Abate AT, Bazezew LY, Abuhay AG, Siyoum TM, Tadesse G, Lakew AM, Gedefaw GD. Major causes and associated factors of anemia among neonates admitted to the five comprehensive and specialized hospitals of Northwest Amhara region in Ethiopia (2023): Cross sectional study. Journal of Neonatal Nursing. 2025 Dec 1;31(6):101743.
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Anemia is very common in neonates admitted to neonatal intensive care units (NICUs), and is a major cause of infant morbidity and mortality. In this large study, conducted in the NICUs of five comprehensive hospitals in the Northwest Amhara Region of Ethiopia, 991 randomly-selected NICU patients were evaluated to determine the prevalence of anemia and then to identify the corresponding underlying etiologies. The prevalence of anemia in this patient population was 25% and the most common association with this condition was RhD blood group incompatibility (i.e., an RhD-positive neonate born to an RhD-negative mother), with an adjusted odds ratio of 3.11. Although Rh disease was not strictly diagnosed in this population, which would require identifying the presence of anti-RhD antibodies in the mother (and neonate) and/or by performing a direct antiglobulin test using neonatal red blood cells, the striking adjusted odds ratio, accompanied by the finding that anemia was more common in neonates born to multiparous mothers (with adjusted odds ratio of 1.41), strongly suggests that Rh disease was the most likely etiology of the anemia seen in these particular NICU patients. Thus, this study highlights the critical need to implement immunoprophylaxis with Rh immune globulin in this region of Ethiopia to decrease, and potentially eliminate, this common cause of neonatal anemia.