Elevated Iron Indices in Preterm Infants: Association with Male Gender

ABSTRACT

Elevated iron indices may be underrecognized in preterm infants. Sixty growing, stable preterm infants < 1500 g studied had elevated iron indices, which was especially elevated in male infants. Careful evaluation of iron indices is essential to prevent potential organ injury and unnecessary iron supplementation.

KEYWORDS

Ferritin - TIBC - percent binding - red cell transfusion - very low-birth-weight infant

REFERENCES

• 1 Buonocore G, Perrone S, Longini M et al.. Non protein bound iron as early predictive marker of neonatal brain damage.  Brain. 2003;  126 1224-1230
• 2 Oppenheimer S J. Iron and its relation to immunity and infectious disease.  J Nutr. 2001;  131(2S–2) 616S-633S
• 3 Ng P C, Lam C WK, Lee C H et al.. Hepatic iron storage in very low birthweight infants after multiple blood transfusions.  Arch Dis Child Fetal Neonatal Ed. 2001;  84 F101-F105
• 4 Leong W-I, Bowlus C L, Tallkvist J, Lonnerdal B. Iron supplementation during infancy-effects on the expression of iron transporters, iron absorption, and iron utilization in rat pups.  Am J Clin Nutr. 2003;  78 1203-1211
• 5 Zlotkin S H, Lay D M, Kjarsgaard J, Longley T. Determination of iron absorption using erythrocyte iron incorporation of two stable isotopes of iron (57Fe and 58Fe) in very low birthweight premature infants.  J Pediatr Gastroenterol Nutr. 1995;  21 190-199
• 6 Konijn A M, Hershko C. Ferritin synthesis in inflammation. I. Pathogenesis of impaired iron release.  Br J Haematol. 1977;  37 7-16
• 7 Griffin I J, Reid M M, McCormick K P, Cooke R J. Zinc protoporphyrin/haem ratio and plasma ferritin in preterm infants.  Arch Dis Child Fetal Neonatal Ed. 2002;  87 F49-F51
• 8 Braekke K, Bechensteen A G, Halvorsen B L, Blomhoff R, Haaland K, Staff A C. Oxidative stress markers and antioxidant status after oral iron supplementation to very low birth weight infants.  J Pediatr. 2007;  151 23-28
• 9 Siner B S, Newman N S. Tables of normal values. Fanaroff and Martin's Neonatal-Prenatal Medicine: Diseases of the Fetus and Infant. 7th ed. St. Louis, MO; Mosby 2002
• 10 Roseff S D, Luban N L, Manno C S. Guidelines for assessing appropriateness of pediatric transfusion.  Transfusion. 2002;  42 1398-1412
• 11 Ribaya-Mercado J D. Importance of adequate vitamin A status during iron supplementation.  Nutr Rev. 1997;  55 306-307
• 12 Obladen M, Diepold K, Maier R F. Venous and arterial hematologic profiles of very low birth weight infants. European Multicenter rhEPO Study Group.  Pediatrics. 2000;  106 707-711
• 13 Murthy J N, Hicks J M, Soldin S J. Evaluation of the Technicon Immuno I random access immunoassay analyser ad calculation of pediatric reference ranges for endocrine tests, T-uptake and ferritin.  Clin Biochem. 1995;  28 181-185
• 14 Soldin S J, Murthy J N, Agarwalla P K et al.. Pediatric reference ranges for creatine kinase, CKMB, Troponin I, iron, and cortisol.  Clin Biochem. 1999;  32 77-80
• 15 Basso D, Fabris C, Del Favero G et al.. Hepatic changes and serum ferritin in pancreatic cancer and other gastrointestinal diseases: the role of cholestasis.  Ann Clin Biochem. 1991;  28(Pt 1) 34-38
• 16 Rao R, Georgieff M K. Iron in fetal and neonatal nutrition.  Semin Fetal Neonatal Med. 2007;  12 54-63
• 17 Siddappa A M, Rao R, Long J D, Widness J A, Georgieff M K. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations.  Neonatology.. 2007;  92 73-82
• 18 Wood J C, Ghugre N. Magnetic resonance imaging assessment of excess iron in thalassemia, sickle cell disease and other iron overload diseases.  Hemoglobin. 2008;  32 85-96
• 19 Dani C, Martelli E, Bertini G et al.. Effect of blood transfusions on oxidative stress in preterm infants.  Arch Dis Child Fetal Neonatal Ed. 2004;  89 F408-F411
• 20 Allen K J, Gurrin L C, Constantine C C et al.. Iron-overload-related disease in HFE hereditary hemochromatosis.  N Engl J Med. 2008;  358 221-230
• 21 Beutler E, Barton J C, Felitti V J et al.. Ferroportin 1 (SCL40A1) variant associated with iron overload in African-Americans.  Blood Cells Mol Dis. 2003;  31 305-309
• 22 Rivers C A, Barton J C, Gordeuk V R et al.. Association of ferroportin Q248H polymorphism with elevated levels of serum ferritin in African Americans in the Hemochromatosis and Iron Overload Screening (HEIRS) Study.  Blood Cells Mol Dis. 2007;  38 247-252
• 23 Tiker F, Celik B, Tarcan A, Kilicdag H, Ozbek N, Gurakan B. Serum pro-hepcidin levels and relationships with iron parameters in healthy preterm and term newborns.  Pediatr Hematol Oncol. 2006;  23 293-297
• 24 Nemeth E, Ganz T. Regulation of iron metabolism by hepcidin.  Annu Rev Nutr. 2006;  26 323-342
• 25 Porto G, De Sousa M. Iron overload and immunity.  World J Gastroenterol. 2007;  13 4707-4715
• 26 Walker Jr E M, Walker S M. Effects of iron overload on the immune system.  Ann Clin Lab Sci. 2000;  30 354-365
• 27 Fishbane S. Review of issues relating to iron and infection.  Am J Kidney Dis. 1999;  34(4, Suppl 2) S47-S52
• 28 Gera T, Sachdev H P. Effect of iron supplementation on incidence of infectious illness in children: systematic review.  BMJ. 2002;  325 1142
• 29 Becroft D M, Dix M R, Farmer K. Intramuscular iron-dextran and susceptibility of neonates to bacterial infections. In vitro studies.  Arch Dis Child. 1977;  52 778-781
• 30 Domellöf M. Iron requirements, absorption and metabolism in infancy and childhood.  Curr Opin Clin Nutr Metab Care. 2007;  10 329-335