DETECTION, CORRECTION AND ULTIMATE PREVENTION OF ANEMIAS IN THE PRETERM INFANT

Preterm infants have a qualitative and quantitative deficiency of red cells. Thus, they may have difficulty in meeting their often high oxygen needs. It is vital therefore to develop a strategy for optimization of their blood for oxygen transport. The ability of the blood both to carry oxygen and to perfuse the whole circulation, are the vital hematologic variables in oxygen delivery. Inadequacy in both of these functions is the rule in most preterm infants during intensive management. Hemoglobin concentration/hematocrit values are incomplete guides to these deficiencies. Circulating blood volume must also be taken into account. A strategy is outlined to allow optimization of the blood ab initio by appropriate placento-fetal transfusion at birth. Maintenance of hemoglobin concentration for oxygen transport later in an infant's clinical course may become possible using recombinant human erythropoietin. Meanwhile, when donor red cell transfusion is needed, the "dose" should reflect and aim to correct the deficiency in circulating red cell mass.