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Published on: January 19, 2024
Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content
Geetika Kennady1, Faraz Afridi2, Dana Neumann1
1Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours Children's Health, Philadelphia, Pennsylvania.
Insights
Approximately one in three very low birth weight (VLBW) infants show iron deficiency at discharge. Delayed cord clamping (DCC) improves iron status in these infants, with reticulocyte hemoglobin content (CHr) guiding supplementation.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Iron Metabolism
Background:
- Very low birth weight (VLBW) infants are at high risk for iron deficiency.
- Iron status assessment prior to discharge is crucial for VLBW infants.
- Reticulocyte hemoglobin content (CHr) is a sensitive indicator of iron status.
Purpose of the Study:
- To assess iron status in VLBW infants before discharge using CHr.
- To evaluate the impact of delayed cord clamping (DCC) on iron status in VLBW infants.
Main Methods:
- Retrospective analysis of VLBW infants from two tertiary NICUs.
- Primary outcome: proportion of infants with low CHr (<29 pg) at discharge.
- Comparison of hematologic parameters between infants with and without DCC.
Main Results:
- 31.4% of VLBW infants had low CHr at discharge.
- Infants receiving DCC had higher hemoglobin and CHr levels at discharge.
- DCC group showed a lower incidence of iron deficiency and reduced need for blood transfusions.
Conclusions:
- A significant proportion of VLBW infants are iron deficient at discharge.
- Delayed cord clamping (DCC) positively impacts iron status in VLBW infants.
- CHr is a valuable tool for guiding iron supplementation to improve outcomes in VLBW infants.
Objective:
This study aimed to assess the iron status prior to discharge in very low birth weight (VLBW) infants utilizing reticulocyte hemoglobin content (CHr) and evaluate the impact of delayed cord clamping (DCC) on iron status.
Study Design:
This is a retrospective analysis of VLBW infants from two tertiary level of care Neonatal Intensive Care Units. The primary outcome was the proportion of VLBW infants with low CHr (<29 pg) prior to discharge. Hematologic parameters were also compared between infants who received or did not receive DCC. Infants with a positive newborn screen for hemoglobin Bart's were excluded.
Results:
Among the 315 infants included, 99 infants (31.4%) had low CHr prior to discharge. The median (interquartile range) CHr prior to discharge was 30.8 pg (28.4-39 pg). DCC was performed in 46.7% of infants. Hemoglobin at birth, discharge, and CHr prior to discharge were higher and the need for blood transfusion and the number of infants with low CHr prior to discharge were lower in the DCC group.
Conclusion:
Approximately 31.4% of VLBW infants had low CHr near the time of discharge suggesting they were iron deficient. DCC improved hematological parameters prior to discharge in VLBW infants. CHr content can be used to guide iron supplementation in VLBW infants to potentially improve their iron status and long-term neurocognitive outcomes.
Key Points:
· DCC was associated with an improved hemoglobin and iron status at discharge in VLBW infants.. · CHr is an early and reliable marker for iron deficiency.. · Approximately one in three VLBW infants can be iron deficient at the time of discharge..
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