The Efficacy and Safety of Early Supplementation of Iron Polymaltose Complex in Preterm Infants

 

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ABSTRACT

The purpose of this study was to examine the efficacy and safety of early nonionic iron supplementation in preterm infants. Infants with gestational age ≤ 32 weeks who were fed enriched human milk were assigned concurrently to receive 5 mg/kg/d enteral iron polymaltose complex (IPC) at 2 or 4 weeks of age. The levels of hemoglobin, reticulocytes, serum iron, ferritin, and soluble transferrin receptor were recorded at 2, 4, and 8 weeks of age. The incidence of morbidities associated with prematurity and the need for red blood cell transfusions (RBCTs) were recorded. The 2-week group (n = 32) had a better iron status than the 4-week group (n = 36) at 4 weeks and at 8 weeks of age. The incidence of morbidities associated with prematurity was not different among the groups (p = 0.26). RBCT was required in one infants of the 2-week group and in 10 infants in the 4-week group (p = 0.045). The number needed to treat to prevent one RBCT was five. Supplementation of 5 mg/kg/d enteral IPC to preterm infants fed enriched human milk as early as 2 weeks of age was more beneficial to iron status than at 4 weeks of age, and was associated with decreased need for RBCTs and no increase in the incidence of morbidities associated with prematurity.

REFERENCES

• 1 Roth P. Anemia in preterm infants.  Pediatr Rev. 1996;  17 370
  PubMedGoogle Scholar
• 2 American Academy of Pediatrics Committee on Nutrition . Nutritional needs of low-birth-weight infants.  Pediatrics. 1985;  75 976-986
  PubMedGoogle Scholar
• 3 Franz A R, Mihatsch W A, Sander S, Kron M, Pohlandt F. Prospective randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams.  Pediatrics. 2000;  106 700-706
  CrossrefPubMedGoogle Scholar
• 4 Inder T E, Clemett R S, Austin N C, Graham P, Darlow B A. High iron status in very low birth weight infants is associated with an increased risk of retinopathy of prematurity.  J Pediatr. 1997;  131 541-544
  PubMedGoogle Scholar
• 5 Tuomainen T P, Nyyssonen K, Porkkala-Sarataho E et al.. Oral supplementation with ferrous sulfate but not with non-ionic iron polymaltose complex increase the susceptibility of plasma lipoproteins to oxidation.  Nutr Res. 1999;  19 1121-1132
  CrossrefPubMedGoogle Scholar
• 6 Franz A R, Pohlandt F. Red blood cell transfusions in very and extremely low birthweight infants under restrictive transfusion guidelines: is exogenous erythropoietin necessary?.  Arch Dis Child Fetal Neonatal Ed. 2001;  84 F96-F100
  PubMedGoogle Scholar
• 7 Jew R K, Owen D, Kaufman D, Balmer D. Osmolarity of commonly used medications and formulas in the neonatal intensive care unit.  Nutr Clin Pract. 1997;  12 158-163
  PubMedGoogle Scholar
• 8 Sweet D G, Savage G A, Tubman R, Lappin T R, Halliday H L. Cord blood transferrin receptors to assess fetal iron status.  Arch Dis Child Fetal Neonatal Ed. 2001;  85 F46-F48
  PubMedGoogle Scholar
• 9 Lundstrom U, Siimes M A, Dallman P R. At what age does iron supplementation become necessary in low-birth-weight infants?.  J Pediatr. 1977;  91 878-883
  PubMedGoogle Scholar
• 10 Hall R T, Wheeler R E, Benson J, Harris G, Rippetoe L. Feeding iron-fortified premature formula during initial hospitalization to infants less than 1800 grams birth weight.  Pediatrics. 1993;  92 409-414
  PubMedGoogle Scholar
• 11 Rao R, Georgieff M. Microminerals. In: Tsang RC, Uauy R, Koletzko B, Zlotkin S Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. 2nd ed. Cincinnati, OH; Digital Educational Publishing 2005: 271-288
  Google Scholar
• 12 Turker G, Sarper N, Gokalp A S, Usluer H. The effect of early recombinant erythropoietin and enteral iron supplementation on blood transfusion in preterm infants.  Am J Perinatol. 2005;  22 449-455
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Rudzinska I M, Kornacka M K, Pawluch R. Treatment with human recombinant erythropoietin and frequency of retinopathy of prematurity.  Przegl Lek. 2002;  59(suppl 1) 83-85
  PubMedGoogle Scholar
• 14 Ohlsson A, Aher S. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants.  Cochrane Database Syst Rev. 2006;  (19) CD004863
  PubMedGoogle Scholar
• 15 Johnson G, Jacobs P. Bioavailability and the mechanisms of intestinal absorption of iron from ferrous ascorbate and ferric polymaltose in experimental animals.  Exp Hematol. 1990;  18 1064-1069
  PubMedGoogle Scholar
• 16 Erichsen K, Ulvik R J, Grimstad T, Berstad A, Berge R K, Hausken T. Effects of ferrous sulphate and non-ionic iron-polymaltose complex on markers of oxidative tissue damage in patients with inflammatory bowel disease.  Aliment Pharmacol Ther. 2005;  22 831-838
  CrossrefPubMedGoogle Scholar
• 17 Buonocore G, Perrone S, Bracci R. Free radicals and brain damage in the newborn.  Biol Neonate. 2001;  79 180-186
  CrossrefPubMedGoogle Scholar
• 18 Kuiper-Kramer E P, Baerts W, Bakker R, van Eyck J, van Raan J, van Eijk H G. Evaluation of the iron status of the newborn by soluble transferrin receptors in serum.  Clin Chem Lab Med. 1998;  36 17-21
  CrossrefPubMedGoogle Scholar
• 19 Melhorn D K, Gross S. Vitamin E-dependent anemia in the premature infant. I. Effects of large doses of medicinal iron.  J Pediatr. 1971;  79 569-580
  PubMedGoogle Scholar

Shmuel ArnonM.D. 

Department of Neonatology, Meir Medical Center, Kfar Saba

44281, Israel