Pediatr Gastroenterol Hepatol Nutr.  2015 Jun;18(2):100-107. 10.5223/pghn.2015.18.2.100.

The Iron Status of Very Low Birth Weight Infants Receiving Multiple Erythrocyte Transfusions during Hospitalization in the Neonatal Intensive Care Unit

• Park SH
• Kim HM

• KMID: 2315556
• DOI: http://doi.org/10.5223/pghn.2015.18.2.100

Abstract

PURPOSE
We investigated the iron status of very low birth weight infants receiving multiple erythrocyte transfusions during hospitalization in the neonatal intensive care unit (NICU).
METHODS
We enrolled 46 very low birth weight infants who were admitted to the Kyungpook National University Hospital between January 2012 and December 2013. Serum ferritin was measured on their first day of life and weekly thereafter. We collected individual data of the frequency and volume of erythrocyte transfusion and the amount of iron intake.
RESULTS
A total of 38 (82.6%) of very low birth weight infants received a mean volume of 99.3+/-93.5 mL of erythrocyte transfusions in NICU. The minimum and maximum serum ferritin levels during hospitalization were 146.2+/-114.9 ng/mL and 456.7+/-361.9 ng/mL, respectively. The total volume of erythrocyte transfusion was not correlated to maximum serum ferritin concentrations after controlling for the amount of iron intake (r=0.012, p=0.945). Non-transfused infants took significantly higher iron intake compared to infants receiving > or =100 mL/kg erythrocyte transfusion (p<0.001). Minimum and maximum serum ferritin levels of non-transfused infants were higher than those of infants receiving <100 mL/kg erythrocyte transfusions (p=0.026 and p=0.022, respectively). Infants with morbidity including bronchopulmonary dysplasia or retinopathy of prematurity received a significantly higher volume of erythrocyte transfusions compared to infants without morbidity (p<0.001).
CONCLUSION
Very low birth weight infants undergoing multiply erythrocyte transfusions had excessive iron stores and non-transfused infants also might had a risk of iron overload during hospitalization in the NICU.

Keyword

Iron; Very low birth weight infant; Erythrocyte transfusions; Ferritins

MeSH Terms

Bronchopulmonary Dysplasia
Erythrocyte Transfusion*
Ferritins
Gyeongsangbuk-do
Hospitalization*
Humans
Infant*
Infant, Newborn
Infant, Very Low Birth Weight*
Intensive Care, Neonatal*
Iron Overload
Iron*
Retinopathy of Prematurity
Ferritins
Iron

Reference

1. Dallman PR. Biochemical basis for the manifestations of iron deficiency. Annu Rev Nutr. 1986; 6:13–40.

2. Singla PN, Gupta VK, Agarwal KN. Storage iron in human foetal organs. Acta Paediatr Scand. 1985; 74:701–706.

3. Shaw JC. Iron absorption by the premature infant. The effect of transfusion and iron supplements on the serum ferritin levels. Acta Paediatr Scand Suppl. 1982; 299:83–89.

4. Widness JA, Seward VJ, Kromer IJ, Burmeister LF, Bell EF, Strauss RG. Changing patterns of red blood cell transfusion in very low birth weight infants. J Pediatr. 1996; 129:680–687.

5. Sullivan JL. Iron, plasma antioxidants, and the 'oxygen radical disease of prematurity'. Am J Dis Child. 1988; 142:1341–1344.

6. Rao R, Georgieff MK. Iron therapy for preterm infants. Clin Perinatol. 2009; 36:27–42.

7. Cooke RW, Drury JA, Yoxall CW, James C. Blood transfusion and chronic lung disease in preterm infants. Eur J Pediatr. 1997; 156:47–50.

8. 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; 131:541–544.

9. Dorea JG. Iron and copper in human milk. Nutrition. 2000; 16:209–220.

10. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163:1723–1729.

11. 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; 92:73–82.

12. Messer RD, Russo AM, McWhirter WR, Sprangemeyer D, Halliday JW. Serum ferritin in term and preterm infants. Aust Paediatr J. 1980; 16:185–188.

13. Mukhopadhyay K, Yadav RK, Kishore SS, Garewal G, Jain V, Narang A. Iron status at birth and at 4 weeks in preterm-SGA infants in comparison with preterm and term-AGA infants. J Matern Fetal Neonatal Med. 2012; 25:1474–1478.

14. Singla PN, Tyagi M, Shankar R, Dash D, Kumar A. Fetal iron status in maternal anemia. Acta Paediatr. 1996; 85:1327–1330.

15. 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; 111:283–286.

16. Georgieff MK, Landon MB, Mills MM, Hedlund BE, Faassen AE, Schmidt RL, et al. Abnormal iron distribution in infants of diabetic mothers: spectrum and maternal antecedents. J Pediatr. 1990; 117:455–461.

17. Arad I, Konijn AM, Linder N, Goldstein M, Kaufmann NA. Serum ferritin levels in preterm infants after multiple blood transfusions. Am J Perinatol. 1988; 5:40–43.

18. Bard H, Widness JA. The life span of erythrocytes transfused to preterm infants. Pediatr Res. 1997; 42:9–11.

19. Hirano K, Morinobu T, Kim H, Hiroi M, Ban R, Ogawa S, et al. Blood transfusion increases radical promoting non-transferrin bound iron in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2001; 84:F188–F193.

20. Jacobs A. Ferritin: an interim review. Curr Top Hematol. 1985; 5:25–62.

21. Zhuang T, Han H, Yang Z. Iron, oxidative stress and gestational diabetes. Nutrients. 2014; 6:3968–3980.

22. Knutson MD, Walter PB, Ames BN, Viteri FE. Both iron deficiency and daily iron supplements increase lipid peroxidation in rats. J Nutr. 2000; 130:621–628.

23. Lachili B, Hininger I, Faure H, Arnaud J, Richard MJ, Favier A, et al. Increased lipid peroxidation in pregnant women after iron and vitamin C supplementation. Biol Trace Elem Res. 2001; 83:103–110.

24. Romagnoli C, Zecca E, Gallini F, Girlando P, Zuppa AA. Do recombinant human erythropoietin and iron supplementation increase the risk of retinopathy of prematurity? Eur J Pediatr. 2000; 159:627–628.