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Intravenous iron administration to very-low-birth-weight newborns receiving total and partial parenteral nutrition
J K Friel1, W L Andrews, M S Hall
1Department of Pediatrics, Memorial University of Newfoundland, St. John's, Canada.
Insights
Intravenous iron supplementation in very-low-birth-weight newborns receiving total parenteral nutrition did not improve iron balance. Blood transfusions also failed to provide adequate iron for these infants.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Pediatric Hematology
Background:
- Intravenous iron is not standard for very-low-birth-weight newborns on total parenteral nutrition due to infection risks.
- Iron needs are often assumed to be met by blood transfusions.
Purpose of the Study:
- To assess the benefits of a prudent intravenous (IV) iron supplement in very-low-birth-weight newborns receiving total parenteral nutrition.
- To evaluate iron balance and retention in this vulnerable population.
Main Methods:
- Twenty-six very-low-birth-weight newborns were randomized to receive total parenteral nutrition with or without iron dextran.
- Iron supplementation provided 200–250 micrograms/kg/d IV iron.
- Multiple samples were collected over four weeks to assess iron levels and balance.
Main Results:
- No significant differences were observed in anthropometric, hematologic, or biochemical parameters between groups.
- Septic events, blood transfusion needs, and blood loss for diagnostics were similar.
- While the iron group retained more iron, iron balance remained negative for most infants in both groups.
Conclusions:
- A total iron intake of 400 micrograms/kg/d, with half from IV iron, is insufficient for very-low-birth-weight newborns on total parenteral nutrition.
- This intake does not meet fetal accretion rates or maintain iron balance.
- Iron from blood transfusions is inadequate to meet the iron requirements of these infants.
Background:
Intravenous iron supplements are not routinely administered to very-low-birth-weight newborns receiving total parenteral nutrition because of the possible increased risk of infection and because iron needs may be met with blood transfusions.
Methods:
To assess the benefits of a prudent IV iron supplement (200 to 250 micrograms/kg/d), 26 very-low-birth-weight newborns (birth weight, 1005 +/- 302 g; gestational age, 28 +/- 2.3 weeks; mean +/- SD) were randomly allocated to receive total parenteral nutrition without iron (No-Iron) or with iron supplied as iron dextran (Iron). These newborns were followed at baseline (2 to 3 days after birth) and at weeks 1 to 4 thereafter. At each sampling time, urine samples, fecal samples (rarely), unused total parenteral nutrition solutions, blood products, and a blood sample (1 mL) were collected.
Results:
There were no differences between the two groups in anthropometric measurements, hematologic or biochemical parameters, number or amount of blood transfusions (2.3 +/- 1.9), amount of blood removed for diagnostic purposes (44 +/- 16 mL), or number of septic events (n = 16). There was no difference between the groups for the total iron excreted; however, the Iron group retained more iron. Iron balance was negative for all but 10 newborns (No-Iron, 3; Iron, 7) throughout the study.
Conclusions:
A total iron intake of 400 micrograms/kg/d, half of which was provided by IV iron, is not sufficient to maintain iron balance or to meet fetal accretion rates (1000 micrograms/kg/d) in very-low-birth-weight newborns receiving total parenteral nutrition. Furthermore, endogenous iron from blood transfusions does not provide an adequate supply of iron.