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Effects of early parenteral iron combined erythropoietin in preterm infants: A randomized controlled trial
Linxia Qiao1, Qingya Tang, Wenying Zhu
1Department of Pediatrics, The First People's Hospital of Kunshan Affiliated to Jiangsu University Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Early parenteral iron and erythropoietin supplementation in preterm infants improved red blood cell production and iron status. This combination therapy proved beneficial for preventing anemia in premature babies.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Nutrition
Background:
- Preterm infants are at high risk for anemia due to limited iron stores and rapid growth.
- Early nutritional interventions are crucial for preventing complications in premature neonates.
- Parenteral iron and erythropoietin are potential therapeutic agents for managing anemia in this population.
Purpose of the Study:
- To evaluate the efficacy of early parenteral iron supplementation combined with erythropoietin (EPO) for anemia prevention in preterm infants.
- To assess the impact of this combined therapy on key hematological and iron metabolism parameters.
Main Methods:
- A randomized controlled trial involving 96 preterm infants assigned to three groups: control, iron-supplemented (IS), and iron-supplemented plus EPO (IS+EPO).
- Primary endpoint: Hemoglobin (Hb) levels. Secondary endpoints: Red blood cell counts (RBC), mean cell volume (MCV), serum iron, ferritin, reticulocyte percentage (RET), total iron binding capacity (TIBC), and oxidative stress markers.
- Measurements were taken at baseline, 2 weeks, 1 month, and 3 months corrected age.
Main Results:
- At 2 weeks, IS+EPO and IS groups showed significantly higher reticulocyte percentages and lower TIBC compared to controls.
- No significant differences in Hb, RBC, ferritin, or oxidative stress markers were observed at 2 weeks or 1 month corrected age.
- At 3 months corrected age, the IS+EPO group exhibited significantly improved Hb and MCV levels compared to the control group.
Conclusions:
- Early parenteral iron supplementation combined with EPO effectively improved reticulocyte percentages and iron status indicators in preterm infants.
- The combination therapy demonstrated a beneficial effect on Hb and MCV levels by 3 months corrected age, suggesting a role in long-term anemia prevention.
- Parenteral iron and EPO supplementation is a promising strategy for improving hematological outcomes in preterm infants.
Backgroud:
The aim of the study was to evaluate the effect of early parenteral iron supplementation combined erythropoietin for prevention of anemia in preterm infants.
Methods:
In total, 96 preterm infants were randomly assigned to 3 groups: a control group receiving standard parenteral nutrition (group 1: n = 31), an iron-supplemented group (group 2: IS, n = 33), and an iron-supplemented combined erythropoietin group (group 3: IS+EPO, n = 32). The primary objective was to assess hemoglobin (Hb) levels. The secondary objectives included assessment of red blood cell counts (RBC), mean cell volume (MCV), serum iron, ferritin, percentages of reticulocyte (RET), total iron binding capacity (TIBC) and oxidative stress, which was assessed by measuring plasma levels of malondialdehyde and superoxide dismutase at baseline and at 2 weeks. The blood routine indices including Hb, RBC, MCV, and percentages of RET were measured at corrected age of 1 and 3 months.
Results:
At 2 weeks of life, the percentages of reticulocyte in group 2 and group 3 were significantly higher than those in group 1 (2.1±0.4, 2.5±0.3, and 1.7±0.3, respectively, P < 0.001, P<0.001), whereas TIBC were significantly lower than those in group 1 (36.7±4.6, 36.0±4.7, and 41.6 ± 5.2 respectively, P = 0.011, P = 0.006). There were no significant differences in RBC counts, the levels of hemoglobin, ferritin, malondialdehyde, and superoxide dismutase among the 3 groups at 2weeks of life. RBC, Hb, MCV, body weight, body length, and head circumference at a corrected age of 1 month did not differ among 3 groups. At corrected age of 3months, more infants in the control group had abnormal Hb and MCV levels (Hb levels: 114.3 ± 21.3, 123.7 ± 31.6, and 125.1 ± 21.2, P = 0.021, P = 0.034, respectively; MCV: 74.1 ± 3.5, 78.3 ± 4.7 and 79.1 ± 5.2, P = 0.017, P = 0.012, respectively), whereas cases of oral iron, cases of breastfeeding, RBC, body weight, body length, and head circumference were not different among 3 groups.
Conclusion:
Early parenteral iron supplementation combined erythropoietin in preterm infants improved the percentages of reticulocyte, decreased total iron binding capacity, and improved the Hb and MCV levels at 3 months of age. Early parenteral iron supplementations with EPO were beneficial for the preterm infants.
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