Anemia of Prematurity - Portal Neonatal

CLINICAL Section 3 of 10
History: Few symptoms are universally accepted as attributable to AOP; however, the following are
among the symptoms that clinicians attribute to AOP:
• Poor weight gain
• Apnea
• Tachypnea
• Decreased activity
• Pallor
• Tachycardia
• Flow murmurs
Physical: Debate regarding the presence or absence of physical findings in the infant with AOP is
ongoing. Clinical trials designed to determine the efficacy of blood transfusions in relieving these
findings have produced conflicting results.
• Poor growth
o Inadequate weight gain despite adequate caloric intake often is attributed to AOP.
o The response of weight gain to transfusions has been inconsistent in the literature.
• Apnea
o If severe enough, anemia may result in respiratory depression manifested by increased
periodic breathing and apnea.
o While some studies have demonstrated a decrease in frequency of these symptoms
subsequent to blood transfusions, others have found similar results with simple
crystalloid volume expansion.
• Decreased activity: Lethargy frequently is attributed to anemia, with subjective improvement
subsequent to transfusion.
• Metabolic acidosis
o Significant anemia can result in decreased oxygen-carrying capacity less than the needs
of the tissue, resulting in increased anaerobic metabolism with production of lactic acid.
o Blood transfusions have been documented to decrease lactic acid levels in otherwise
healthy infants who are anemic and premature. Some medical professionals have
suggested using lactate levels as an aid in determining the need for transfusion.
• Tachycardia
o Infants with AOP may respond by increasing cardiac output through increased heart
rates, presumably in response to inadequate oxygen delivery to the tissues caused by
anemia.
o Blood transfusions have been associated with a lowering of the heart rate in infants who
are anemic.
• Tachypnea
• Flow murmurs