NICU – Anemia of Prematurity / Hemoglobin Levels

When you have a preemie, you want all issues fixed NOW! You have no patience left.

Anemia of Prematurity is one of those issues, you go through ups and downs, watch your baby transfused blood, have conversations with doctors, and then finally sit and wait until your baby leaves the preemie phase.

Anemia of Prematurity is explained with low Hemoglobin levels found in the blood. Hemoglobin is a vital protein for babies whose organs are rapidly developing. It carries oxygen to body's organs and tissues and transports carbon dioxide from organs and tissues back to lungs, which makes it crucial for the organs to function properly and brain to develop well. *

D.’s hemoglobin level started going down below the range by the third week of our stay. One other parameter NICU team kept checking apart from Hemoglobin level was RETICULOCYTE** count, which indicated how quickly the baby is making new red blood cells on his own. D.’s RETICULOCYTE count was promising all along. Doctor’s opinion was that hemoglobin production was in place, however, her body used much more hemoglobin than D. could produce, which is considered as “normal” for preemies. This is called Anemia of Prematurity. It means that your preemie is still going through biological changes to produce new blood cells independent of you and your placenta. It is expected to resolve over time as she grows.

In the meantime, plan was to supplement through blood transfusion. D. received blood transfusion three times, which gave me butterflies in the stomach each time. But story for another entry.

Pattern was that she would get blood transfused; her hemoglobin would go up to an acceptable range. After 2-3 weeks, it would go down below the range again, which we could tell from her face. Her face would get pale, and she would be more sleepy than usual. Doctors were also suspicious about her irregular breathing pattern could be caused by low insufficient hemoglobin. Blood tests were run too, usually to prove the obvious.

I, on the other hand kept asking: Why? What is the reason for hemoglobin to keep decreasing? For me, if we could find out the root cause, we could solve the problem. According to the doctors, it could have been a few reasons: Brain bleeding, which D. had a mild one yet difficult to tell if it was the reason or not. It could have been infection in her body, which was checked on a regular basis with a negative result all along. Decision was to wait and see like we had to do for other issues D. had.

We got discharged at the end of 36th week and she received her third blood transfusion on the day of discharge. Post discharge, her doctor never asked for a test again because she thrived in terms of her weight, height, and head circumference. We supplemented her with iron drops from the day of discharge until she is one as prescribed by our doctors.

*https://www.mayoclinic.org/tests-procedures/hemoglobin-test/about/pac-20385075#:~:text=Hemoglobin%20is%20a%20protein%20in,blood%20cell%20count%20(anemia).

** RETICULOCYTE COUNT definition from The Premature Baby Book, William Sears, page 297

*** photo credit: https://stock.adobe.com/ae/images/structure-of-human-hemoglobin-molecule/178153603

photo credit: https://www.verywellhealth.com/what-is-anemia-in-preterm-infants-2748622