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Postdischarge Iron Status in Very Preterm Infants Receiving Prophylactic Iron Supplementation after Birth
Carmen Landry1, Jon Dorling1, Ketan Kulkarni1
1Department of Pediatrics, IWK Health Centre and Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Despite early iron supplementation, 32% of very preterm infants experienced iron deficiency. Key risk factors include maternal gestational hypertension and extremely premature birth, highlighting the need for ongoing monitoring.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Hematology
Background:
- Very preterm infants are at high risk for iron deficiency due to limited iron stores at birth and rapid growth.
- Standard care includes prophylactic iron supplementation, but its effectiveness in preventing deficiency requires evaluation.
Purpose of the Study:
- To determine the postdischarge iron status in very preterm infants.
- To identify factors associated with iron deficiency in this vulnerable population.
Main Methods:
- Retrospective cohort study using a provincial database (2005-2018).
- Included very preterm infants receiving standard iron prophylaxis and tested for iron deficiency at corrected ages of 4 or 6 months.
- Multivariate logistic regression analyzed risk factors for iron deficiency.
Main Results:
- 32.1% of 411 infants had iron deficiency; 2.7% had iron deficiency anemia.
- Prevalence decreased from 37.6% (2005-2011) to 25.8% (2012-2018).
- Maternal gestational hypertension and gestational age <27 weeks were independent risk factors. Mixed feeding was associated with lower odds of deficiency compared to exclusive formula feeding.
Conclusions:
- Iron deficiency remains prevalent in very preterm infants despite early prophylaxis.
- Monitoring iron stores during preterm follow-up is crucial.
- Identifying and mitigating risk factors is essential for preventing iron deficiency in this population.
Objective:
To determine postdischarge iron status and associated factors in very preterm infants.
Study Design:
A retrospective cohort study was conducted through a provincial database on all very preterm infants born in Nova Scotia between 2005 and 2018. As a standard of care, all infants received prophylactic iron supplements starting at 2-4 weeks of chronological age and were tested for iron deficiency at 4 or 6 months corrected age. Iron deficiency was defined as serum ferritin <20 g/L at 4 months or <12 g/L at 6 months. Multivariate logistic regression analysis identified factors associated with iron deficiency.
Results:
Among 411 infants, 132 (32.1%) had iron deficiency and 11 (2.7%) had iron deficiency anemia. The prevalence of iron deficiency decreased over time, from 37.6% in 2005-2011 to 25.8% in 2012-2018. Gestational hypertension in the mother (P = .01) and gestational age <27 weeks (P = .02) were independent risk factors for iron deficiency. In addition, the odds of iron deficiency were lower in the mixed-fed group (ie, with breast milk and formula combined) compared with the exclusive formula-fed group (P = .01).
Conclusions:
Iron deficiency was prevalent in 32% of the very preterm infants despite early iron prophylaxis. These results demonstrate the importance of monitoring iron stores during preterm follow-up. Information about risk factors is important to mitigate iron deficiency in very preterm infants.
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