Intramuscular iron-dextran and susceptibility of neonates to bacterial infections. In vitro studies.

Abstract

SUMMARY An increased incidence of E. coli sepsis has been observed in neonates given intramuscular iron-dextran for prevention of iron deficiency. Mechanisms for this apparent effect on susceptibility to infection were investigated by comparing phagocytic and antibacterial functions in paired samples of venous blood from 7 infants, median age 5 days, before and after iron-dextran. Post-treatment sera had increased inhibitory effects on leucocyte chemotaxis and markedly reduced bacteriostatic effects against E. coli. The clinical relevance of the effects on chemotaxis is uncertain. The reduction in serum bacteriostasis is similar to that observed in other forms of hyperferraemia not associated with saturation of transferrin, and is a likely cause of the increased susceptibility to infection in vivo. We consider that prophylactic treatment with parenteral iron-dextran is contraindicated in early infancy.The prevention of iron deficiency in 'high risk' infant populations by giving iron-dextran intramuscularly to babies in maternity hospitals was advocated in New Zealand after favourable results were reported from pilot studies (Tonkin, 1970;Cantwell, 1972 Cellular.

Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries

“…These data, drawn from a large sample size, led to clinical concerns about the use of iron interventions in the first few weeks of life. In vitro studies using neonatal blood have implicated iron as enhancing the growth of pathogens that cause neonatal sepsis, including E. coli , Klebsiella pneumoniae , Pseudomonas aeruginosa , Staphylococcus aureus , and L. monocytogenes . Altered fetal iron homeostasis following chorioamnionitis was reported for neonates who had zinc protoporphyrin values that were higher than expected for gestational age.…”

Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations

“…Norway. o 1983 British Journal of Obstetrics and Gynaecologv 0306-5456/83/0200-0 101 $02.00 adverse effects of iron repletion on certain infections have been reported (Murray et al 1978), e.g., hyperferraemic patients are more susceptible to fungal and bacterial pathogens than are normo-or hypo-ferraemic individuals (Becroft et al 1977;Weinberg 1974).…”

Efeitos da eritropoetina recombinante humana em recém-nascidos pré-termo com doenças infecciosas

“…Na maioria dos estudos randomizados e controlados sobre o uso de rHuEpo em recém-nascidos pré-termo, o ferro foi administrado por via oral ou endovenosa, em doses variáveis de 1 a 10 mg/Kg/ dia 3,[5][6][7][8][9][10][11][17][18][19][20][21][22][23][24][25][26] . Estudos anteriores demonstraram associação entre o uso de ferro e maior suscetibilidade para sepse neonatal por bactérias gram-negativas 27,28 . Apesar desses achados estarem relacionados ao uso de ferro dextran, administrado por via intramuscular, trouxe-nos preocupação o uso indiscriminado de ferro para RNPT infectados, já que o ferro age como doador de elétron na formação de radicais livres.…”