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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.
American Journal of Perinatology
|February 20, 2026
Summary
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.
