Hematological and iron content evolution in exclusively breastfed late-preterm newborns

Abstract

OBJECTIVES:To analyze and compare the evolution of hematological parameters and body iron content between exclusively breastfed late-preterm and term newborns during the first two months of life.METHODS:Cohort study. Weight, length, head circumference, body mass index, hemoglobin, hematocrit, reticulocytes, total iron-binding capacity, transferrin saturation, serum iron and ferritin were measured in 25 late-preterm and 21 term newborns (at birth and at one and two months of age) who were exclusively breastfed. Statistical analysis: Kolmogorov-Smirnov test, one-way ANOVA or Kruskal-Wallis test; and Student's t-test or Mann-Whitney test. Significance: p<0.05.RESULTS:The corrected gestational ages of the late-preterm infants were 39.98 weeks at one month of life and 44.53 weeks at two months. Anthropometric measures and the body mass index increased over time (p<0.001) and hemoglobin, hematocrit, reticulocytes and body iron content decreased (p<0.001). Late-preterm infants at term corrected gestational age had reduced hemoglobin, hematocrit and reticulocyte concentrations, and reduced total iron-binding capacity (p<0.001) and serum iron (p = 0.0034) compared with values observed in term newborns at birth. Late-preterm newborns at a corrected gestational age of one month post-term had hemoglobin (p = 0.0002), hematocrit (p = 0.0008), iron (p<0.0001) and transferrin saturation (p<0.001) levels lower than those of term newborns at one month of age and a higher total iron-binding capacity (p = 0.0018). Ferritin did not differ between the groups.CONCLUSION:Exclusively breastfed late-preterm newborns presented greater reductions in hemoglobin/hematocrit and lower iron stores at a corrected gestational age of one month post-term than did term newborns, suggesting specific iron supplementation needs.

Variation in hemoglobin across the life cycle and between males and females

“…Studies of over 40,000 term and preterm infants in the United States have shown that mean Hb decreases from about 180 g/L at birth to ∼120−130 g/L at 1 month, and then to just over 110 g/L at 3 months . Similar decreases in mean Hb have been seen among Brazilian infants ( n = 46), from 160 g/L at birth to 120 g/L at 1 month to 110 g/L at 2 months . Among infants in the Gambia ( n = 675), Hb declined significantly with increasing age from 2 to 10 months (estimated 2.5th and 97.5th percentiles for infants 2−5 months: 90−127 g/L for males and 93−129 g/L for females; and 6−10 months: 82−123 g/L for males and 86−126 g/L for females) .…”

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

“…Micronutrient stores in preemies are rapidly depleted in the first weeks after birth, and their fast growth rate is associated with higher micronutrient requirements 7 , 30 , 31 . Yamada et al 32 compared late preemies with term infants and found lower Hb levels and iron stores in preemies one month after birth, which reinforces the need for iron supplementation in this population. Fares et al 33 found a high incidence of vitamin A deficiency (75.9%) in very low birth weight preemies.…”

ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34–36 6/7 Weeks of Gestation) and Early Term Infants (37–38 6/7 Weeks of Gestation), Second Revision 2016

“…48 c. Breastfed late preterm infants are at increased risk for iron deficiency and iron deficiency anemia compared with term infants, and routine iron supplementation is recommended. [54][55][56] (lV, lll, and lB) d. Late preterm infants are also more likely to sleep in unsafe situations as compared with term infants, 57 thus adding to the established increased risk of sudden infant death syndrome (SIDS) in preterm infants. Therefore, regular inquiry into sleep position and location is also warranted.…”