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Intravenous iron for critically ill children. Comparison of three dose regimens
Laura Butragueño-Laiseca1,2,3,4, Sara de la Mata Navazo1,2,3,4, Amelia Caridad Sánchez Galindo1,2,3,4
1Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Insights
Intravenous iron sucrose is safe and effective for treating anemia in critically ill children. A 7 mg/kg dose showed better iron replacement and faster results compared to lower doses.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Pharmacology
Background:
- Anemia is prevalent in pediatric intensive care units.
- Intravenous iron is a potential alternative to transfusions.
- Limited data exist on IV iron in critically ill children.
Purpose of the Study:
- To assess the safety and efficacy of intravenous iron sucrose for anemia in pediatric critical care.
- To compare different dose regimens (3, 5, and 7 mg/kg) of iron sucrose.
Main Methods:
- A prospective study conducted in a tertiary pediatric intensive care unit from October 2017 to November 2022.
- 115 critically ill children received intravenous iron sucrose infusions.
- Iron deficiency biomarkers, hemoglobin, and adverse events were monitored.
Main Results:
- Hemoglobin levels significantly increased post-treatment (9.2 to 11.6 g/dL).
- Transferrin saturation index and serum iron showed significant improvement.
- The 7 mg/kg dose group achieved higher iron deficit replacement (94%) faster than lower doses.
- Adverse reactions were rare (1.3%) and mild, primarily gastrointestinal.
Conclusions:
- Intravenous iron sucrose is safe and effective in pediatric critical care.
- The 7 mg/kg dose regimen is more effective for iron deficit replacement.
- This therapy offers a promising alternative for managing anemia in critically ill children.
Background:
Anemia is extremely common among patients admitted to pediatric intensive care. Alternative treatments to transfusions such as intravenous iron must be considered. There are no published data for a prospective intravenous (IV) iron study focused in the critically ill children. The objective is to examine the safety and efficacy of intravenous iron sucrose infusion to manage anemia in pediatric critical care. A secondary objective is to examine the effect of different dose regimens of iron sucrose (3, 5, and 7 mg/kg dose).
Procedure:
Prospective investigation of intravenous iron sucrose utilization at a tertiary pediatric intensive care unit between October 2017 and November 2022.
Results:
In all 115 patients received a total of 616 infusions of IV iron. Transferrin saturation index (TSI) was the most common altered iron deficiency biomarker (91.8%). After IV iron treatment, hemoglobin showed a significant increase within a 30-day follow-up (9.2 vs. 11.6 g/dL, p < .001). There was also a significant improvement in TSI and serum iron (p < .001). Iron deficit replacement was higher in the 7 mg/kg dose group (94%) compared to 85.9% in the 5 mg/kg regimen and 77.5% in the lower dose group (p = .008), requiring less doses and a shorter time. Very few mild adverse reactions were reported (1.3% of infusions), with no differences between groups. The most frequent adverse effect was gastrointestinal in three cases. There were no anaphylaxis-like or other serious/life-threatening adverse effects.
Conclusions:
This is the first study to evaluate intravenous iron therapy in pediatric critical care, providing preliminary evidence of safety and efficacy of IV iron sucrose. The 7 mg/kg dose regimen showed higher iron deficit replacement in a shorter time, which could be beneficial in critically ill children.
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