The dosage and optimal time to begin supplemental iron in preterm infants is controversial. Some authors recommend earlier and larger doses in ELBW infants than the recommendations by the AAP of 2- 3 mg/kg/ day from 2 months of age. To test the hypothesis that ELBW infants who receive multiple blood transfusions accumulate adequate iron stores and do not need iron supplementation in the first 16 weeks (wks) of life,the iron status of ELBW infants fed only low iron containing milk with no supplemental iron was prospectively evaluated. We measured serum ferritin, transferrin saturation and transferrin receptor (TfR) levels every 2 wks from 2 to 16wks of age. S.TfR is a truncated form of tissue transferrin receptor that plays a critical role in iron transport.Unlike ferritin, TfR is unaffected by acute inflammation. Iron deficiency was defined as ferritin <16 ng/mL, transferrin saturation <10%, and TfR >8.5μg/mL. Iatrogenic blood losses and transfusions were monitored. Preliminary data on 36 infants is shown. The mean (± s.d.) birth weight was 0.796(± 0.164) kg and gestational age was 26.3(± 1.87) wks. The volume of packed red cells(PRBC) transfused was significantly greater than the volume of blood lost at 4, 6, 8, 10, 14 and 16 wks of age (p<0.05). Multiple regression analysis revealed an inverse correlation between TfR and ferritin levels from 6 to 12 wks of age (p=0.005), and a positive correlation between ferritin levels and PRBC transfusions only at 8 wks of age (p=0.0017). The high ferritin with normal TfR levels indicate that multiply transfused ELBW infants are iron replete up to 16 wks. Iron supplementation in ELBW infants should be individualized. Figures in parenthesis in the table represent standard errors.

Table 1
Full size table