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Reticulocyte hemoglobin content changes after treatment of anemia of prematurity
Mitsumaro Nii1, Toshio Okamoto1, Tatsutoshi Sugiyama1
1Division of Neonatology, Center for Maternity and Infant Care, Asahikawa Medical University Hospital, Hokkaido, Japan.
Insights
Reticulocyte hemoglobin content (RET-He) in preterm infants declines after birth and with recombinant human erythropoietin (rHuEPO) therapy. Oral iron supplementation showed a delayed increase in RET-He, indicating prolonged low iron status.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Nutrition
Background:
- Iron deficiency in infancy impacts neurological development; iron overload poses risks.
- Reticulocyte hemoglobin content (RET-He) assesses iron status and hemoglobin synthesis in preterm infants.
- Limited data exists on chronological RET-He changes during iron supplementation in preterm infants.
Purpose of the Study:
- To evaluate chronological changes in RET-He during oral iron supplementation.
- To assess RET-He in preterm very low birthweight infants receiving recombinant human erythropoietin (rHuEPO).
Main Methods:
- Retrospective analysis of very low birthweight infants.
- Recorded Hemoglobin (Hb), reticulocyte percentage (Ret), mean corpuscular volume, RET-He, serum iron (Fe), and serum ferritin.
- Data collected at birth, start of rHuEPO, start of oral iron, and at 1-8 weeks post-iron initiation.
Main Results:
- RET-He was highest at birth, declining rapidly, particularly after rHuEPO initiation.
- No immediate increase in RET-He was observed after starting oral iron supplementation.
- A slow rise in RET-He was noted 5-6 weeks after initiating iron therapy.
Conclusions:
- Low RET-He levels can persist during anemia of prematurity treatment.
- Anemia of prematurity requires individualized assessment and treatment.
- Consideration of preterm infants' iron metabolic capacity is crucial for effective management.
Background:
Iron deficiency during infancy is associated with poor neurological development, but iron overload causes severe complications. Appropriate iron supplementation is therefore vital. Reticulocyte hemoglobin content (RET-He) provides a real-time assessment of iron status and chracterezes hemoglobin synthesis in preterm infants. However, the existing literature lacks detailed reports assessing chronological changes in RET-He. The aim of this study was to assess the chronological changes in RET-He during oral iron dietary supplementation, and concomitant therapy with recombinant human erythropoietin (rHuEPO) in preterm very low birthweight infants.
Methods:
Very low birthweight infants, admitted to our neonatal intensive care unit were analyzed retrospectively. Hemoglobin (Hb), reticulocyte percentage (Ret), mean corpuscular volume, RET-He, serum iron (Fe), and serum ferritin were recorded. Data at birth (T0), the initial day of rHuEPO therapy (T1), the initial day of oral iron supplementation (T2), 1-2 weeks (T3), 3-4 weeks (T4), 5-6 weeks (T5), and 7-8 weeks (T6) from the initial day of oral iron supplementation were extracted, and their changes over time were examined.
Results:
Reticulocyte hemoglobin content was highest at birth and declined rapidly thereafter, especially after starting rHuEPO therapy. There was no upward trend in RET-He after the initiation of oral iron supplementation, with a slower increase during 5-6 weeks after the initiation of iron therapy.
Conclusions:
During the treatment of anemia of prematurity, low RET-He levels may be prolonged. Anemia of prematurity should therefore be assessed and treated on a case-by-case basis, while considering the iron metabolic capacity of preterm infants.
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