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Red Blood Cell Transfusion and Risk of Iron Overload in Preterm Infants: A Prospective Study on Serum Ferritin and

Hui Yang1, Keying Yang2, Fangmei Deng3

  • 1Department of Neonatology, Shenzhen Children's Hospital, Shenzhen, China.

Neonatology
|February 11, 2026
PubMed

Insights

High-volume red blood cell transfusions (RBCT) in preterm infants increase iron overload risk. Hepcidin shows promise as a biomarker for predicting this condition in neonates.

Area of Science:

  • Neonatal Medicine
  • Hematology
  • Pediatric Research

Background:

  • Preterm infants undergoing red blood cell transfusion (RBCT) face risks of iron metabolism disruption and overload.
  • Monitoring iron status and overload risk is crucial for this vulnerable population.

Purpose of the Study:

  • To evaluate iron metabolism changes and overload risk following RBCT in preterm infants.
  • To assess the diagnostic utility of hepcidin as a biomarker for iron overload in this cohort.

Main Methods:

  • Prospective study of 72 preterm infants (mean GA 30.1 weeks) stratified by RBCT volume (>40 mL/kg vs. ≤40 mL/kg).
  • Serum ferritin and hepcidin levels were measured.
  • Clinical parameters and iron overload risks were analyzed.

Main Results:

  • Infants receiving >40 mL/kg RBCT had significantly lower gestational age and birth weight.
  • Elevated serum ferritin and hepcidin levels were observed in the high-volume RBCT group.
  • High-volume RBCT (>40 mL/kg) was an independent risk factor for increased iron overload (RR=1.6) and severe iron overload (RR=4.5).
  • Hepcidin demonstrated predictive value for iron overload (AUC=0.731).

Conclusions:

  • High-volume RBCT significantly elevates the risk of iron overload in preterm infants.
  • Hepcidin shows potential as a predictive biomarker for iron overload in neonates receiving transfusions.

Keywords:
FerritinHepcidinIron overloadPreterm infantsRed blood cell transfusion

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