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Enteral Iron Supplementation in Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis
Rukman M Manapurath1, Barsha Gadapani Pathak1, Bireshwar Sinha1,2
1Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
Insights
Enteral iron supplementation benefits preterm and low birth weight (LBW) infants fed human milk, improving linear growth and reducing anemia. Further research is needed to confirm these findings for infant development.
Area of Science:
- Neonatal Nutrition
- Pediatric Iron Metabolism
- Infant Growth and Development
Background:
- Preterm and low birth weight (LBW) infants are at high risk for iron deficiency, crucial for growth and development.
- Human milk feeding is common for these vulnerable infants, necessitating optimized iron delivery.
- Assessing the impact of enteral iron supplementation is vital for improving infant outcomes.
Purpose of the Study:
- To evaluate the effects of enteral iron supplementation on mortality, morbidity, growth, and neurodevelopment in preterm or LBW infants.
- To examine the impact on biomarkers, optimal dosage, and timing of iron supplementation.
- To synthesize evidence from controlled and quasi-experimental studies.
Main Methods:
- Systematic review of PubMed, Embase, and Cochrane Library databases up to March 16, 2021.
- Inclusion of controlled or quasi-experimental studies with independent data extraction by two reviewers.
- Analysis of data from eight trials involving 1093 participants across seven countries.
Main Results:
- No significant effect on mortality, infection, or necrotizing enterocolitis.
- Moderate evidence of increased linear growth (length) and improved anemia rates.
- Limited impact observed on weight, head circumference, or cognitive development; no effect on serum ferritin.
Conclusions:
- Enteral iron supplementation offers significant benefits for preterm and LBW infants receiving human milk.
- Improvements in linear growth and anemia are notable findings.
- Further randomized controlled trials are essential to strengthen the evidence base and guide clinical practice.
Background And Objectives:
Iron is needed for growth and development of infants globally, but preterm and low birth weight (LBW) infants are at risk for severe iron deficiencies. To assess the effect of enteral iron supplementation on mortality, morbidity, growth, and neurodevelopment outcomes in preterm or LBW infants fed human milk. Secondary objectives were to assess the effect on biomarkers and dose and timing.
Methods:
Data sources include PubMed, Embase and Cochrane Library databases to March 16, 2021. Study Selection includes controlled or quasi experimental study designs. Two reviewers independently extracted data.
Results:
Eight trials (eleven reports; 1093 participants, 7 countries) were included. No trials reported mortality. At latest follow-up, there was little effect on infection (very low certainty evidence, 4 studies, 401 participants, relative risk [RR] 0.98, 95% confidence interval [95% CI] 0.56 to 1.73, I2 = 0.00%) and necrotising enterocolitis (3 studies, 375 participants, RR 1.47, 95% CI 0.68 to 3.20, I2 = 0.00%). There was an increase in linear growth (length) (moderate certainty evidence, 3 studies, 384 participants, mean difference 0.69 cm, 95% CI 0.01 to 1.37, I2 = 0%) but little effect on weight, head circumference, or cognitive development. There was an improvement in anemia (moderate certainty evidence, 2 studies, 381 participants, RR 0.25, 95% CI 0.10 to 0.62, I2 = 0.00%) but no effect on serum ferritin. Limitations include heterogeneity in the included studies.
Conclusions:
There are important benefits for human milk-fed preterm and LBW infants from enteral iron supplementation. However, more randomized control trials are required to improve the certainty of evidence.
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