Iron status in low-birth-weight infants, small and appropriate for gestational age. A follow-up study

Iron Deficiency and Iron Homeostasis in Low Birth Weight Preterm Infants: A Systematic Review

Iron is an essential micronutrient that is involved in many functions in humans, as it plays a critical role in the growth and development of the central nervous system, among others. Premature and low birth weight infants have higher iron requirements due to increased postnatal growth compared to that of term infants and are, therefore, susceptible to a higher risk of developing iron deficiency or iron deficiency anemia. Notwithstanding, excess iron could affect organ development during the postnatal period, particularly in premature infants that have an immature and undeveloped antioxidant system. It is important, therefore, to perform a review and analyze the effects of iron status on the growth of premature infants. This is a transversal descriptive study of retrieved reports in the scientific literature by a systematic technique. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adapted for the review strategy. The inclusion criteria for the studies were made using the PICO (population, intervention, comparison, outcome) model. Consequently, the systematic reviews that included studies published between 2008–2018 were evaluated based on the impact of iron status on parameters of growth and development in preterm infants.

Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial

OBJECTIVES

To evaluate whether preterm very low birth weight (VLBW) infants receiving early iron (EI) supplementation (2 mg/kg/day elemental iron) at 2 weeks postnatal age have improved serum ferritin levels compared with late iron (LI) supplementation at 6 weeks postnatal age.

DESIGN

Single-blinded parallel-group interventional randomised controlled trial.

SETTING

Tertiary care centre in southern India.

INTERVENTIONS

Randomised at 2 weeks postnatal age to EI and LI groups and evaluated at 2, 6 and 12 weeks postnatal age.

OUTCOME

The primary outcome was serum ferritin level at 12 weeks, and the secondary outcomes were the incidence of neonatal morbidities, haemoglobin level, anthropometric parameters and blood transfusion requirements.

RESULTS

Of the 104 babies randomised, outcomes were analysed in 46 and 47 babies in EI and LI groups, respectively. Serum ferritin level was significantly higher (p<0.001) at 12 weeks (82±5 vs 63±3 ng/mL) in the EI group. Haemoglobin (10.1±0.4 vs 9.2±0.4 g/dL) and mean corpuscular haemoglobin concentration (31±0.5 vs 29.4±0.5 g/dL) were also significantly (p<0.001) higher at 12 weeks in the EI group. There was a significant decrease of ferritin in the LI group and significant increase in ferritin in the EI group at 6 weeks compared with 2 weeks. There were no significant differences in the incidences of neonatal morbidities (necrotising enterocolitis, periventricular leukomalacia, retinopathy of prematurity), anthropometric parameters and blood transfusion requirements between the two groups.

CONCLUSIONS

EI supplementation in preterm VLBW infants improves serum ferritin and haemoglobin levels.

TRIAL REGISTRATION

CTRI/2013/01/003277.

Prevalence and risk factors for iron-deficiency anemia in very-low-birth-weight preterm infants at 1 year of corrected age

OBJECTIVE

To determine the prevalence of iron-deficiency anemia and iron deficiency at 1 year of corrected age (CA) in preterm very-low-birth-weight infants, and to identify risk factors for iron-deficiency anemia.

METHODS

A cohort of infants with birth weight <1500 g and gestational age <34 weeks on iron prophylaxis were followed up to 12 months' CA. Anemia diagnosis was based on hemoglobin <11 g/dl. Iron deficiency was defined by ferritin levels <10 μg/l, transferrin saturation <10% and mean corpuscular volume <80 fl. Neonatal data and feeding at 6 and 12 months' CA (breastfeeding and/or cow's milk or infant formula); hospitalizations during the first year and weight, head circumference, body mass index and length at 12 months' CA were analyzed.

RESULTS

Prevalence of anemia in 310 participants was 26.5% [95% confidence interval (CI) 21.8-31.6%] and of iron deficiency was 48% (95% CI 39.0-56.9%). Increased consumption of cow's milk at 6 months [relative risk (RR) 1.687; 95% CI 1.146-2.483], lower maternal age (RR 0.953; 95% CI 0.923-0.983), high number of pregnancies (RR 1.256; 95% CI 1.122-1.406) and being born small for gestational age (RR 1.578; 95% CI 1.068-2.331) were independently associated with anemia after adjustments.

CONCLUSIONS

Prevalence of anemia is high at 1 year of CA. Dietary and environmental education strategies may help prevent anemia after discharge.

Enteral iron supplementation in preterm and low birth weight infants

BACKGROUND

Preterm infants are at risk of exhausting their body iron stores much earlier than healthy term newborns. It is widespread practice to give enteral iron supplementation to preterm and low birth weight infants to prevent iron deficiency anaemia. However, it is unclear whether supplementing preterm and low birth weight infants with iron improves growth and neurodevelopment. It is suspected that excess exogenous iron can contribute to oxidative injury in preterm babies, causing or exacerbating conditions such as necrotising enterocolitis and retinopathy of prematurity. Additionally, the optimal dose and timing of commencement and cessation of iron supplementation are uncertain.

OBJECTIVES

To evaluate the effect of prophylactic enteral iron supplementation on growth and neurodevelopmental outcomes in preterm and low birth weight infants. The secondary objectives were to determine whether iron supplementation results in improved haematological parameters and prevents other causes of morbidity and mortality.

SEARCH METHODS

We used the standard search strategy of the Cochrane Neonatal Review Group. We searched Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (1951 to August 2011), CINAHL (1982 to August 2011) and conference proceedings and previous reviews.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-randomised trials that compared enteral iron supplementation with no iron supplementation, or different regimens of enteral iron supplementation in preterm or low birth weight infants or both.

DATA COLLECTION AND ANALYSIS

We extracted data using the standard methods of the Cochrane Neonatal Review Group. Both review authors separately evaluated trial quality and data extraction. We synthesised data using risk ratios (RRs), risk differences (RDs) and weighted mean differences (WMDs). Where data about the methodology and results or both were lacking, we made an attempt to contact the study authors for further information.

MAIN RESULTS

We included twenty-six studies (2726 infants) in the analysis. The heterogeneity of participants, methods and results precluded an extensive quantitative synthesis. Of the 21 studies comparing iron supplementation with controls, none evaluated neurodevelopmental status as an outcome. Of thirteen studies reporting at least one growth parameter as an outcome, only one study of poor quality found a significant benefit of iron supplementation. Regarding haematological outcomes, no benefit for iron supplementation was demonstrated within the first 8.5 weeks of postnatal life (16 trials), except by two poor quality studies. After this age, most studies reported a higher mean haemoglobin in iron-supplemented infants. We were only able to include a limited number of studies in a quantitative meta-analysis, which suggested the haemoglobin concentration in iron-supplemented infants was higher by about 6 g/L at six to nine months. One study comparing high dose and low dose iron supplementation monitored neurodevelopmental outcome for one year, without finding any significant difference between the groups. One study comparing early versus late commencement of iron supplementation found no difference in cognitive outcome, but an increased rate of abnormal neurological examination in the late iron group at five years of age. The studies comparing high and low doses of iron indicated that there was no discernible haematological benefit in exceeding 'standard' doses of iron (i.e. 2 mg/kg/day to 3 mg/kg/day).

AUTHORS' CONCLUSIONS

The available data suggest that infants who receive iron supplementation have a slightly higher haemoglobin level, improved iron stores and a lower risk of developing iron deficiency anaemia when compared with those who are unsupplemented. However, it is unclear whether iron supplementation in preterm and low birth weight infants has long term benefits in terms of neurodevelopmental outcome and growth. The optimum timing and duration of iron supplementation remains unclear.

Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate

Anemia prevalence is highest in preschool children, women of reproductive age, and women who are pregnant. While the etiology of anemia is multifactorial, iron deficiency is the most commonly recognized nutritional cause. Observational studies imply that supplementation with iron or iron-folic acid should be started early in pregnancy, if not before, in order to prevent low-birth-weight and preterm delivery. Despite this, findings from clinical trials, even those conducted during early pregnancy, are equivocal. Recent follow-up studies of children born to women supplemented with iron-folic acid suggest that mortality is decreased and that the infant's iron endowment reflects the mother's iron status during pregnancy.

Iron supplements reduce the risk of iron deficiency anemia in marginally low birth weight infants

OBJECTIVE

Low birth weight infants are at risk for iron deficiency (ID). Most LBW infants have marginally low birth weight (MLBW, 2000-2500 g) and it is not known whether they benefit from iron supplements. The objective of this trial was to study the effects of iron supplementation in MLBW infants.

METHOD

In a randomized controlled trial, we assigned 285 healthy, MLBW infants to receive iron supplements at a dose of 0 (placebo), 1, or 2 mg/kg per day between 6 weeks and 6 months of age. Hemoglobin levels, ferritin levels, transferrin saturation, mean cell volume, and transferrin receptor levels were analyzed at 6 months. Growth and morbidity were monitored.

RESULTS

Iron supplementation resulted in significant dose-dependent effects on hemoglobin and all iron status indicators at 6 months. The prevalence of ID at 6 months was 36% in the placebo group, 8.2% in the 1 mg/kg per day group, and 3.8% in the 2 mg/kg per day group (P<.001). The prevalence rates of ID anemia (IDA) were 9.9%, 2.7%, and 0%, respectively (P=.004). Among infants who were exclusively breastfed at 6 weeks, the prevalence of IDA was 18% in the placebo group. There were no significant differences between groups in growth or morbidity.

CONCLUSIONS

MLBW infants have relatively high risks of ID and IDA, especially if they are breastfed. Iron supplementation at 2 mg/kg per day from 6 weeks to 6 months reduces this risk effectively, with no short-term adverse effects on morbidity or growth.

Iron status in pregnant women in the Republic of Seychelles

OBJECTIVE

To establish the Fe status of pregnant women and their neonates in the Republic of Seychelles.

DESIGN

A prospective study.

SETTING

Republic of Seychelles.

SUBJECTS

Pregnant women were recruited and blood samples taken at enrolment and post-delivery along with cord blood samples. Ferritin and soluble transferrin receptor (sTfR) were measured in maternal (n 220) and cord blood (n 123) samples.

RESULTS

Maternal Fe deficiency (ferritin < 15 ng/ml, sTfR > 28 nmol/l) was present in 6 % of subjects at enrolment and in 20 % at delivery. There was no significant decrease in maternal ferritin. A significant increase in sTfR was observed between enrolment and delivery (P < 0.001). Maternal BMI and use of Fe supplements at 28 weeks' gestation were associated with improved maternal Fe status at delivery, whereas parity had a negative effect on sTfR and ferritin at delivery.

CONCLUSIONS

Fe status of pregnant Seychellois women was, on average, within normal ranges. The incidence of Fe deficiency throughout pregnancy in this population was similar to that in a Westernised population. Increased awareness of the importance of adequate Fe intake during pregnancy, particularly in multiparous women, is warranted.

Iron therapy for preterm infants

Preterm infants are at risk for both iron deficiency and iron overload. The role of iron in multiple organ functions suggests that iron supplementation is essential for the preterm infant. Conversely, the potential for iron overload and the poorly developed antioxidant measures in the preterm infant argue against indiscriminate iron supplementation in this population. This article reviews the predisposing factors and consequences of iron deficiency and iron overload in the preterm infant, discusses the current recommendation for iron supplementation and its appropriateness, and describes potential management strategies that strike a balance between iron deficiency and iron toxicity.

Relationship between the iron status of pregnant women and their newborns

OBJECTIVE: To determine the relationship between iron nutritional status of pregnant women and their newborns using a combination of hematological and biochemical parameters for the diagnosis of iron deficiency. METHODS: A cross-sectional study was conducted in Jundiaí, Southeastern Brazil, in 2000. Venous blood samples collected from 95 pregnant women and from their umbilical cord and used for the determination of complete blood count, serum iron, total iron-binding capacity, serum ferritin, zinc protoporphyrin, and transferrin saturation. Women were classified into three groups: anemic, iron deficient and non-iron deficient. Statistical analysis included the Tukey-HSD test, Pearson's correlation coefficient and multiple linear regression analysis. RESULTS: Among pregnant women, 19% were anemic (97.9% mildly anemic and 2.1% moderately anemic) and 30.5% were iron deficient. No significant difference was seen in mean values of any parameter studied between newborns in the three groups (p>0.05). Multiple linear regression analysis showed weak association between neonatal and maternal parameters. CONCLUSIONS: The iron nutritional status of pregnant women with iron deficiency or mild anemia does not seem to have a significant impact on the iron levels of their children.

Iron in fetal and neonatal nutrition

Both iron deficiency and iron excess during the fetal and neonatal period bode poorly for developing organ systems. Maternal conditions such as iron deficiency, diabetes mellitus, hypertension and smoking, and preterm birth are the common causes of perinatal iron deficiency. Long-term neurodevelopmental impairments and predisposition to future iron deficiency that are prevalent in infants with perinatal iron deficiency require early diagnosis, optimal treatment and adequate follow-up of infants at risk for the condition. However, due to the potential for oxidant-mediated tissue injury, iron overload should be avoided in the perinatal period, especially in preterm infants.

A double-blind randomized controlled trial of antenatal mebendazole to reduce low birthweight in a hookworm-endemic area of Peru

OBJECTIVE

To assess the effect on birthweight of antenatal mebendazole plus iron vs. placebo plus iron in a highly hookworm-endemic area.

METHODS

Double-blind, randomized controlled trial set in rural and peri-urban communities in the Peruvian Amazon region. A total of 1042 second trimester pregnant women between the ages of 18 and 44 years were recruited from April to November 2003, and followed to July 2004. Women were randomly assigned to receive either mebendazole (500 mg single dose) plus iron supplements (60 mg elemental iron daily) or placebo plus iron supplements. The primary outcome was mean infant birthweight and secondary measures included proportion of low birthweight babies and maternal anaemia.

RESULTS

The prevalence of hookworm infection was 47.5%. There were no differences between intervention groups in mean birthweight (3104 g vs. 3090 g, P = 0.629), proportion of low birthweight (<2500 g; 8.1%vs. 8.7%, P = 0.755) or maternal anaemia in the third trimester [33.0% (158/479) vs. 32.3% (152/471), P = 0.815]. However, the proportion of very low birthweight (<1500 g) was significantly lower in the mebendazole group [0% (0/479) vs. 1.5% (7/471), P = 0.007].

CONCLUSIONS

This trial provides additional evidence for the use of anthelmintics, over and above iron supplementation, within antenatal care programmes in hookworm-endemic areas. Benefits of de-worming may be higher in countries not having an antenatal iron supplementation programme or where intensity of hookworm infections is higher.

Anemia, iron deficiency, and iron deficiency anemia in 12-36-mo-old children from low-income families

BACKGROUND

Iron deficiency (ID) is the most common nutritional deficiency in the world and remains relatively common in at-risk groups in the United States. The actual prevalence of anemia, ID, and iron deficiency anemia (IDA) in California remains unclear.

OBJECTIVE

The objective was to determine the prevalence of anemia, low iron stores, ID, and IDA in children participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) population, and to assess the value of using hemoglobin to predict ID.

DESIGN

This was a cross-sectional study of a convenience sample of 12-36-mo-old children from WIC clinics in 2 California counties.

RESULTS

The prevalence of anemia was 11.1% (hemoglobin <110 g/L at 12-24 mo or <111 g/L at 24-36 mo). Study- and literature-determined abnormal values for iron measures were as follows: serum ferritin <or=8.7 or <10.0 microg/L, serum transferrin receptor >or=8.4 or >10.0 microg/mL, and transferrin saturation <or=13.2% or <10.0%, respectively. The prevalences of low iron stores (low ferritin) were 24.8% and 29.0%, of ID (>or=2 abnormal iron measures) were 16.2% and 8.8%, and of IDA (ID with low hemoglobin) were 3.4% and 3.2% on the basis of study- and literature-determined cutoffs, respectively. Hemoglobin concentration was used to predict study- and literature-determined ID on the basis of receiver operating characteristic curves. The sensitivity of low hemoglobin in predicting study- and literature-determined ID was low (23.2% and 40.0%, respectively).

CONCLUSIONS

Anemia and ID were prevalent in this WIC sample, but IDA was uncommon. Low hemoglobin is a poor predictor of ID.

[Variations in serum ferritin and erythrocyte index in the first eight weeks of life in term newborn infants]

OBJECTIVE

To describe changes in erythrocyte index during the first 8 weeks of life in neonates in relation to their iron store.

MATERIAL AND METHODS

We performed a longitudinal study of a group of healthy term newborn infants, in whom we evaluated erythrocyte index and serum ferritin (SF) values at birth and at weeks 4 and 8 of age. Depending on the comparison made in SF values between birth and 2 months, the infants were divided into two groups: group I (without variation in SF) and group II (with a decrease in SF).

RESULTS

A total of 110 neonates were included, with 46 neonates in group I and 64 in group II. No differences in demographic or hematologic data were found, including neonates with anemia or a decrease in hemoglobin values (5.2 vs. 5.5 g/dL). SF decreased to lower values in group II than in group I (215 vs. 194 microg/L, p < 0.001), with a greater number of neonates with low iron stores at 2 months of age (0.15 vs. 0.37, p < 0.01; RR 2.464, 95 % CI: 1.162-5.227).

CONCLUSIONS

In healthy term newborn infants, erythrocyte index at birth showed no relation with iron store. SF values at 2 months of age depended on SF concentrations at birth. Decreased hemoglobin and SF values are part of physiological adaptation in the first few months of life.

Haematological effect of iron supplementation in breast fed term low birth weight infants

AIMS

To determine the haematological effects of iron supplementation in predominantly breast fed term low birth weight (LBW) infants.

METHODS

Seventy three healthy term LBW (<2500 g), predominantly breast fed infants aged 50-80 days were randomised into two groups to receive either iron (3 mg/kg/day) (iron supplemented (IS) group; n = 37) or placebo drops (placebo (P) group; n = 36). Haematological parameters and anthropometry were measured at baseline and repeated after four and eight weeks.

RESULTS

A total of 62 subjects (32 in the IS group and 30 in the P group) came for the first follow up and 26 (13 in the IS group and 13 in the P group) reported for the second visit. There were no significant differences in serum ferritin and anthropometry. However, covariates (infant age, haemoglobin, and ferritin, and maternal haemoglobin) adjusted haemoglobin change was significantly higher in the IS group after four weeks (4.6 g/l; 95% CI 0.5 to 8.8) and eight weeks (8.6 g/l; 95% CI 1.8 to 15.4).

CONCLUSIONS

Iron supplementation in a therapeutic dose in term breast fed LBW infants results in a marginal increase in haemoglobin. The functional benefit of this haemoglobin rise requires further evaluation.

Neurodevelopmental outcome at 8 months and 4 years among infants born full-term small-for-gestational-age

OBJECTIVES

To examine the association between intrauterine growth restriction and neurodevelopmental outcome among full-term small-for-gestational-age (SGAT) infants at 8 months and 4 years of age.

STUDY DESIGN

Growth parameters at birth and test scores on measures of neurodevelopmental function for 3922 children born SGAT were compared with those of 29,369 children born appropriately grown-for-gestational-age term from similar economic backgrounds. Additional within-SGAT/economic group comparisons were made for 1684 SGAT infants with symmetric undergrowth at birth and 2034 SGAT infants with asymmetric undergrowth at birth.

RESULTS

Regardless of socioeconomic background, infants born SGAT were found to be at significantly increased risk for neurodevelopmental difficulties at 8 months and at 4 years of age. Few within SGAT/socioeconomic group differences in neurodevelopmental outcome appeared to be associated with specific pattern of growth restriction at birth.

CONCLUSIONS

The present findings provide further evidence of the individual and public health impact of SGAT birth.

Predicting iron status in low birthweight infants

OBJECTIVE

To determine the iron status of a selected group of low birthweight infants at approximately 9 months of age, and examine the feasibility of predicting iron status by examining the history of supplementary iron intake.

METHODS

All live low birthweight infants recorded in the Dunedin Hospital Queen Mary Maternity Unit birth register who reached 9 months of age between November 1995 and September 1996 were eligible to participate. Infants were categorized into 'high' or 'low' iron intake groups depending on their consumption of infant formula or medicinal iron for one month prior to the study, and their iron status compared.

RESULTS

Eighty-one infants of 73 mothers, with an average age of 10 months (range 8-13 months), participated. Thirty-three per cent (n = 27) were iron deficient: 19% (n = 15) had latent iron deficiency and 15% (n = 12) had iron deficiency anaemia. Those with a 'low' iron intake were 13-fold more likely to be iron deficient than infants with a 'high' iron intake (95% confidence interval: 4.4-41.5). Screening for iron deficiency using categories based on supplementary iron intake had a positive predictive value of 66% and a negative predictive value of 88%.

CONCLUSIONS

The risk of iron deficiency was considerably greater for infants who had not received supplementary iron daily over the course of the previous month. Current preventative methods for avoiding poor iron status in this group of high risk infants are not effective. Screening for iron deficiency in low birthweight infants on the basis of iron intake from infant formula or medicinal iron provides a useful method for identifying infants whose iron status should be investigated.

Zinc protoporphyrin/heme as an indicator of iron status in NICU patients

OBJECTIVE

Zinc protoporphyrin/heme ratio (ZnPP/H) has been well established as an indicator of functional iron deficiency in subjects 6 months of age to adult. The primary objective of this study was to establish normative values for ZnPP/H in NICU patients and secondarily to explore the utility of this test as an indicator of iron deficiency in neonates. Study design ZnPP/H and complete blood counts were obtained weekly on consecutive NICU patients. Gestational age, growth variables, iron supplementation, erythropoietin treatment, and blood transfusions were documented. Results are reported as mean +/- SD. A value of P <.05 was considered significant.

RESULTS

ZnPP/H ratios (n = 639) were evaluated from 143 infants. During the first week of life, ZnPP/H was inversely correlated with gestational age (n = 78, P <.001, r = -0.72). Maternal diabetes, growth retardation, and exposure to chorioamnionitis were independent risk factors for high ZnPP/H. Both iron supplementation and blood transfusion decreased ZnPP/H (P <.001). Erythropoietin treatment was associated with an increase in reticulocyte count and ZnPP/H (P <.001).

CONCLUSIONS

ZnPP/H is inversely correlated with gestational age, and the range in all newborn infants is higher than in adults. ZnPP/H is elevated in certain infant subpopulations, which suggests that they may require additional iron supplementation.

Determinação dos valores hematológicos e das concentrações séricas de ferro e ferritina em sangue de cordão umbilical de recém-nascidos de termo e pré-termo no Hospital Israelita Albert Einstein de São Paulo

Determinaram-se os valores hematológicos (Hb, Ht, VCM, HCM, CHCM, reticulócitos) e as concentrações séricas de ferro e ferritina no sangue de cordão umbilical de recém-nascidos (RN) no Hospital Albert Einstein. A amostra continha 32 RN de termo (T) e 30 RN pré-termo (PT). Os RN apresentavam-se clinicamente sadios, sendo excluídos os que apresentaram intercorrências clínicas ou no momento do parto. O sangue foi colhido por punção da veia umbilical até 5 minutos após a dequitação e encaminhado ao laboratório de patologia clínica para processamento laboratorial. Os valores hematológicos encontram-se mais elevados no grupo de RNT em relação ao grupo de RNPT (p<0,05). Ajustando-se um modelo de regressão logística múltipla, o Ht tem valor preditivo para a prematuridade, observando-se uma relação inversamente proporcional entre o valor do Ht e a idade gestacional.

Venous and arterial hematologic profiles of very low birth weight infants. European Multicenter rhEPO Study Group

OBJECTIVE

In very low birth weight (VLBW) infants, diagnostic and therapeutic decisions depend on hematologic values. As few data are available, we studied the course during the first 6 weeks of life.

DESIGN

Four prospective longitudinal cohort studies were retrospectively combined assessing hematologic profiles of 562 VLBW infants. For characterization of red blood cells and iron, infants receiving erythropoietin were excluded. For characterization of white blood cells and platelets, infants receiving antibiotics were excluded.

RESULTS

The third (3rd)/median/97th percentiles on day 3 were as follows: hemoglobin: 11.0/15.6/19.8 g/dL; hematocrit: 35/47/60%; red blood cells: 3.2/4.2/5.3 x 10(12)/L; reticulocytes:. 6/7.1/27.8%; platelets: 58/203/430 x 10(9)/L; white blood cells: 3. 6/9.5/38.3 x 10(9)/L; neutrophils:.7/4.7/25.3 x 10(9)/L; ferritin: 27/140/504 ng/mL; iron:.8/7.5/26.7 micromol/L; transferrin saturation: 2.6/22.7/79.8%. Transferrin saturation was <24% in 51%, ferritin concentration <100 ng/mL in 32%, and platelets <150 x 10(9)/L in 29% of this population. The steady decrease of red cell parameters was mitigated by transfusions. Neutrophils decreased steadily, and were <1.75 x 10(9)/L in 35% at 6 weeks.

CONCLUSIONS

Iron indices and platelet counts on day 3 and neutrophil counts at 2 to 6 weeks of age are lower than previously assumed in VLBW infants and lower than in larger prematures.

[Erythrocyte indices and iron stores in cord blood]

BACKGROUND

Reevaluation of normal red cell values in the cord blood is necessary since these values were established before the use of automated analysers and the introduction of iron supplementation during pregnancy.

POPULATION AND METHODS

Cord blood samples from all healthy babies from Monday to Friday for 2 months have been analysed for red cell count and red cell indices, hemoglobin concentration, hemoglobin electrophoresis, serum and erythrocyte ferritin concentration. The results were compared for the mothers to age, parity and duration of iron supplementation and for the neonates to gestational age and birth weight.

RESULTS

One hundred and fifty-nine neonates were studied; 87% of their 154 mothers had been given iron during pregnancy. Mean red cell indices were found to be slightly below those of previous reports in the literature. They were associated with mean ferritin concentrations of 135 micrograms/l and 348 ag/cell for plasma and erythrocytic ferritin, respectively.

CONCLUSION

There were no correlations between red cell indices and ferritin values in such an iron-repleted population.

Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery

Doppler ultrasound provides a non invasive method to assess fetal haemodynamics. We looked at the outcome of doppler velocimetry of the umbilical artery in three groups of pregnancies: those with positive end diastolic velocities (PED; n = 214), absent end diastolic velocities (AED; n = 178) and reversed end diastolic velocities (RED; n = 67). We collected our data from 9 European centers. Logistic regression showed that compared with pregnancies with hypertension only, pregnancies complicated by intra uterine growth retardation (IUGR) had a higher risk of developing absent or reversed end diastolic velocity waveforms (ARED) flow. ARED flow in the umbilical artery (odds ratio: OR = 3.1). Pregnancies complicated by both IUGR and hypertension had an even higher risk (OR = 7.4). Maternal age and smoking habits did not influence the risk of developing ARED flow. The overall perinatal mortality rate was 28%. Significantly more neonates in the ARED flow group needed admittance to the neonatal intensive care unit (PED group 60%, AED group 96%, RED group 98%). The OR for perinatal mortality in pregnancies complicated by AED flow was 4.0 and in RED flow was 10.6, compared with PED flow, even after adjustment for menstrual age. ARED flow in the umbilical artery did not influence the risk of respiratory distress syndrome or necrotising enterocolitis of the neonate, but ARED flow significantly influenced the risk of cerebral haemorrhage, anaemia, or hypoglycaemia. We advise that pregnancies complicated by IUGR and/or hypertension should be followed up with doppler velocimetry to trace utero-placental problems as early as possible. A caesarean section is recommended in all pregnancies complicated by ARED flow if the gestational age and predicted neonatal weight can be handled by the local neonatal intensive care unit.

Intervenções nutricionais na anemia ferropriva

O objetivo deste estudo de revisão bibliográfica é fornecer subsídios para o planejamento e avaliação de medidas de combate à anemia ferropriva. A necessidade de intervenções para o controle da prevalência da anemia ferropriva deve ser determinada pela magnitude da defi ciência nutricional e pelo conhecimento de seus efeitos na qualidade de vida, morbidade e mortalidade. A abordagem mais usual é fornecer ferro suplementar a gestantes, nutrizes e lactentes em programas de assistência primária à saúde, reconhecidamente os grupos de maior vulnerabilidade. A fortificação de alimentos e orientações sobre modificações da dieta representam medidas complementares e devem ser incrementadas.