Early iron supplementation and iron sufficiency at one month of age in NICU patients at-risk for iron deficiency

Bahr, Timothy M.; Carr, Nicholas; Christensen, Thomas R.; Wilkes, Jacob; O’Brien, Elizabeth; German, Kendell; Ohls, Robin K.; Christensen, Robert D.

doi:10.1016/j.bcmd.2021.102575

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…32 In a study by Bahr et al, 16% of the infants admitted to the NICU and at-risk for ID had CHr < 25 pg at 1 month of age despite early iron supplementation. 33 In a study by Franz et al, 15% of VLBW infants (birth weight < 1,301 g) were iron deficient at 2 months of age despite receiving 4 to 6 mg/kg/ day of enteral iron. 34 Most of the previous studies have used serum ferritin levels to diagnose ID while Bahr et al used CHr cutoff <25 pg to define ID.…”

Section: Discussionmentioning

confidence: 99%

“…33 In a study by Bahr et al, 16% of the infants admitted to the NICU and at-risk for ID had CHr <25pg at 1 month of age despite early iron supplementation. 34 Most of the previous studies have used serum ferritin levels to diagnose ID while Bahr et al used CHr cutoff <25pg to define ID. The rate of ID in our cohort could be higher due to the higher cutoff for low CHr, inclusion of only VLBW infants, lack of specific and early iron supplementation guidelines, differences in the phlebotomy and transfusion rates, lower rates of DCC and the differences in the timing of screening (59 days vs 1 month of age).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content

Kennady,

Afridi,

Neumann

et al. 2023

Am J Perinatol

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Objective To assess the iron status prior to discharge in very low birth weight (VLBW) infants utilizing reticulocyte hemoglobin content (CHr) and evaluate the impact of delayed cord clamping (DCC) on iron status. Methods Retrospective analysis of VLBW infants from two tertiary level of care NICUs. The primary outcome was the proportion of VLBW infants with low CHr (<29 pg) prior to discharge. Hematologic parameters were also compared between infants who received or did not receive DCC. Infants with a positive newborn screen for Bart’s hemoglobin were excluded. Results Among the 315 infants included, 99 infants (31.4%) had low CHr prior to discharge. The median (IQR) CHr prior to discharge was 30.8 pg (28.4-39). DCC was performed in 46.7 % of infants. Hemoglobin at birth, discharge, and CHr prior to discharge were higher and the need for blood transfusion and the number of infants with low CHr prior to discharge were lower in the DCC group. Conclusion Approximately 31.4 % of VLBW infants had low CHr near the time of discharge suggesting they were iron deficient. DCC improved hematological parameters prior to discharge in VLBW infants. CHr content can be used to guide iron supplementation in VLBW infants to potentially improve their iron status and long-term neurocognitive outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content

Kennady,

Afridi,

Neumann

et al. 2023

Am J Perinatol

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“…The RET-He serves as a metric of the iron available for hemoglobin production during the previous several days. 6,7,44 The validity of RET-He as a marker of iron status has been well studied in adult and pediatric patients. 45 However, like ferritin, limited data validate RET-He as a marker of iron status in preterm neonates.…”

Section: Developing Practical Ways To Identify Neonatal Iron Deficiencymentioning

confidence: 99%

“…52 In one of our studies of iron dosing in a multihospital collaborative group, we did not find emesis to be a common problem in preterm neonates receiving ferrous sulfate as early as 10-14 days after birth. 44 In adults with iron deficiency, vitamin C given along with the enteral iron improves the iron absorption. 53 This has not been formally investigated in neonates but should be.…”

Section: Developing More Effective Treatments F O R Neonatal Iron Def...mentioning

confidence: 99%

“…54 This theory is consistent with one of our pilot studies. 44 Identifying iron-deficient neonates who have high hepcidin levels, or who have other mechanisms causing refractoriness to enteral iron treatment, could permit the use of intravenous iron for those unlikely to respond to high enteral dosing. Clearly, new oral preparations of iron and also improvements in intravenous iron administration are needed for neonates as are better non-invasive means of monitoring the efficacy of iron treatment, as are ways to make these improvements practical and inexpensive.…”

Section: Developing More Effective Treatments F O R Neonatal Iron Def...mentioning

confidence: 99%

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Iron Deficiency in Newborn Infants: Global Rewards for Recognizing and Treating This Silent Malady

Christensen¹,

Bahr²

2022

Newborn

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Iron deficiency can exist at birth. Even if iron is sufficient at birth, deficiency can develop during the neonatal period, or during infancy, or during childhood. Iron deficiency can exist despite a normal hematocrit and a normal blood hemoglobin concentration, because anemia is a very late manifestation of iron deficiency. It is likely that adverse neurodevelopmental consequences occur during perinatal biochemical iron deficiency, despite a normal hematocrit and hemoglobin. Consequently, measuring those parameters is a very insensitive method for perinatal iron deficiency screening. This review focuses on potentially better practices for diagnosing perinatal iron deficiency, including recent advances in understanding the pathogenesis of this condition, and also on practical means of treatment, and on global rewards of so doing.

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Reticulocyte Hemoglobin Equivalent has Comparable Predictive Accuracy as Conventional Serum Iron Indices for Predicting Iron Deficiency and Anemia in a Nonhuman Primate model of Infantile Iron Deficiency

Rao

Lubach

Ennis-Czerniak

et al. 2023

The Journal of Nutrition

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Early iron supplementation and iron sufficiency at one month of age in NICU patients at-risk for iron deficiency

Cited by 7 publications

References 39 publications

Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content

Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content

Iron Deficiency in Newborn Infants: Global Rewards for Recognizing and Treating This Silent Malady

Reticulocyte Hemoglobin Equivalent has Comparable Predictive Accuracy as Conventional Serum Iron Indices for Predicting Iron Deficiency and Anemia in a Nonhuman Primate model of Infantile Iron Deficiency

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