Intravenous iron administration to very-low-birth-weight newborns receiving total and partial parenteral nutrition

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 19; no. 2; p. 114
• Main Authors: Friel, J K, Andrews, W L, Hall, M S, Rodway, M S, Keith, M, McCloy, U C, Matthew, J D, Long, D R
• Format: Journal Article
• Language: English
• Published: United States 01.03.1995
• Subjects: Anthropometry; Food, Fortified; Humans; Infant, Low Birth Weight - metabolism; Infant, Newborn; Infusions, Intravenous; Iron - administration & dosage; Parenteral Nutrition - methods; Parenteral Nutrition - standards
• ISSN: 0148-6071
• DOI: 10.1177/0148607195019002114

Intravenous iron supplements are not routinely administered to very-low-birth-weight newborns receiving total parenteral nutrition because of the possible increased risk of infection and because iron needs may be met with blood transfusions. To assess the benefits of a prudent IV iron supplement (200 to 250 micrograms/kg/d), 26 very-low-birth-weight newborns (birth weight, 1005 +/- 302 g; gestational age, 28 +/- 2.3 weeks; mean +/- SD) were randomly allocated to receive total parenteral nutrition without iron (No-Iron) or with iron supplied as iron dextran (Iron). These newborns were followed at baseline (2 to 3 days after birth) and at weeks 1 to 4 thereafter. At each sampling time, urine samples, fecal samples (rarely), unused total parenteral nutrition solutions, blood products, and a blood sample (1 mL) were collected. There were no differences between the two groups in anthropometric measurements, hematologic or biochemical parameters, number or amount of blood transfusions (2.3 +/- 1.9), amount of blood removed for diagnostic purposes (44 +/- 16 mL), or number of septic events (n = 16). There was no difference between the groups for the total iron excreted; however, the Iron group retained more iron. Iron balance was negative for all but 10 newborns (No-Iron, 3; Iron, 7) throughout the study. 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.