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Comparison of two markers of iron sufficiency and neurodevelopmental outcomes
Kendell R German1, Phuong T Vu2, Sara Neches1
1Department of Pediatrics, University of Washington, Seattle, WA, USA.
Insights
Neonatal iron status markers, specifically zinc protoporphyrin-to-heme ratios (ZnPP/H), are linked to better neurodevelopmental outcomes. Using ZnPP/H may improve iron supplementation strategies in the NICU for infant brain development.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Biochemistry
Background:
- Iron deficiency in early development can negatively impact brain growth.
- Identifying reliable neonatal iron status markers is crucial for effective iron supplementation.
- Suboptimal neurodevelopmental outcomes are a concern in iron-deficient neonates.
Purpose of the Study:
- To evaluate ferritin and zinc protoporphyrin-to-heme ratios (ZnPP/H) as markers of iron sufficiency.
- To assess the correlation between these iron markers and neurodevelopmental outcomes in neonates.
Main Methods:
- Retrospective cohort study design.
- Inclusion of infants with concurrent ferritin and ZnPP/H measurements and Bayley Scales of Infant Development, 3rd Edition (BSID-III) at 24 months corrected age.
- Analysis of associations between iron markers (minimum, maximum, median ferritin and ZnPP/H) and BSID-III scores.
Main Results:
- Significant associations were found between ZnPP/H and both motor and cognitive scores.
- Higher ZnPP/H values showed trends towards lower BSID-III scores, though not statistically significant.
- Ferritin values demonstrated less consistent associations with BSID scores compared to ZnPP/H.
Conclusions:
- Zinc protoporphyrin-to-heme ratios (ZnPP/H) show a positive association with neurodevelopmental outcomes.
- Ferritin's association with outcomes was inconsistent, possibly due to inflammatory influences.
- Preferential use of ZnPP/H for adjusting neonatal intensive care unit (NICU) iron supplementation may enhance neurodevelopmental outcomes.
Background:
Iron deficiency during critical windows of brain development is associated with suboptimal neurodevelopmental outcomes. Identifying markers of neonatal iron status that best correlate with neurodevelopmental outcome is critical for optimal management of iron supplementation of neonates.
Aims:
We aimed to evaluate two markers of iron sufficiency, ferritin and zinc protoporphyrin-to-heme ratios (ZnPP/H), with neurodevelopmental outcomes.
Study Design:
This is a retrospective cohort study.
Subjects:
All infants with concurrent ferritin and ZnPP/H measurements obtained between October 2014 and April 2017 and Bayley Scales of Infant Development, 3rd Edition (BSID-III) evaluated at 24 months corrected age were included.
Outcome Measures:
Associations between iron markers (minimum, maximum and median ferritin and ZnPP/H) and BSID-III score at 24 months were assessed.
Results:
223 lab measurements from 62 infants were assessed. Mean gestational age was 28.1 weeks (SD = 2.6) with a mean birth weight of 1.1 kg (SD = 0.4). Significant associations between maximum and median ZnPP/H and motor score, and between median ZnPP/H and cognitive score were observed. Trends were also seen with higher minimum, median and maximum ZnPP/H associated with lower BSID-III scores, but did not reach statistical significance (p > 0.05). The associations between ferritin values and BSID scores were less consistent.
Conclusions:
A positive association was seen between ZnPP/H values and BSID-III scores. Trends between ferritin and BSID values were less consistent, potentially because ferritin is more affected by inflammation. Consideration should be given to using ZnPP/H preferentially to adjust iron supplementation in the NICU to improve neurodevelopmental outcomes.
