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Utilization of supplemental iron by premature infants fed fortified human milk
G J Moody1, R J Schanler, S A Abrams
1USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston 77030, USA.
Insights
Adding supplemental iron to fortified human milk effectively increases red blood cell iron incorporation (RBC-inc) in premature infants. This method is practical, as high nutrient content in the fortifier did not hinder iron utilization.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Hematology
Background:
- Premature infants require adequate iron for growth and development.
- Human milk fortification is standard practice for preterm infants.
- Assessing iron bioavailability from fortified human milk is crucial.
Purpose of the Study:
- To evaluate red blood cell iron incorporation (RBC-inc) from supplemental iron in preterm infants fed fortified human milk.
- To compare two methods of supplemental iron administration.
- To determine if human milk fortifier composition affects iron utilization.
Main Methods:
- Measured RBC-inc using stable isotopes (57Fe and 54Fe) in 13 human milk-fed premature infants.
- Administered supplemental iron (2 mg/kg/d ferrous sulfate) via direct mixing into fortifier or as a bolus.
- Analyzed iron incorporation rates and correlated with reticulocyte counts.
Main Results:
- Similar RBC-inc observed between direct mixing and bolus administration (4.7% vs 4.6%).
- Supplemental iron contributed the majority of incorporated iron.
- No interference with iron utilization by high nutrient content (including calcium) in the fortifier.
- Positive correlation found between reticulocyte count and RBC-inc.
Conclusions:
- Directly adding iron to or incorporating it into commercial human milk fortifiers is a practical approach for preterm infants.
- This method ensures adequate iron delivery without compromising utilization.
- Further research can optimize iron fortification strategies for vulnerable infant populations.
Abstract:
We measured red blood cell iron incorporation (RBC-inc) in 13 human milk-fed premature infants (birthweight 1037 +/- 289 g, gestational age 27 +/- 2 wk, weight at start of study 1571 +/- 426 g) who were receiving full tube-feedings of human milk fortified with a commercial human milk fortifier (FortHM). The relative RBC-inc of supplemental iron (2 mg/kg/d of ferrous sulfate) was assessed using 57Fe sulfate mixed directly into a 24-h volume of FortHM, and 54Fe sulfate given as a bolus between two FortHM feedings the next day. RBC-inc was similar between the two methods of supplemental iron administration (4.7 +/- 2.5% vs 4.6 +/- 1.5%, respectively). Although these values are lower than RBC-inc expected from iron native to human milk, the relatively large amount of iron in the supplements contributed most of the iron incorporated into RBC by the infants. There was a significant positive correlation between the reticulocyte count and RBC-inc. As the high nutrient (especially calcium) content of the FortHM did not interfere with iron utilization, adding iron directly to FortHM, or incorporating it into commercial fortifiers, may be a practical method to provide iron to premature infants.