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Rao RB. Biomarkers of Brain Dysfunction in Perinatal Iron Deficiency. Nutrients 2024; 16:1092. [PMID: 38613125 PMCID: PMC11013337 DOI: 10.3390/nu16071092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Iron deficiency in the fetal and neonatal period (perinatal iron deficiency) bodes poorly for neurodevelopment. Given its common occurrence and the negative impact on brain development, a screening and treatment strategy that is focused on optimizing brain development in perinatal iron deficiency is necessary. Pediatric societies currently recommend a universal iron supplementation strategy for full-term and preterm infants that does not consider individual variation in body iron status and thus could lead to undertreatment or overtreatment. Moreover, the focus is on hematological normalcy and not optimal brain development. Several serum iron indices and hematological parameters in the perinatal period are associated with a risk of abnormal neurodevelopment, suggesting their potential use as biomarkers for screening and monitoring treatment in infants at risk for perinatal iron deficiency. A biomarker-based screening and treatment strategy that is focused on optimizing brain development will likely improve outcomes in perinatal iron deficiency.
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Affiliation(s)
- Raghavendra B. Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
- Masonic Institute for the Developing Brain, Minneapolis, MN 55414, USA
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Bahr TM, Tan S, Smith E, Beauman SS, Schibler KR, Grisby CA, Lowe JR, Bell EF, Laptook AR, Shankaran S, Carlton DP, Rau C, Baserga MC, Flibotte J, Zaterka-Baxter K, Walsh MC, Das A, Christensen RD, Ohls RK. Serum ferritin values in neonates <29 weeks' gestation are highly variable and do not correlate with reticulocyte hemoglobin content. J Perinatol 2023; 43:1368-1373. [PMID: 37596391 PMCID: PMC10825191 DOI: 10.1038/s41372-023-01751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To compare serum ferritin and RET-He values among extremely low gestational age neonates ELGANs with other markers of iron-deficient erythropoiesis. STUDY DESIGN This is a secondary analysis of the NICHD Darbepoetin Trial. Study data from placebo recipients who had a serum ferritin, a RET-He, and a mean corpuscular volume (MCV) measurement within a 24-hour period were analyzed for correlation. RESULTS Mixed linear regression models showed no association between ferritin and RET-He at both early (β = 0.0016, p = 0.40) and late (β = -0.0001, p = 0.96) time points. Positive associations were observed between RET-He and MCV at baseline, early, and late time points (p < 0.01, =0.01, <0.001, respectively), while ferritin was not associated with MCV at any time point. CONCLUSIONS Our study shows that RET-He is better correlated with MCV as a marker of iron-limited erythropoiesis than ferritin. The results suggest that ferritin is limited as a marker of iron sufficiency in premature infants. STUDY IDENTIFICATION FDA IND Number 100138; ClinicalTrials.gov number NCT03169881; NRN ID number NICHD-NRN-0058 (Darbe).
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA.
- Department of Neonatology, Intermountain Healthcare, Murray, UT, USA.
| | - Sylvia Tan
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Emily Smith
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Sandra S Beauman
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Kurt R Schibler
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cathy A Grisby
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean R Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Abbot R Laptook
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - David P Carlton
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Carrie Rau
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - Mariana C Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - John Flibotte
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Zaterka-Baxter
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Michele C Walsh
- Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
- Department of Neonatology, Intermountain Healthcare, Murray, UT, USA
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
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Gao Z, Hu Y, Gao Y, Ma X, Hu Z. The association of hepcidin, reticulocyte hemoglobin equivalent and anemia-related indicators on anemia in chronic kidney disease. Medicine (Baltimore) 2023; 102:e33558. [PMID: 37115087 PMCID: PMC10145874 DOI: 10.1097/md.0000000000033558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Hepcidin is an essential regulator of iron homeostasis in chronic kidney disease (CKD) anemia, reticulocyte hemoglobin equivalent (RET-He) can be used to evaluate the availability of iron for erythropoiesis. Previous research has found that hepcidin indirectly regulates RET-He. This study aimed to investigate the association of hepcidin, RET-He and anemia-related indicators on anemia in chronic kidney disease. A total of 230 individuals were recruited, including 40 CKD3-4 patients, 70 CKD5 patients without renal replacement therapy, 50 peritoneal dialysis patients, and 70 hemodialysis patients. The serum levels of hemoglobin (Hb), reticulocyte, RET-He, serum iron, serum creatinine, serum ferritin, total iron binding capacity, hepcidin-25, high sensitivity C-reactive protein, transferrin, erythropoietin, intrinsic factor antibody, soluble transferrin receptor and interleukins-6 (IL-6) were measured. Hepcidin-25 was positively associated with IL-6, and negatively with total iron binding capacity, intrinsic factor antibody, and transferrin. Reticulocyte Hb equivalent was associated positively with Hb, serum ferritin, serum iron, transferrin saturation, and negatively with serum creatinine, reticulocyte, IL-6, STfR. Hepcidin-25 was not associated with RET-He, while IL-6 was independently associated with hepcidin-25 and RET-He, suggesting that hepcidin has no effffect on the iron dynamics of reticulocytes in CKD, may be related to IL-6, indicate a likelihood of a threshold for stimulation of hepcidin-25 expression by IL-6 in order to indirectly regulates RET-He.
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Affiliation(s)
- Zhaoli Gao
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Yingying Hu
- Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yanxia Gao
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Xiaotian Ma
- Department of Medicine Experimental Center, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Prevalence and Implications of Low Reticulocyte-Hemoglobin Levels among Extreme Preterm Neonates: A Single-Center Retrospective Study. Nutrients 2022; 14:nu14245343. [PMID: 36558502 PMCID: PMC9788547 DOI: 10.3390/nu14245343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
This retrospective cohort study aims to determine the epidemiology of iron deficiency among extreme preterm neonates and the association of iron-deficient status during the NICU stay with neurodevelopmental outcomes at 18−24 months. Neonates ≤29 weeks gestational age (GA) born between June 2016 and December 2019, who received routine iron supplementation were enrolled. Iron deficiency was defined as reticulocyte−hemoglobin (Ret-Hb) levels ≤ 29 pg at 36 weeks corrected age. A subcohort of neonates completed standardized developmental assessment at 18−24 months corrected age. Significant neurodevelopmental impairment (sNDI) was defined as either Bayley Scales of Infant Development score < 70 or cerebral palsy or blindness or hearing aided. Among a cohort of 215 neonates [GA 25.8 (1.7) weeks, birthweight 885 (232) g], prevalence of iron deficiency was 55%, 21%, 26%, and 13%, in neonates <24 weeks, 24−25 + 6 weeks, 26−27 + 6 weeks, and ≥ 28 weeks GA, respectively. Male sex and receipt of corticosteroid therapy were associated with iron-deficiency. In the subcohort analysis (n = 69), there was no statistically significant association between Ret-Hb levels at 36 weeks corrected age and the risk of sNDI [OR 0.99 (95% CI 0.85−1.2)]. Male infants and those who received postnatal corticosteroids are likely to have iron-limited erythropoiesis at corrected term despite routine iron-supplementation; however, low Ret-Hb levels during the neonatal period were not associated with significant neurological disability in early childhood.
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Babacheva E, Rallis D, Christou H, Mitsiakos G, Mikos T, Dampala K, Tsakalidis C, Kioumi A, Goulis D, Soubasi V. Maternal diabetes and the role of neonatal reticulocyte hemoglobin content as a biomarker of iron status in the perinatal period. Front Endocrinol (Lausanne) 2022; 13:1011897. [PMID: 36425471 PMCID: PMC9679283 DOI: 10.3389/fendo.2022.1011897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS We aimed to evaluate the effects of maternal diabetes on neonatal iron status, measuring erythrocyte indices including hemoglobin, hematocrit, reticulocytes, mean corpuscular volume (MCV), percent (%) hypochromia, ferritin, and additionally mean reticulocyte hemoglobin content (MCHr) as an early marker of iron deficiency, and examine the association between neonatal MCHr, red cell indices, and ferritin. MATERIALS AND METHODS We conducted a hospital-based prospective cohort study in a tertiary neonatal unit of a University Hospital from 2018 to 2020. We enrolled 126 maternal-infant pairs of mothers whose pregnancy was associated with diabetes and 74 maternal-infant pairs from uncomplicated pregnancies. Erythrocyte indices were analyzed within the first twelve hours after birth. Erythrocyte parameters were compared between infants of the diabetes and the non-diabetic group. We examined the correlation of the neonatal MCHr with perinatal characteristics, including gestation, birth weight, maternal body mass index, the erythrocytic indices, maternal diabetes, maternal obesity, prematurity, small-for-gestational-age status, maternal preeclampsia, and maternal anemia. Finally, we evaluated the discordance between neonatal MCHr and neonatal ferritin. RESULTS Infants of the diabetes group had a significantly lower MCHr (32.6 pg vs. 34.2 pg, p=0.003) compared with infants of uncomplicated pregnancies. Neonatal MCHr was significantly correlated with maternal hypochromia (r=-0.237, p=0.004) and neonatal MCV (r=0.674, p<0.001). Neonatal MCHr was significantly associated with maternal diabetes [standardized coefficients 0.21, 95% confidence interval (CI) 0.05-0.58, p=0.003) and maternal preeclampsia (standardized coefficients 0.17, 95% CI 0.02-0.92, p=0.019), after adjusting for maternal anemia, maternal obesity, prematurity, and small-for-gestational-age status. Those results were consistent also when analyzing maternal-infant pairs with pre-existing diabetes, and maternal-infant pairs with gestational diabetes. There was significant discordance between neonatal MCHr and neonatal ferritin (p=0.001). CONCLUSIONS MCHr was significantly lower in infants of mothers whose pregnancy was associated with diabetes compared with infants of non-diabetic mothers and correlated with neonatal and maternal red cell indices of iron deficiency. Since there was significant discordance between neonatal MCHr and ferritin during the first postnatal day, it is possible that MCHr could be used as a screening test for iron deficiency, especially in infants.
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Affiliation(s)
- Evgeniya Babacheva
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
- *Correspondence: Evgeniya Babacheva,
| | - Dimitrios Rallis
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Helen Christou
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - George Mitsiakos
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Themistoklis Mikos
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Kalliopi Dampala
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Christos Tsakalidis
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Anna Kioumi
- Department of Hematology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Vasiliki Soubasi
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Bahr TM, Christensen TR, Henry E, Wilkes J, Ohls RK, Bennett ST, Ward DM, Pysher TJ, Christensen RD. Neonatal Reference Intervals for the Complete Blood Count Parameters MicroR and HYPO-He: Sensitivity Beyond the Red Cell Indices for Identifying Microcytic and Hypochromic Disorders. J Pediatr 2021; 239:95-100.e2. [PMID: 34389321 PMCID: PMC9123644 DOI: 10.1016/j.jpeds.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To create neonatal reference intervals for the MicroR and HYPO-He complete blood count (CBC) parameters and to test whether these parameters are sensitive early markers of disease at early stages of microcytic/hypochromic disorders while the CBC indices are still normal. STUDY DESIGN We retrospectively collected the CBC parameters MicroR and HYPO-He, along with the standard CBC parameters, from infants aged 0-90 days at Intermountain Healthcare hospitals using Sysmex hematology analyzers. We created reference intervals for these parameters by excluding values from neonates with proven microcytic disorders (ie, iron deficiency or alpha thalassemia) from the dataset. RESULT From >11 000 CBCs analyzed, we created reference intervals for MicroR and HYPO-He in neonates aged 0-90 days. The upper intervals are considerably higher in neonates than in adults, validating increased anisocytosis and polychromasia among neonates. Overall, 52% of neonates with iron deficiency (defined by reticulocyte hemoglobin equivalent <25 pg) had a MicroR >90% upper interval (relative risk, 4.14; 95% CI, 3.80-4.53; P < .001), and 68% had an HYPO-He >90% upper interval (relative risk, 6.64; 95% CI, 6.03-7.32; P < .001). These 2 new parameters were more sensitive than the red blood cell (RBC) indices (P < .001) in identifying 24 neonates with iron deficiency at birth. CONCLUSIONS We created neonatal reference intervals for MicroR and HYPO-He. Although Sysmex currently designates these as research use only in the US, they can be measured as part of a neonate's CBC with no additional phlebotomy volume or run time and can identify microcytic and hypochromic disorders even when the RBC indices are normal.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, University of Utah Health, Salt Lake City, UT; Center for Iron and Heme Disorders, University of Utah Health, Salt Lake City, UT.
| | | | - Erick Henry
- Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, UT
| | - Jacob Wilkes
- Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, UT
| | - Robin K Ohls
- Division of Neonatology, University of Utah Health, Salt Lake City, UT
| | | | - Diane M Ward
- Department of Pathology, University of Utah Health, Salt Lake City, UT
| | - Theodore J Pysher
- Department of Pathology, University of Utah Health, Salt Lake City, UT; Pediatric Pathology, Primary Children's Hospital, Salt Lake City, UT
| | - Robert D Christensen
- Division of Neonatology, University of Utah Health, Salt Lake City, UT; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT; Center for Iron and Heme Disorders, University of Utah Health, Salt Lake City, UT; Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, UT
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German KR, Juul SE. Iron and Neurodevelopment in Preterm Infants: A Narrative Review. Nutrients 2021; 13:nu13113737. [PMID: 34835993 PMCID: PMC8624708 DOI: 10.3390/nu13113737] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
Abstract
Iron is critical for brain development, playing key roles in synaptogenesis, myelination, energy metabolism and neurotransmitter production. NICU infants are at particular risk for iron deficiency due to high iron needs, preterm birth, disruptions in maternal or placental health and phlebotomy. If deficiency occurs during critical periods of brain development, this may lead to permanent alterations in brain structure and function which is not reversible despite later supplementation. Children with perinatal iron deficiency have been shown to have delayed nerve conduction speeds, disrupted sleep patterns, impaired recognition memory, motor deficits and lower global developmental scores which may be present as early as in the neonatal period and persist into adulthood. Based on this, ensuring brain iron sufficiency during the neonatal period is critical to optimizing neurodevelopmental outcomes and iron supplementation should be targeted to iron measures that correlate with improved outcomes.
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8
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Comparison of two markers of iron sufficiency and neurodevelopmental outcomes. Early Hum Dev 2021; 158:105395. [PMID: 34082259 DOI: 10.1016/j.earlhumdev.2021.105395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/18/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Iron deficiency during critical windows of brain development is associated with suboptimal neurodevelopmental outcomes. Identifying markers of neonatal iron status that best correlate with neurodevelopmental outcome is critical for optimal management of iron supplementation of neonates. AIMS We aimed to evaluate two markers of iron sufficiency, ferritin and zinc protoporphyrin-to-heme ratios (ZnPP/H), with neurodevelopmental outcomes. STUDY DESIGN This is a retrospective cohort study. SUBJECTS All infants with concurrent ferritin and ZnPP/H measurements obtained between October 2014 and April 2017 and Bayley Scales of Infant Development, 3rd Edition (BSID-III) evaluated at 24 months corrected age were included. OUTCOME MEASURES Associations between iron markers (minimum, maximum and median ferritin and ZnPP/H) and BSID-III score at 24 months were assessed. RESULTS 223 lab measurements from 62 infants were assessed. Mean gestational age was 28.1 weeks (SD = 2.6) with a mean birth weight of 1.1 kg (SD = 0.4). Significant associations between maximum and median ZnPP/H and motor score, and between median ZnPP/H and cognitive score were observed. Trends were also seen with higher minimum, median and maximum ZnPP/H associated with lower BSID-III scores, but did not reach statistical significance (p > 0.05). The associations between ferritin values and BSID scores were less consistent. CONCLUSIONS A positive association was seen between ZnPP/H values and BSID-III scores. Trends between ferritin and BSID values were less consistent, potentially because ferritin is more affected by inflammation. Consideration should be given to using ZnPP/H preferentially to adjust iron supplementation in the NICU to improve neurodevelopmental outcomes.
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Gerday E, Brereton JB, Bahr TM, Elmont JO, Fullmer S, Middleton BA, Ward DM, Ohls RK, Christensen RD. Urinary ferritin; a potential noninvasive way to screen NICU patients for iron deficiency. J Perinatol 2021; 41:1419-1425. [PMID: 32709979 DOI: 10.1038/s41372-020-0746-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/23/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Building on our previous study, showing a correlation between ferritin in serum and urine, we conducted a feasibility evaluation, measuring urinary ferritin as a potential noninvasive screening test for iron deficiency among NICU patients. STUDY DESIGN This was a prospective analysis of paired serum/urine ferritin levels. We defined iron-limited erythropoiesis by a RET-He <5th percentile lower reference interval (<28 pg). RESULTS We obtained 49 paired serum/urine samples from neonates judged as at-risk for iron deficiency. Urine ferritin ("corrected" for urine creatinine and specific gravity) correlated with serum ferritin (correlation coefficient of log10-transformed values 0.44). A corrected urine ferritin <12 ng/mL had a sensitivity of 82% (95% CI, 67-93%) and a specificity of 100% (CI, 66-100%) for detecting iron-limited erythropoiesis, with a positive predictive value of 100% (CI, 89-100%). CONCLUSIONS Measuring urinary ferritin in NICU patients is feasible. Since low values identify iron-limitation, this could become a useful noninvasive screen.
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Affiliation(s)
- Erick Gerday
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA.,Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Jennifer B Brereton
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA
| | - Timothy M Bahr
- Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Jennifer O Elmont
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA
| | - Susan Fullmer
- Department of Nutrition, Dietetics, and Food Science, Brigham Young University, Provo, UT, USA
| | | | - Diane M Ward
- Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah Health, Salt Lake City, UT, USA
| | - Robin K Ohls
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA.,Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Robert D Christensen
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA. .,Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA. .,Department of Pediatrics, Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA.
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10
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Bahr TM, Carr NR, Christensen TR, Wilkes J, O'Brien EA, German KR, Ohls RK, Ward DM, Christensen RD. Early iron supplementation and iron sufficiency at one month of age in NICU patients at-risk for iron deficiency. Blood Cells Mol Dis 2021; 90:102575. [PMID: 33989937 DOI: 10.1016/j.bcmd.2021.102575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/16/2022]
Abstract
In order to reduce iron deficiency in neonates at-risk for iron deficiency, we implemented a guideline to increase the consistency of early iron supplementation in infants of diabetic mothers, small for gestational age neonates and very low birthweight premature neonates. Three years following implementation we performed a retrospective analysis in order to assess adherence to the guideline and to compare timing of early iron supplementation and reticulocyte-hemoglobin (RET-He) values at one month of life in at-risk infants. Adherence with early iron supplementation guidelines was 73.4% (399/543) with 51% (275/543) having RET-He values obtained at one month. Despite good adherence, 16% (44/275) had RET-He <25 pg (5th percentile for gestational age). No infants receiving red blood cell transfusion (0/20) had RET-He <25 pg vs. 26.1% (40/153) of those treated with darbepoetin (p < 0.001). There was no evidence of increased feeding intolerance (episodes of emesis/day) with early iron supplementation.
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Affiliation(s)
- Timothy M Bahr
- Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA.
| | - Nicholas R Carr
- Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | | | - Jacob Wilkes
- Intermountain Healthcare Research, Salt Lake City, UT, USA
| | - Elizabeth A O'Brien
- Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Intermountain Healthcare Research, Salt Lake City, UT, USA
| | - Kendell R German
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA, USA
| | - Robin K Ohls
- Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Diane M Ward
- Department of Pathology, University of Utah Health, Salt Lake City, UT, USA; Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA
| | - Robert D Christensen
- Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Intermountain Healthcare Research, Salt Lake City, UT, USA; Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Department of Pediatrics, Division of Hematology/Oncology, University of Utah Health, Salt Lake City, UT, USA
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Reconciling markedly discordant values of serum ferritin versus reticulocyte hemoglobin content. J Perinatol 2021; 41:619-626. [PMID: 33012780 DOI: 10.1038/s41372-020-00845-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/02/2020] [Accepted: 09/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine why serum ferritin and reticulocyte hemoglobin (RET-He), drawn to assess neonatal iron sufficiency, sometimes have markedly discordant results. STUDY DESIGN Retrospective records review of five NICUs over 28 months, identifying all patients with a ferritin and RET-He within 48 h. We examined records of all who had marked discordance (one value >95th % reference interval, the other <5th %). RESULTS Of 190 paired ferritin and RET-He measurements, 16 (8%) were markedly discordant. Fifteen of the 16 discordant samples involved a high ferritin and a low RET-He. In these, low MCV and high %Micro-R, and low MCH and high %HYPO-He were present. In total, 8 of the 15 had laboratory or clinical evidence of an inflammatory process and five had suspicion of infection documented. CONCLUSIONS When ferritin and RET-He were discordant, erythrocyte microcytosis and hypochromasia suggested that the RET-He gave the more accurate interpretation; that iron deficiency was likely present.
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