ABSTRACT
The purpose of this study was to examine the efficacy and safety of early nonionic iron supplementation in preterm infants. Infants with gestational age ≤ 32 weeks who were fed enriched human milk were assigned concurrently to receive 5 mg/kg/d enteral iron polymaltose complex (IPC) at 2 or 4 weeks of age. The levels of hemoglobin, reticulocytes, serum iron, ferritin, and soluble transferrin receptor were recorded at 2, 4, and 8 weeks of age. The incidence of morbidities associated with prematurity and the need for red blood cell transfusions (RBCTs) were recorded. The 2-week group (n = 32) had a better iron status than the 4-week group (n = 36) at 4 weeks and at 8 weeks of age. The incidence of morbidities associated with prematurity was not different among the groups (p = 0.26). RBCT was required in one infants of the 2-week group and in 10 infants in the 4-week group (p = 0.045). The number needed to treat to prevent one RBCT was five. Supplementation of 5 mg/kg/d enteral IPC to preterm infants fed enriched human milk as early as 2 weeks of age was more beneficial to iron status than at 4 weeks of age, and was associated with decreased need for RBCTs and no increase in the incidence of morbidities associated with prematurity.
KEYWORDS
Preterm infants - iron supplementation - morbidities associated with prematurity - iron polymaltose complex
REFERENCES
-
1
Roth P.
Anemia in preterm infants.
Pediatr Rev.
1996;
17
370
-
2
American Academy of Pediatrics Committee on Nutrition .
Nutritional needs of low-birth-weight infants.
Pediatrics.
1985;
75
976-986
-
3
Franz A R, Mihatsch W A, Sander S, Kron M, Pohlandt F.
Prospective randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams.
Pediatrics.
2000;
106
700-706
-
4
Inder T E, Clemett R S, Austin N C, Graham P, Darlow B A.
High iron status in very low birth weight infants is associated with an increased risk of retinopathy of prematurity.
J Pediatr.
1997;
131
541-544
-
5
Tuomainen T P, Nyyssonen K, Porkkala-Sarataho E et al..
Oral supplementation with ferrous sulfate but not with non-ionic iron polymaltose complex increase the susceptibility of plasma lipoproteins to oxidation.
Nutr Res.
1999;
19
1121-1132
-
6
Franz A R, Pohlandt F.
Red blood cell transfusions in very and extremely low birthweight infants under restrictive transfusion guidelines: is exogenous erythropoietin necessary?.
Arch Dis Child Fetal Neonatal Ed.
2001;
84
F96-F100
-
7
Jew R K, Owen D, Kaufman D, Balmer D.
Osmolarity of commonly used medications and formulas in the neonatal intensive care unit.
Nutr Clin Pract.
1997;
12
158-163
-
8
Sweet D G, Savage G A, Tubman R, Lappin T R, Halliday H L.
Cord blood transferrin receptors to assess fetal iron status.
Arch Dis Child Fetal Neonatal Ed.
2001;
85
F46-F48
-
9
Lundstrom U, Siimes M A, Dallman P R.
At what age does iron supplementation become necessary in low-birth-weight infants?.
J Pediatr.
1977;
91
878-883
-
10
Hall R T, Wheeler R E, Benson J, Harris G, Rippetoe L.
Feeding iron-fortified premature formula during initial hospitalization to infants less than 1800 grams birth weight.
Pediatrics.
1993;
92
409-414
-
11 Rao R, Georgieff M. Microminerals. In: Tsang RC, Uauy R, Koletzko B, Zlotkin S Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. 2nd ed. Cincinnati, OH; Digital Educational Publishing 2005: 271-288
-
12
Turker G, Sarper N, Gokalp A S, Usluer H.
The effect of early recombinant erythropoietin and enteral iron supplementation on blood transfusion in preterm infants.
Am J Perinatol.
2005;
22
449-455
-
13
Rudzinska I M, Kornacka M K, Pawluch R.
Treatment with human recombinant erythropoietin and frequency of retinopathy of prematurity.
Przegl Lek.
2002;
59(suppl 1)
83-85
-
14
Ohlsson A, Aher S.
Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants.
Cochrane Database Syst Rev.
2006;
(19)
CD004863
-
15
Johnson G, Jacobs P.
Bioavailability and the mechanisms of intestinal absorption of iron from ferrous ascorbate and ferric polymaltose in experimental animals.
Exp Hematol.
1990;
18
1064-1069
-
16
Erichsen K, Ulvik R J, Grimstad T, Berstad A, Berge R K, Hausken T.
Effects of ferrous sulphate and non-ionic iron-polymaltose complex on markers of oxidative tissue damage in patients with inflammatory bowel disease.
Aliment Pharmacol Ther.
2005;
22
831-838
-
17
Buonocore G, Perrone S, Bracci R.
Free radicals and brain damage in the newborn.
Biol Neonate.
2001;
79
180-186
-
18
Kuiper-Kramer E P, Baerts W, Bakker R, van Eyck J, van Raan J, van Eijk H G.
Evaluation of the iron status of the newborn by soluble transferrin receptors in serum.
Clin Chem Lab Med.
1998;
36
17-21
-
19
Melhorn D K, Gross S.
Vitamin E-dependent anemia in the premature infant. I. Effects of large doses of medicinal iron.
J Pediatr.
1971;
79
569-580
Shmuel ArnonM.D.
Department of Neonatology, Meir Medical Center, Kfar Saba
44281, Israel