Background: Iron supplementation is universally prescribed to preterm infants while assessment of iron storage status is not routinely recommended. Deficiency or excess of iron can have harmful effects; consequently iron status evaluation for optimal supplementation is essential.
Aims: To evaluate iron status, iron supplementation efficacy / toxicity in preterm infants using new laboratory methods.
Methods:
50 Very Low Birth Weight (VLBW) infants; standardly supplemented (4mg/kg/day of elemental iron from week 4th) were studied. Lab work obtained: CBC, reticulocyte count, iron, transferrin, transferrin saturation, ferritin, erythropoietin, hepcidin, CRP, and non-transferrin bound iron (NTBI). Three samples were obtained on supplementation days: 7- 0; 4 -7 and ≥14.
Results: 26(54.2%) male, 22(45.8%) female; mean birth weight (MBW) 1264.5±342 g; gestational age 29.1± 2.5 weeks; hospital discharge 57.6± 20 days. 35(70%) of the infants received blood transfusions (BT). MBW was lower in BT 1199±351 g vs No-BT groups 1416±273 g, (p=0.04). Mean red blood cell, hemoglobin, and hematocrit were lower; erythropoietin, platelet and reticulocyte were higher in No-BT, showing infants’ erythropoietic response. In BT infants the mean serum iron, ferritin, transferrin saturation, hepcidin and NTBI were higher, whereas the transferrin was lower; reflecting an increased iron burden.
Conclusions:
VLBW infants show regulatory mechanisms for iron homeostasis/utilization; however NTBI with potential toxic effects can be observed. Blood transfused infants have higher hemoglobin and ferritin levels, and reduced erythropoiesis.
The combination of conventional and novel biomarkers is effective for iron status evaluation in WLBW infants.
An individualized iron supplementation approach based on infants’ transfusion history and iron status is recommended.
