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Prevalence and Predictors of Iron Deficiency at Hospital Discharge in Very-Low-Birth-Weight Infants: A Prospective
Pacharapan Surapolchai1, Phakatip Sinlapamongkolkul1, Sariya Prachukthum1
1Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand.
Insights
Iron deficiency is common in very-low-birth-weight (VLBW) infants, often preceding anemia. Early detection using serum ferritin and RET-He at discharge is crucial for timely intervention and preventing complications.
Area of Science:
- Neonatalogy
- Pediatric Hematology
- Nutritional Science
Background:
- Iron deficiency is prevalent in very-low-birth-weight (VLBW) infants due to limited stores, rapid growth, and blood draws.
- Early identification of iron deficiency is critical to prevent anemia and potential neurodevelopmental issues in VLBW infants.
Purpose of the Study:
- To determine the prevalence of iron deficiency at hospital discharge in VLBW infants.
- To identify clinical factors associated with iron deficiency at discharge using serum ferritin and reticulocyte haemoglobin equivalent (RET-He).
Main Methods:
- Prospective cohort study of 68 VLBW infants evaluated at 36 weeks post-menstrual age (PMA) or discharge.
- Iron deficiency defined as serum ferritin <75 ng/mL or RET-He <28 pg.
- Logistic regression analyses explored factors associated with iron deficiency; iron status reassessed at 6-12 months.
Main Results:
- At discharge, 39.7% of VLBW infants had iron deficiency, while only 1.5% were anemic.
- Higher gestational age and lower birth hemoglobin were independently associated with iron deficiency.
- Bronchopulmonary dysplasia showed a potential association, requiring cautious interpretation.
Conclusions:
- Iron deficiency is common in VLBW infants and often occurs before anemia develops.
- Assessing iron status beyond hemoglobin before discharge may guide early supplementation.
- Further multicenter studies are needed to validate routine dual-biomarker screening for iron deficiency in VLBW infants.
Abstract:
Background: Iron deficiency is common in very-low-birth-weight (VLBW) infants because of limited iron stores, rapid postnatal growth and repeated phlebotomy. Early detection is essential to prevent anaemia and neurodevelopmental impairment. This study investigated the prevalence of, and factors associated with, iron deficiency at hospital discharge using serum ferritin and the reticulocyte haemoglobin equivalent (RET-He). Methods: In this prospective cohort study, iron status was evaluated in 68 VLBW infants admitted between April 2022 and March 2024 at 36 weeks post-menstrual age (PMA) or at discharge. Iron deficiency was defined as serum ferritin below 75 ng/mL or RET-He below 28 pg. Univariable and multivariable logistic regression analyses were performed to explore clinical factors associated with iron deficiency. Iron status and anaemia were reassessed at 6-12 months of age. Results: At 36 weeks PMA or discharge, 39.7% of the infants were iron deficient, whereas only 1.5% were anaemic. Higher gestational age (aOR 1.81, 95% CI 1.07-3.06) and lower haemoglobin at birth (aOR 0.63, 95% CI 0.42-0.96) were independently associated with iron deficiency. Bronchopulmonary dysplasia showed a possible association (aOR 14.02, 95% CI 1.23-160.34), though this estimate should be interpreted cautiously. At 6-12 months, 18.8% of the patients had anaemia and 50% had iron deficiency, with no significant associated factors identified, likely reflecting the limited sample availability. Conclusions: Iron deficiency is common in VLBW infants and often precedes anaemia. Assessment of iron status beyond haemoglobin before discharge may be clinically justified to guide early supplementation, though further prospective multicentre studies are needed to confirm whether routine dual-biomarker screening is warranted.
