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Reticulocyte hemoglobin concentration for screening iron deficiency in very low birth weight preterm neonates
Mallika Pomrop1, Satit Manopunya1, Watcharee Tantiprabha1
1Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand.
Insights
Reticulocyte hemoglobin concentration effectively screens for iron deficiency in preterm infants. A cutoff of <29 pg accurately identifies iron deficiency in very low birth weight neonates, aiding early diagnosis and intervention.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Nutritional Science
Background:
- Preterm and low birth weight infants face elevated risks of iron deficiency.
- Early detection of iron deficiency is crucial for optimal infant development.
Purpose of the Study:
- To assess the diagnostic accuracy of reticulocyte hemoglobin concentration (CHr) for iron deficiency in very low birth weight (VLBW) preterm neonates.
- To determine an optimal CHr cutoff value for this population.
Main Methods:
- The study included preterm infants with gestational age ≤34 weeks and birth weight ≤1500g.
- Iron deficiency was defined using established criteria (low MCV, transferrin saturation, or ferritin).
- Reticulocyte hemoglobin concentration was measured, and ROC analysis identified the optimal cutoff value.
Main Results:
- Nine out of 57 (15.7%) VLBW preterm neonates exhibited iron deficiency.
- A reticulocyte hemoglobin concentration cutoff of <29 pg demonstrated high diagnostic accuracy (sensitivity 89%, specificity 79%).
- This cutoff achieved a negative predictive value of 97%, indicating strong reliability in ruling out iron deficiency.
Conclusions:
- Reticulocyte hemoglobin concentration serves as a valuable screening tool for diagnosing iron deficiency in VLBW preterm neonates.
- The established cutoff of <29 pg provides acceptable accuracy for clinical screening.
Background:
Preterm and low birth weight infants are at risk of iron deficiency. Reticulocyte hemoglobin concentration may be useful as a screening test to diagnose iron deficiency in preterm neonates.
Objective:
To evaluate the accuracy and establish the reticulocyte hemoglobin concentration cutoff value for iron deficiency diagnosis in very low birth weight preterm neonates.
Method:
This study was conducted between May 2018 and March 2019 at Chiang Mai University Hospital. Preterm infants born at gestational age ≤34 weeks and birth weight ≤1500 g were enrolled. Blood samplings were obtained within the first 48 h of life. Iron deficiency was defined by using two or more of these following parameters: mean corpuscular volume <100 fL, transferrin saturation <16% and serum ferritin <30 µg/L. Neonatal anemia was defined as hemoglobin <15 g/dL. The optimum reticulocyte hemoglobin concentration cutoff values were performed by using predictive values and receiving operation characteristic analysis.
Result:
Fifty-seven preterm neonates were enrolled. Nine (15.7%) and three (5.3%) neonates had iron deficiency and iron deficiency anemia, respectively. The reticulocyte hemoglobin concentration cutoff value of <29 pg showed the optimum accuracy to diagnose iron deficiency in very low birth weight preterm neonates with sensitivity, specificity, positive and negative predictive values of 89%, 79%, 42% and 97%, respectively.
Conclusion:
Reticulocyte hemoglobin concentration can be used as a screening parameter to diagnose iron deficiency for VLBW preterm neonates. The optimum cutoff value which provided the acceptable accuracy was <29 pg.
