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Pre-discharge iron status and its determinants in premature infants
Sanjiv B Amin1, Lori Scholer, Manisha Srivastava
1Department of Pediatrics, Division of Neonatology, The University of Rochester School of Medicine and Dentistry , Rochester, NY 14642, USA. Sanjiv_amin@urmc.rochester.edu
Insights
Preterm infants show highly variable iron status before discharge. Prior erythrocyte transfusions and net erythrocyte balance significantly impact infant iron levels, with many receiving multiple transfusions developing iron overload.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
Background:
- Premature infants, especially those born at ≤ 32 weeks gestational age (GA), are at risk for altered iron status.
- Monitoring iron status is crucial for optimal infant development and health outcomes.
Purpose of the Study:
- To evaluate the iron status of premature infants before hospital discharge.
- To identify factors influencing iron status in this vulnerable population.
Main Methods:
- A prospective observational study included infants born at 24-32 weeks GA, excluding those with congenital infections or anomalies.
- Iron status was assessed using serum ferritin (SF) levels at 35 weeks post-menstrual age (PMA).
- Infants with recent infection or elevated C-reactive protein were excluded from iron status evaluation.
Main Results:
- Among 131 infants, 23% had latent iron deficiency, 58% had normal iron status, and 19% had iron overload.
- Factors associated with iron status included preeclampsia, GA, birth weight, patent ductus arteriosus, erythrocyte transfusions, phlebotomy, and chronic lung disease.
- Prior erythrocyte transfusions and net erythrocyte balance were significant predictors of iron status.
Conclusions:
- Iron status at 35 weeks PMA in premature infants is highly variable.
- Erythrocyte transfusions and net erythrocyte balance are key determinants of pre-discharge iron status in preterm infants.
Objective:
To evaluate pre-discharge iron status and identify its determinants in infants' ≤ 32 weeks gestational age (GA).
Methods:
In a prospective observational study, 24-32 weeks GA infants who did not meet exclusion criteria: congenital viral infections, chromosomal disorders, or cranio-facial anomalies were eligible. Iron status was evaluated by measuring serum ferritin (SF) at 35 weeks post-menstrual age (PMA). Infants with infection or elevated C-reactive protein within 10 days prior to evaluation of iron status were excluded.
Results:
Of 131 infants studied, 23% had latent iron deficiency (SF < 76 ng/ml), 58% had normal iron status (75-400 ng/ml), and 19% had iron overload (SF > 400 ng/ml). On bivariate analysis, preeclampsia, GA, birth weight, patent ductus arteriosus, prior erythrocyte transfusion, phlebotomy loss, and chronic lung disease were associated with iron status. On ordered logistic regression, prior erythrocyte transfusion (frequency [OR 1.41, 95% CI:1.2-1.6] or cumulative amount [OR 1.03, 95% CI:1.02-1.04]) or net erythrocyte balance (amount of erythrocyte transfusion minus phlebotomy loss; OR 1.04, 95% CI:1.02-1.05) was significantly associated with iron status. Among infants who received > three erythrocyte transfusions, 50% developed iron overload.
Conclusions:
Iron status at 35 weeks PMA is extremely variable and is predicted by prior erythrocyte transfusions or net erythrocyte balance in premature infants.
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