolytic pathology, then the jaundice that appears in this case should be differentiated from physiological jaundice. And the main distinguishing feature is that hemoglobin in physiological jaundice is within normal limits.

Treatment low hemoglobin in a newborn.

Treatment of iron deficiency anemia has two goals: eliminating the cause that led to the development of iron deficiency (stopping bleeding, treating the underlying disease), and pathogenetic therapy with iron preparations aimed at eliminating iron deficiency. Treatment of low hemoglobin in a newborn is necessarily carried out in several ways: correction of the nursing mother's diet or changes in the baby's formula if he is bottle-fed, as well as drug treatment with iron preparations.

Iron preparations have different ionic iron content and are selected individually, so those that are not always well tolerated. This is due to the irritating effect of iron salts on the mucous membrane of the digestive tract, manifested by belching, taste in the mouth, bloating, diarrhea. Iron preparations are usually prescribed orally. It should be taken into account that the possibility of its absorption is limited and is 7-10% of the iron that is introduced into the stomach, and only after blood loss, in case of severe deficiency it can increase to 20-25%. In this regard, the doses of iron that are introduced into the body should correspond to therapeutic ones, but not less than 100-300 mg per day. At the same time, it is advisable to prescribe ascorbic acid with iron preparations, which improves the absorption of iron. The dosage of any drug for a newborn is 3-5 milligrams per kilogram of body weight, calculated based on elemental iron. The following sequence of iron preparations is suggested: first, protective iron sulfate, and in case of pathology from the stomach or intestines, other forms are used in the form of gluconate, succinate or fumarate. Additional administration of ascorbic acid will increase the absorption of iron and allow the use of smaller doses, as well as reduce the number of side effects.

The activity of absorption and further action of iron directly depends on the form of the medicine. Liquid medicines (drops, syrups) are better absorbed and exhibit a pronounced therapeutic effect.

The absorption and action of drugs is impaired in cases of dysbacteriosis, and probiotics accordingly promote its absorption.

A dose-dependent paradox has been revealed: as the single dose increases from 40 to 400 mg, the amount of iron absorbed decreases from 30-35% to 5-7%. For children, the most convenient forms are recommended: Ferrous sulfate oxide mixture for children, containing 12 mg of elemental iron in 5 ml or a polysaccharide-ion complex (niferex), containing 100 mg of elemental iron in 5 ml. It is diluted before use. Iron in slow-release and chelated forms is less likely to cause severe intoxication.

As a rule, regular iron tablets are coated with a bright coating and contain ascorbic acid (Tardiferon, where iron is 80 mg, ascorbic acid is 30 mg), Sorbifer Durules (lentil-shaped tablets with 100 mg of iron and 60 mg of vitamin C, Hemofer - red biconvex tablets with 325 mg of iron).

In addition, iron preparations are prescribed in gelatin capsules (Aktiferin in the form of an oily paste containing 34.5 mg of iron sulfate), Feretate (ferric fumarate) with 0.5 mg of folic acid, Orofer (polymaltose complex of ferric iron with folic acid - 0.55 mg) and in dragees - Feroplex (with 30 mg of ascorbic acid). An interesting dosage form for the treatment of anemia is chewable tablets Multifer-fol.

Convenient for dosing in drops for oral administration divalent iron preparations: (Hemofer), polymaltose complex of trivalent iron (Multofer hydroxide), in syrups (Ferrum lek and Orofer in polymaltose complex with a dosing spoon, where in 5 ml there is 50 mg of iron hydroxide), Multofer with 10 mg of iron in 1 ml, Totema (complex of iron gluconate, manganese and copper in ampoules for oral administration), suspensions - Feronat (iron fumarate, where in 1 ml there is 10 mg of elemental iron).

Low hemoglobin should be treated with iron preparations administered intravenously and intramuscularly only when intestinal absorption is impaired (nonspecific ulcerative colitis in a newborn). Blood transfusions for iron deficiency are prescribed only for vital indications - in the case of severe hemodynamic impairment, preparation for emergency surgery.

The effectiveness of iron therapy is monitored by blood tests. After 10-12 days from the start of therapy, an increase in the number of reticulocytes is detected, followed by an increase in the hemoglobin content. Treatment should be carried out until the hemoglobin level and color index are normalized. After this, maintenance treatment should be carried out for several months with half doses of the same drug that was used for treatment. An iron-rich diet is also recommended for the mother. It should include mandatory daily intake of meat and green vegetables. If the child is bottle-fed, then he should be transferred to an iron-rich formula.

The main drugs for treating low hemoglobin are:

1. Maltofer is a trivalent iron preparation, which is contained in the form of polymaltosate. This drug is used to treat anemia in newborns due to the ease of dosing, as it is available in the form of drops, syrup and capsules. One milliliter of the drug contains 50 milligrams of elemental iron. The dosage for newborns with low hemoglobin is 3-5 milligrams per kilogram or one drop per kilogram of the child's weight. The minimum course of treatment is one month. Side effects may include bloating, colic, diarrhea. Precautions - do not use to treat hemolytic conditions.
2. Sorbifer is a preparation of divalent iron in the form of sulfate with a complex of ascorbic acid, which improves the absorption of this preparation. One tablet contains 100 milligrams of pure iron. The dosage of the preparation is calculated based on the child's body weight (3-5 milligrams per kilogram). Method of application - can be dissolved in juice and given to the child or in clean water. Side effects may include delayed stool, staining it black.
3. Aktiferin is a preparation of divalent iron in the form of sulfate. This medicine is available in the form of drops, syrup and capsules, which can be used for small children. One milliliter of syrup or drops contains 34.5 milligrams of iron. The dosage is calculated as 3-5 milligrams. The method of administration should be oral, by dividing the daily dose into three times with taking an hour after water and two hours before meals. Precautions - this form of iron can cause nausea in a child, so the drug should be washed down with a little water. Side effects can be in the form of dyspepsia.
4. Tardiferon is a divalent drug in combination with ascorbic acid. This drug is available in the form of tablets with prolonged action. The dosage of the drug for children is based on body weight. One tablet contains 80 milligrams of iron. Method of administration - it is not recommended to break the tablets, so it is better to dissolve them in water. Precautions - given the prolonged form and difficult availability of the drug, it is better to use it for maintenance therapy when the hemoglobin level has already normalized.
5. Feroplex is a preparation of iron sulfate with ascorbic acid. It is produced in the form of dragees and contains 11 milligrams of pure iron. This product is dosed based on the child's weight and for ease of use it can be dissolved in water. Side effects can be nausea, stool disorders, the child's refusal of the drug, which requires dose adjustment. Precautions - do not use in children with congenital intestinal pathologies.

Vitamins for a child with low hemoglobin are good to use already at the stage of maintenance therapy with iron preparations. This ensures the normalization of the level of iron and other necessary vitamins for red blood cells and other cells of the body. For this purpose, complex vitamin preparations approved for newborns are used.

Physiotherapeutic treatment is not used in the acute period.

Folk remedies

Traditional methods of treatment can be used to improve the effect of drug treatment. In most cases, such methods can be used by the mother if she is breastfeeding, since this can be a risk for the newborn baby to develop allergic reactions.

1. Pomegranate is an incomparable source of vitamins C, B, and iron. Given the content of ascorbic and succinic acid, it helps improve the absorption of iron and leads to a faster increase in hemoglobin levels. A folk method of treatment involves taking pomegranate juice every day for the mother. It immediately gets to the baby with milk after four hours and has a beneficial effect. To avoid allergic reactions, it is recommended to take two tablespoons five to six times a day.
2. Beetroot is also considered a universal remedy that helps to increase hemoglobin. For treatment, you need to boil the beetroot, peel it and grind it in a blender. Add five drops of lemon juice to this mass and drain all the resulting juice. When adding lemon, it may become lighter, which should not be alarming. If desired, you can add a little salt or sugar to the juice. It should be taken fresh, one tablespoon three times after meals.
3. A very useful medicine for correcting low hemoglobin in a baby is made from the following ingredients: you need to take two dessert spoons of cocoa, two teaspoons of butter, and two dessert spoons of honey. All this needs to be mixed and melted in a water bath to get a homogeneous mass. Then you need to grind one hundred grams of black rowan in a blender and, adding the resulting mass to the rowan, bring to a homogeneous consistency. You need to cool it a little, thus you will get a semi-solid mass. The mother needs to take this medicine one teaspoon in the morning on an empty stomach for a month.

Mother can also use herbal treatment to improve the results.

1. You need to mix 20 grams of fresh clover leaves and 30 grams of dry dandelion leaves. Add one hundred grams of hot water to the herbs and steam for 30 minutes. After that, you can take 50 grams in the morning and evening. There may be a slight dizziness, which is considered normal, since these herbs slightly lower blood pressure. In this case, you must take it after meals.
2. Rose hips have many beneficial properties, including normalizing hemoglobin levels. This is mainly due to the fact that rose hips increase the formation of globin protein in the liver, which is a direct part of hemoglobin. This accelerates the formation of new red blood cells. For treatment, add 300 grams of dill to 100 grams of rose hips and boil for five minutes. A nursing mother should take this infusion for at least one month, a glass per day, which can be divided into several doses.
3. Strawberry leaves and birch buds should be taken in equal quantities and filled with cold water overnight. After that, such a solution should be boiled and infused for another two hours. The mother should take a teaspoon of such an infusion five times a day. Such a solution can increase the number of urinations in a child, which is normal and does not require any action.

Homeopathy can be used to correct anemia of various etiologies, and hemolytic conditions are not a contraindication for this. This is the advantage of such treatment methods. There are also homeopathic remedies that can be taken by a baby on the recommendation of a doctor.

1. Calcarea phosphorica is a homeopathic remedy used to treat low hemoglobin in children and adults. The drug enhances the formation of new red blood cells by activating sprouts in the bone marrow. For treatment, you need to use the drug in the form of homeopathic granules. For a newborn, the dose is one granule four times a day. How to use - you can crumble the granule and put it on the baby's tongue and it will melt itself. Side effects are very rare, but there may be slight muscle twitching, which indicates the need to reduce the dose. The minimum course of treatment is one month.
2. Ferrum phosphoricum is an inorganic preparation that includes processed and diluted phosphorus, which is a specific stimulator of red blood cell formation. The preparation can be taken by a nursing mother in the form of tablets. Dosage - one tablet five times a day. Side effects may include diarrhea, which goes away after several days of regular use of the preparation. Precautions - do not use for treatment if the child has very pronounced jaundice, since the preparation reduces the utilization of bilirubin.
3. Lycetinum in the sixth dilution is an organic homeopathic preparation, the main substance of which is lecithin. Depending on the production, it is obtained from the yolk of eggs or from the tail parts of seafood. To treat low hemoglobin, you need to use egg extract, as it is less allergenic for newborns. How to use for a mother - you need to start with one grain per day and increase the dose over the course of a week to six per day, if the child does not have an allergy. If there are allergic manifestations, then you need to return to a smaller dose and take it for three weeks. Side effects can be in the form of rashes.
4. Hina is an organic homeopathic medicine that can be used for low hemoglobin when its level is not critical and is caused by minor blood loss, such as hemorrhagic disease of the newborn. The dosage of the drug for a baby is two grains once a day before feeding, they need to be ground and can be dissolved in water. Side effects can be bloating, which goes away after feeding.

Blood transfusion to a newborn with low hemoglobin is usually performed in hemolytic disease, when the bilirubin level is high and there is a risk of acute brain damage. In this case, there is also a low hemoglobin level, since anemia develops against the background of hemolysis. In this case, blood is transfused by catheterization of the umbilical vein. Blood of the same group and single Rh is necessarily transfused, which is also taken from the umbilical artery to determine the group, since after birth there may be errors with the child's maternal antibodies. Washed red blood cells are transfused with subsequent determination of laboratory hemoglobin indicators and supportive treatment, if necessary, in the form of detoxification. Iron preparations are not prescribed for some time after this.

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Prevention

Prevention of low hemoglobin in a newborn is aimed at timely treatment of diseases that can cause iron deficiency, the appointment of iron preparations to children born to anemic mothers, women during pregnancy, lactation and in the case of polymenorrhea, a full and varied diet of the mother first of all. In the future, premature babies are recommended prophylactic doses of iron to prevent the development of latent deficiency in the neonatal period.

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Forecast

The prognosis for low hemoglobin in a newborn is favorable, provided that the cause of iron deficiency is radically eliminated and the iron deficiency is fully compensated. If the cause is congenital hemolytic anemia, it is important to monitor the level of not only hemoglobin, but also bilirubin, then the prognosis for preventing complications will be favorable.

Low hemoglobin in a newborn is one of the signs of congenital or acquired anemia. Correction of these conditions should be carried out as early as possible, since a sufficient amount of oxygen is necessary for the full growth and development of the baby. Therefore, mothers should know when they should think about the level of hemoglobin in the child and when it is necessary to prevent these conditions.

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