Assessment of Iron Status and the Effect of Red Blood Cell Transfusion in Premature Infants

Abstract

Objective The objective of this study was to evaluate iron deficiency in preterm infants and determine impact of blood transfusions on serum iron (SI) and ferritin (FTN).

Study Design A prospective evaluation of baseline and weekly hemoglobin (Hgb), hematocrit (Hct), SI, FTN levels in premature infants with birth weights (BWs) < 2,500 g or gestational age (GA) < 34 weeks was performed to determine the impact of GA, BW, and blood transfusion on iron status. Comparisons of the baseline and 1 month values of these measures were performed as well as pre- and posttransfusion.

Results In 125 preterm infants, the mean Hgb, Hct, and SI levels at birth were lower for infants < 28 weeks GA. Post hoc analysis revealed statistically significant lower iron values in infants ≤ 28 weeks GA compared with infants at 28 to 34 weeks GA (p = 0.013) and infants ≥ 34 weeks GA (p = 0.007). FTN and SI values at 1 month were not significantly impacted by blood transfusions.

Conclusion Infants < 28 weeks have lower SI levels at birth. The SI and FTN at 1 month of age were not significantly influenced by blood transfusions.

Keywords

premature infant - serum iron level - serum ferritin level - red blood cell transfusion

• References

• 1 Rao R, Georgieff MK. Iron therapy for preterm infants. Clin Perinatol 2009; 36 (01) 27-42
• 2 Steinmacher J, Pohlandt F, Bode H, Sander S, Kron M, Franz AR. Randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams: neurocognitive development at 5.3 years' corrected age. Pediatrics 2007; 120 (03) 538-546
• 3 de Deungria M, Rao R, Wobken JD, Luciana M, Nelson CA, Georgieff MK. Perinatal iron deficiency decreases cytochrome c oxidase (CytOx) activity in selected regions of neonatal rat brain. Pediatr Res 2000; 48 (02) 169-176
• 4 Youdim MB, Yehuda S. The neurochemical basis of cognitive deficits induced by brain iron deficiency: involvement of dopamine-opiate system. Cell Mol Biol 2000; 46 (03) 491-500
• 5 Kasper DC, Widness JA, Haiden N. , et al. Characterization and differentiation of iron status in anemic very low birth weight infants using a diagnostic nomogram. Neonatology 2009; 95 (02) 164-171
• 6 Cheng C, Juul S. Iron balance in the neonate. Neoreviews 2011; 12: e148-e158
• 7 Siimes MA, Addiego Jr JE, Dallman PR. Ferritin in serum: diagnosis of iron deficiency and iron overload in infants and children. Blood 1974; 43 (04) 581-590
• 8 Kett JC. Anemia in infancy. Pediatr Rev 2012; 33 (04) 186-187
• 9 Strauss RG. Anaemia of prematurity: pathophysiology and treatment. Blood Rev 2010; 24 (06) 221-225
• 10 Collard KJ. Transfusion related morbidity in premature babies: possible mechanisms and implications for practice. World J Clin Pediatr 2014; 3 (03) 19-29
• 11 Inder TE, Clemett RS, Austin NC, Graham P, Darlow BA. High iron status in very low birth weight infants is associated with an increased risk of retinopathy of prematurity. J Pediatr 1997; 131 (04) 541-544
• 12 Silvers KM, Gibson AT, Russell JM, Powers HJ. Antioxidant activity, packed cell transfusions, and outcome in premature infants. Arch Dis Child Fetal Neonatal Ed 1998; 78 (03) F214-F219
• 13 Christensen RD. Associations between “early” red blood cell transfusion and severe intraventricular hemorrhage, and between “late” red blood cell transfusion and necrotizing enterocolitis. Semin Perinatol 2012; 36 (04) 283-289
• 14 Hågå P. Plasma ferritin concentrations in preterm infants in cord blood and during the early anaemia of prematurity. Acta Paediatr Scand 1980; 69 (05) 637-641
• 15 Hesse L, Eberl W, Schlaud M, Poets CF. Blood transfusion. Iron load and retinopathy of prematurity. Eur J Pediatr 1997; 156 (06) 465-470
• 16 Ng PC, Lam CWK, Lee CH. , et al. Hepatic iron storage in very low birthweight infants after multiple blood transfusions. Arch Dis Child Fetal Neonatal Ed 2001; 84 (02) F101-F105
• 17 Arnon S, Shiff Y, Litmanovitz I. , et al. The efficacy and safety of early supplementation of iron polymaltose complex in preterm infants. Am J Perinatol 2007; 24 (02) 95-100
• 18 Baker RD, Greer FR. ; Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126 (05) 1040-1050
• 19 Hercberg S, Galan P. Biochemical effects of iron deprivation. Acta Paediatr Scand Suppl 1989; 361: 63-70
• 20 Rao R, Georgieff MK. Iron in fetal and neonatal nutrition. Semin Fetal Neonatal Med 2007; 12 (01) 54-63
• 21 Georgieff MK. Nutrition and the developing brain: nutrient priorities and measurement. Am J Clin Nutr 2007; 85 (02) 614S-620S
• 22 Tamura T, Goldenberg RL, Hou J. , et al. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr 2002; 140 (02) 165-170
• 23 Lozoff B, Smith JB, Kaciroti N, Clark KM, Guevara S, Jimenez E. Functional significance of early-life iron deficiency: outcomes at 25 years. J Pediatr 2013; 163 (05) 1260-1266
• 24 Siddappa AM, Rao R, Long JD, Widness JA, Georgieff MK. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations. Neonatology 2007; 92 (02) 73-82
• 25 Chockalingam UM, Murphy E, Ophoven JC, Weisdorf SA, Georgieff MK. Cord transferrin and ferritin values in newborn infants at risk for prenatal uteroplacental insufficiency and chronic hypoxia. J Pediatr 1987; 111 (02) 283-286
• 26 Baynes R, Bezwoda W, Bothwell T, Khan Q, Mansoor N. The non-immune inflammatory response: serial changes in plasma iron, iron-binding capacity, lactoferrin, ferritin and C-reactive protein. Scand J Clin Lab Invest 1986; 46 (07) 695-704
• 27 Arad I, Konijn AM, Linder N, Goldstein M, Kaufmann NA. Serum ferritin levels in preterm infants after multiple blood transfusions. Am J Perinatol 1988; 5 (01) 40-43
• 28 Valieva OA, Strandjord TP, Mayock DE, Juul SE. Effects of transfusions in extremely low birth weight infants: a retrospective study. J Pediatr 2009; 155 (03) 331-337.e1