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Iron Deficiency Screening with Reticulocyte-Hemoglobin Content and 2-Year Neurodevelopmental Outcomes in Extremely
Whitley N Hulse1,2, Timothy M Bahr2,3, Betsy Ostrander4
1Division of Neonatology and Newborn Nursery, Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States.
Insights
Higher daily iron doses in infants born prematurely correlate with improved cognitive outcomes at two years. Reticulocyte-hemoglobin levels did not show an association with neurodevelopmental results in this NICU cohort.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Nutritional Science
Background:
- Iron deficiency is prevalent in preterm infants in Neonatal Intensive Care Units (NICUs).
- Assessing neurodevelopmental outcomes in this vulnerable population is crucial.
- Reticulocyte-hemoglobin (RET-He) is an indicator of iron status.
Purpose of the Study:
- To evaluate the relationship between reticulocyte-hemoglobin (RET-He) and daily iron dosing with cognitive outcomes at two years.
- To determine if RET-He or iron supplementation impacts neurodevelopment in high-risk neonates.
Main Methods:
- A multicenter retrospective cohort study analyzed 78 infants born before 28 weeks' gestation or <1,250g birth weight.
- Data included RET-He measurements, iron supplementation, and Bayley Scales of Infant and Toddler Development-III (Bayley-III) scores at 2 years.
- Multiple linear regression models were used for analysis.
Main Results:
- Each 1 mg/kg increase in mean daily iron dose was associated with a 2.9-point increase in Bayley-III cognitive scores (p=0.023).
- No significant association was found between RET-He levels and Bayley-III cognitive outcomes.
- 38.4% of infants experienced iron deficiency (RET-He <29 pg) during hospitalization.
Conclusions:
- Higher mean daily iron doses are linked to better cognitive outcomes in high-risk neonates.
- RET-He levels were not associated with neurodevelopmental outcomes in this cohort.
- Standard iron dosing may be insufficient for preterm infants, highlighting the need for further research into optimal iron supplementation strategies.
Objective:
The objective of this study is to assess reticulocyte-hemoglobin (RET-He) and daily iron dosing with 2-year cognitive outcomes.
Study Design:
A multicenter retrospective cohort study of 78 infants born between 2014 and 2018 at less than 28 weeks' gestation or less than 1,250 g birth weight throughout level III or IV neonatal intensive care units (NICUs). RET-He measurement, iron supplementation, and the Bayley Scales of Infant and Toddler Development-III (Bayley-III) test were analyzed using multiple linear regression models.
Results:
For every 1 mg/kg increase in mean total daily iron supplementation, the Bayley-III cognitive score increased by 2.9 points (95% confidence interval [CI]: 0.4-5.4, p = 0.023). No associations were identified between minimum or maximum RET-He and Bayley-III cognitive outcomes. Infants with a RET-He value < 29 pg tended to be 2.53 times more likely to have a Bayley-III language score below 70 (odds ratio: 2.53, 95% CI: 0.92-6.95, p = 0.071). Thirty-eight out of 78 (38.4%) infants were iron-deficient during their NICU hospitalization, with at least one RET-He < 29 pg.
Conclusion:
An association was identified between a higher mean daily iron dose and improved cognitive outcomes for infants, but not between the iron index RET-He and neurodevelopmental outcomes. Iron deficiency remains common among NICU patients undergoing follow-up, suggesting that standard iron dosing may be inadequate for high-risk neonates.
Key Points:
· Higher daily iron dose improves cognitive outcomes.. · Reticulocyte-hemoglobin level is not associated with neurodevelopmental outcomes.. · Iron deficiency is common in very low birth weight infants, affecting 38.4%..
