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Reticulocyte hemoglobin content as a function of iron stores at 35-36 weeks post menstrual age in very premature
Kanhai Amin1, Meenakshi Bansal2, Nonie Varley2
1Student Academic Internship Program, University of Rochester Medical Center, Rochester, NY, USA.
Insights
Premature infants receiving iron supplements show adequate iron levels before discharge. Reticulocyte hemoglobin content (RET-He) correlates with iron stores, suggesting targeted supplementation may prevent infant iron deficiency.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Nutritional Science
Background:
- Premature infants have limited iron stores and are susceptible to iron deficiency.
- Routine oral iron supplementation (2 mg/kg/day) is standard for premature infants.
- Reticulocyte hemoglobin content (RET-He) is an emerging marker for iron deficiency but underevaluated in this population.
Purpose of the Study:
- To assess RET-He and its correlation with serum ferritin (SF) in premature infants at 35-36 weeks postmenstrual age (PMA).
- To evaluate iron status in infants born at or before 32 weeks gestational age (GA) receiving standard iron supplementation.
Main Methods:
- Prospective study of 98 infants (24-32 weeks GA) on oral iron (2 mg/kg/day) with full enteral feeds.
- Exclusion criteria included major congenital anomalies, chromosomal disorders, TORCH infections, sepsis, and erythropoietin use.
- Measurements included serum ferritin (SF) and RET-He at 35-36 weeks PMA; iron deficiency defined as RET-He <27 pg.
Main Results:
- Twenty-one infants (21.4%) exhibited RET-He <27 pg, indicating iron deficiency.
- A significant positive correlation was found between RET-He and SF (coefficient 0.22, p=0.03), even after adjusting for GA and transfusion history.
- Correlation was significant in females (coefficient 0.23, p=0.02) but not in males (coefficient 0.05).
Conclusions:
- Most premature infants on standard oral iron supplementation are iron replete for erythropoiesis by 35-36 weeks PMA.
- RET-He increases with rising iron stores, validating its use as an indicator.
- Consideration of additional iron supplementation for premature infants with borderline low RET-He before discharge may be beneficial for preventing early infancy iron deficiency.
Background:
Premature infants are born with lower iron stores and are at risk for iron deficiency during early infancy. To prevent iron deficiency, premature infants are routinely supplemented with 2 mg/kg/day oral elemental iron. Reticulocyte hemoglobin content (RET-He), a measure of iron deficiency, has not been well evaluated prior to discharge in premature infants.
Objectives:
Our objectives were to evaluate RET-He and its correlation with serum ferritin (SF), an index of iron stores, at 35-36 weeks postmenstrual age (PMA) in ≤32 weeks gestational age (GA) infants.
Methods:
We performed a prospective nested study involving 24-32 weeks GA infants who were receiving 2 mg/kg/day oral elemental iron with full enteral feedings at 35-36 weeks PMA. Infants with the following conditions were excluded: craniofacial malformation, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex), culture-proven sepsis, C-reactive protein >5 mg/l within 10 days of iron status assessment, or erythropoietin therapy. SF and RET-He were measured at 35-36 weeks PMA using chemiluminescence immunoassay and Sysmex XN hematology analyzer, respectively. RET-He <27 pg was deemed indicative of iron deficiency.
Results:
Ninety-eight infants were studied, of which 21 infants had RET-He <27 pg. There was a positive correlation between RET-He and SF (coefficient 0.22, p = .03) that remained significant after controlling for GA (coefficient 0.21, p = .03) and frequency of prior erythrocyte transfusions (coefficient 0.21, p = .03). On stratified analysis, there was a positive correlation between SF and RET-He in females (N = 52, coefficient 0.23, p = .02), but not in males (N = 46, coefficient 0.05).
Conclusions:
Most premature infants receiving 2 mg/kg/day oral elemental iron are iron replete for erythropoiesis at 35-36 weeks PMA. RET-He increases with an increase in iron stores, suggesting that additional iron supplementation prior to discharge to very premature infants with borderline low RET-He may help prevent iron deficiency during early infancy.
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