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Iron Deficiency Prevention, Screening, and Treatment: A Quality Improvement Initiative Introducing Reticulocyte
Narmin Javadova1, Pamela J Kling1, Sally Norlin1,2
1Department of Pediatrics, Division of Neonatology, University of Wisconsin, Madison, WI 53792, USA.
Nutrients
|November 13, 2025
Summary
A new guideline using reticulocyte hemoglobin content (RET-He) improved iron deficiency screening in premature infants. However, screening remained low for small for gestational age neonates, highlighting ongoing challenges in neonatal iron deficiency management.
Area of Science:
- Neonatalogy
- Pediatric Hematology
- Quality Improvement Science
Background:
- Neonatal iron deficiency (ID) poses risks to neurodevelopment.
- Reticulocyte hemoglobin content (RET-He) is a sensitive marker for early ID.
- Current screening practices require optimization, especially for vulnerable infant populations.
Purpose of the Study:
- To implement and evaluate a novel guideline for neonatal ID screening.
- Utilize RET-He for targeted screening in premature and small for gestational age (SGA) neonates.
- Achieve a screening rate of at least 80% by June 2024.
Main Methods:
- Quality improvement initiative in a level III NICU (April 2022-August 2024).
- Interdisciplinary team approach to guideline implementation.
- RET-He screening at 30 ± 7 days (preterm) or pre-discharge (SGA).
Main Results:
- Screening rates for preterm neonates (<33 weeks PMA) improved to 85.9% after initial decline.
- ID screening failure rate increased from 12.6% to 32.1% over two months.
- Screening rates for SGA neonates (≥33 weeks PMA) remained low, peaking at 36%.
Conclusions:
- RET-He based guideline successfully enhanced screening for premature infants.
- The guideline showed limited effectiveness in improving screening for SGA neonates.
- High ID prevalence at discharge necessitates improved nutritional strategies for all at-risk neonates.
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