Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content

Geetika Kennady; Faraz Afridi; Dana Neumann; Barbara Amendolia; Nicole Kilic; Vishwanath Bhat; Vineet Bhandari; Zubair H Aghai

doi:10.1055/a-2200-3285

Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content

Am J Perinatol. 2023 Nov 28. doi: 10.1055/a-2200-3285. Online ahead of print.

Authors

Geetika Kennady¹, Faraz Afridi², Dana Neumann¹, Barbara Amendolia², Nicole Kilic², Vishwanath Bhat², Vineet Bhandari², Zubair H Aghai¹

Affiliations

¹ Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours Children's Health, Philadelphia, Pennsylvania.
² Division of Neonatology, Department of Pediatrics, Cooper University Hospital, Camden, New Jersey.

PMID: 37890510
DOI: 10.1055/a-2200-3285

Abstract

Objective: This study aimed to assess the iron status prior to discharge in very low birth weight (VLBW) infants utilizing reticulocyte hemoglobin content (CHr) and evaluate the impact of delayed cord clamping (DCC) on iron status.

Study design: This is a retrospective analysis of VLBW infants from two tertiary level of care Neonatal Intensive Care Units. The primary outcome was the proportion of VLBW infants with low CHr (<29 pg) prior to discharge. Hematologic parameters were also compared between infants who received or did not receive DCC. Infants with a positive newborn screen for hemoglobin Bart's were excluded.

Results: Among the 315 infants included, 99 infants (31.4%) had low CHr prior to discharge. The median (interquartile range) CHr prior to discharge was 30.8 pg (28.4-39 pg). DCC was performed in 46.7% of infants. Hemoglobin at birth, discharge, and CHr prior to discharge were higher and the need for blood transfusion and the number of infants with low CHr prior to discharge were lower in the DCC group.

Conclusion: Approximately 31.4% of VLBW infants had low CHr near the time of discharge suggesting they were iron deficient. DCC improved hematological parameters prior to discharge in VLBW infants. CHr content can be used to guide iron supplementation in VLBW infants to potentially improve their iron status and long-term neurocognitive outcomes.

Key points: · DCC was associated with an improved hemoglobin and iron status at discharge in VLBW infants.. · CHr is an early and reliable marker for iron deficiency.. · Approximately one in three VLBW infants can be iron deficient at the time of discharge..