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Non Breast-Milk-Fed Very Preterm Infants Are at Increased Risk of Iron Deficiency at 4-6-Months Corrected Age: A
Grace Power1,2, Lisa Morrison1, Ketan Kulkarni1,2
1IWK Health Centre, Halifax, NS B3K 6R8, Canada.
Insights
Iron deficiency is more common in formula-fed preterm infants than breast-milk-fed ones, despite higher iron intake in formula. This finding suggests current iron supplementation guidelines may need revision for these vulnerable infants.
Area of Science:
- Neonatal nutrition
- Pediatric hematology
- Public health
Background:
- Iron supplementation is standard for breast-milk-fed preterm infants.
- Guidelines for iron supplementation in formula-fed preterm infants are inconsistent.
- Feeding practices significantly impact infant iron status.
Purpose of the Study:
- To investigate the influence of feeding type on iron status in very preterm infants.
- To compare iron deficiency prevalence between breast-milk-fed and formula-fed very preterm infants.
- To inform updated recommendations for iron supplementation in preterm infants.
Main Methods:
- Retrospective cohort study of very preterm infants (<31 weeks gestational age) in Nova Scotia (2005-2018).
- Data extracted on feeding type, iron intake, and iron status at 4-6 months corrected age (CA).
- Iron deficiency defined by serum ferritin levels at 4 and 6 months CA.
Main Results:
- Higher iron intake (2.6 mg/kg/day) in non-breast-milk-fed infants compared to breast-milk-fed (2.0 mg/kg/day).
- Iron deficiency prevalence was 36.8% in non-breast-milk-fed infants versus 20.6% in breast-milk-fed infants.
- Iron deficiency was significantly more prevalent in formula-fed preterm infants.
Conclusions:
- Prevalence of iron deficiency is higher in very preterm infants fed primarily iron-rich formula compared to those receiving breast milk.
- Current iron intake from iron-rich formula may be insufficient to prevent iron deficiency in very preterm infants.
- Recommendations for iron supplementation in formula-fed preterm infants require re-evaluation.
Abstract:
Iron supplementation is routinely recommended for breast-milk-fed preterm infants. However, the Canadian Pediatric Society recommends no additional iron supplementation for preterm infants fed primarily with iron-rich formula. Other pediatric societies don't provide specific guidance on supplemental iron for formula-fed preterm infants. This study investigated how feeding type influences iron status of very preterm infants at 4-6-months corrected age (CA). A retrospective cohort study was conducted using a population-based database on all very preterm infants (<31 weeks gestational age) born in Nova Scotia, Canada from 2005-2018. Information about feeding type, iron intake from formula, supplemental iron therapy and iron status at 4-6-months CA was extracted. Iron deficiency (ID) was defined as serum ferritin <20 and <12 µg/L at 4-and 6-months CA, respectively. Of 392 infants, 107 were "breast-milk-fed" (exclusively or partially) and 285 were "not breast-milk-fed" (exclusively fed with iron-rich formula) at 4-6-months CA. Total daily iron intake was higher in the non-breast-milk-fed group (2.6 mg/kg/day versus 2.0 mg/kg/day). Despite this, 36.8% of non-breast-milk-fed infants developed ID versus 20.6% of breast-milk-fed infants. ID is significantly more prevalent in non-breast-milk-fed infants than breast-milk-fed infants despite higher iron intake. This suggests the need to revisit recommendations for iron supplementation in non-breast-milk-fed preterm infants.
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