Intravenous iron administration to very-low-birth-weight newborns receiving total and partial parenteral nutrition.
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.
Friel
J K
JK
Department of Pediatrics, Memorial University of Newfoundland, St. John's, Canada.
Andrews
W L
WL
Hall
M S
MS
Rodway
M S
MS
Keith
M
M
McCloy
U C
UC
Matthew
J D
JD
Long
D R
DR
D000886:Anthropometry; D005527:Food, Fortified; D006801:Humans; D007230:Infant, Low Birth Weight / Q000378:metabolism*; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007501:Iron / Q000008:administration & dosage*; D010288:Parenteral Nutrition / Q000379:methods / Q000592:standards*
D007501:Iron