Iron supplementation for preterm infants receiving restrictive red blood cell transfusions: reassessment of practice safety.
OBJECTIVE
To reassess iron supplementation practice safety in very low birth weight (VLBW) preterm infants receiving restrictive red blood cell transfusions during initial hospitalization.


METHODS
Iron status, including hemoglobin (Hb), serum iron, ferritin, and soluble transferrin receptor (sTfR) levels and reticulocyte count of transfused (n=236) and non-transfused (n=166) preterm infants at ≤24 h and 2, 4 and 8 weeks were recorded. As per protocol, a restrictive blood transfusion policy and supplementation of 5 mg kg(-1) per day of iron polymaltose complex from 4 weeks and 25 mg(-1) per day of vitamin E from 2 weeks were imposed for all infants. Normative reference cord-blood ferritin value of preterm infants was used for comparison. Vitamin E levels and incidence of morbidities associated with prematurity were recorded.


RESULTS
At ≤24 h, the characteristics and iron status of both groups were similar. At 2, 4 and 8 weeks, the transfused group had significantly higher Hb, iron and ferritin levels; sTfR levels were lower at 4 and 8 weeks (all indices, P<0.05). At 8 weeks, the median ferritin levels of our transfused group were lower than that of normative reference cord-blood value (115 (50th percentile) vs 79 (43 to 107) μg l(-1), respectively). Vitamin E levels and the incidence of morbidities associated with prematurity of the transfused and non-transfused groups were not different (both indices, P>0.18).


CONCLUSIONS
Adding iron supplementation to preterm infants receiving restrictive blood transfusions has shown to be a judicious and safe practice in terms of iron status for VLBW preterm infants.
Arnon
S
S
Department of Neonatology, Meir Medical Center, Kfar Saba, Israel. harnon@netvision.net.il
Dolfin
T
T
Bauer
S
S
Regev
R H
RH
Litmanovitz
I
I
D054316:Biomarkers, Pharmacological / Q000097:blood*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena / Q000187:drug effects*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood / Q000254:growth & development; D019102:Infant, Very Low Birth Weight / Q000097:blood / Q000254:growth & development; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism; D015596:Nutrition Assessment; D009752:Nutritional Status / Q000187:drug effects; D014131:Trace Elements / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism; D014810:Vitamin E / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism; D014815:Vitamins / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism
D054316:Biomarkers, Pharmacological; D014131:Trace Elements; D014815:Vitamins; D014810:Vitamin E; D007501:Iron