Intravenous Iron Administration to Very‐Low‐Birth‐Weight Newborns Receiving Total and Partial Parenteral Nutrition

Abstract

A total iron intake of 400 micrograms/kg/d, half of which was provided by IV iron, is not sufficient to maintain iron balance or to meet fetal accretion rates (1000 micrograms/kg/d) in very-low-birth-weight newborns receiving total parenteral nutrition. Furthermore, endogenous iron from blood transfusions does not provide an adequate supply of iron.

Randomized Trial of Early Versus Late Enteral Iron Supplementation in Infants With a Birth Weight of Less Than 1301 Grams: Neurocognitive Development at 5.3 Years' Corrected Age

“…In fact, despite increasing iron supplementation up to 4 mg/kg per day (in formula-fed infants up to 6 mg/kg per day) as soon as the hematocrit fell below 0.30, iron deficiency occurred in ϳ15% of infants in the early-iron group during the initial randomized trial. 20 This is not surprising, considering that (1) only ϳ25% (range: 10%-50%) of enterally administered iron is absorbed, 25,42 (2) the daily needs of growing preterm infants are thought to be ϳ0.5 to 1 mg/kg per day, 43 and (3) that every milliliter of blood loss represents a loss of 0.35 to 0.5 mg of iron (assuming hemoglobin concentrations of 10 -15 g/dL). Consequently, higher doses of enteral iron supplementation may be required to meet the needs of at least some preterm infants and to optimize neurodevelopmental outcome in this vulnerable population.…”

Iron Therapy for Preterm Infants

“…The accelerated breakdown of erythrocytes may lead to excess iron accumulation [26] and a need for repeated transfusions. Each mL of transfused packed erythrocytes potentially delivers 0.5–1.0 mg of iron to the body [27,28]. Elevated serum iron and ferritin concentrations, and liver iron concentration are common after multiple transfusions in preterm infants [29–31].…”

Intravenous iron administration together with parenteral nutrition to very preterm Jehovah's Witness twins

“…Friel et al 4 administered intravenous iron dextran in parenteral nutrition solutions to very-low-birth-weight newborns in a randomised study. They found no difference between iron (200–250 μg/kg/day) and no iron in relation to infections during the 1-month study period.…”

“…Based on expert opinion from 1988, there is a recommendation of intravenous iron of 200 µg Fe/kg for infants receiving total parenteral nutrition (TPN),3 while two newer papers based on clinical trials suggest higher doses of intravenous iron of 1000 µg/kg/day for preterm infants receiving total parenteral nutrition 4 5…”