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Background Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, repeated phlebotomy, and the body’s increased demand for iron during growth. The risk of ID increases at 2 months of age, when hemoglobin (Hb) levels start to decrease. Adequacy of body iron level is assessed by ferritin, serum iron (SI), transferrin saturation (Tfsat), total iron-binding capacity (TIBC), and Hb measurements.
Objective To describe iron profiles in preterm infants at 2 months of chronological age (CA).
Methods This cross-sectional study was conducted in 2-month-old infants, born at 32-36 weeks of gestational age, and who visited the Growth and Development Clinics at Cipto Mangunkusumo, Fatmawati, or Budi Kemuliaan Hospitals. Parental interviews and medical record reviews were done during the clinic visits. Complete blood count, blood smear, SI, TIBC, Tfsat, and ferritin level tests were performed.
Results Eighty-three subjects were enrolled in this study. Most subjects were male (51%) and born to mothers >20 years of age (93%). Subjects’ birth weights ranged from 1,180 g to 2,550 g. The prevalence of iron deficiency anemia (IDA) was 6% and that of ID was 10%. The lowest Hb level found in IDA infants was 6.8 g/dL, while the lowest ferritin level was 8.6 ng/mL. Median values for the other tests were as follows: SI 48 µg/dL, TIBC 329µg/dL, and Tfsat 17%. Subjects with IDA were all male (5/5), mostly achieved more than twice their birth weight (4/5), were non-iron supplemented (3/5), born to mothers with low educational background (3/5), and of low socioeconomic status (3/5).
Conclusion The prevalence of IDA is 6% and that of ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat, and low ferritin level. Most of the all-male IDA subjects weigh more than twice their birth weight, are non-iron supplemented, and born to mothers with low educational background and low socioeconomic status.
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2. Blencowe H, Cousens S, Oestergaard M, Chou D, Moller A, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162–72.
3. Armony-Sivan R, Eidelman AI, Lanir A, Sredni D, Yehuda S. Iron status and neurobehavioral development of premature infants. J Perinatol. 2004;24(12):757–62.
4. JA W. Pathophysiology of anemia during the neonatal period, including anemia of prematurity. Neoreviews. 2008;9:e520-5.
5. Hammond D, Murphy A. The influence of exogenous iron on formation of hemoglobin in the premature infant. Pediatrics. 1960;25:362–74.
6. Chaparro CM. Setting the stage for child health and development: prevention of iron deficiency in early infancy. J Nutr. 2008;138:2529–33.
7. Berglund S, Westrup B, Domellof M. Iron supplements reduce the risk of iron deficiency anemia in marginally low birth weight infants. Pediatrics. 2010;126:e874-83.
8. Ferri C, Procianoy RS, Silveira RC. Prevalence and risk factors for iron-deficiency anemia in very-low-birth-weight preterm infants at 1 year of corrected age. J Trop Pediatr. 2014;60:53–60.
9. Özdemir H, Akman I, Demirel U, Coşkun Ş, Bilgen H, Özek E. Iron deficiency anemia in late-preterm infants. Turk J Pediatr. 2013;55:500–5.
10. Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001;107:1381–6.
11. Lozoff B, Andraca I De, Castillo M, Smith JB, Walter T, Pino P. Anemia in Healthy Full-Term Infants. Pediatrics. 2003;112:846–54.
12. Sekartini R, Soedjatmiko, Wawolumaya C, Yuniar I, Dewi R, Nycane, et al. Prevalensi Anemia Defisiensi Besi pada Bayi Usia 4 – 12 Bulan di Kecamatan Matraman dan Sekitarnya, Jakarta Timur. Sari Pediatr. 2005;1:2–8.
13. Siddappa A, Rao R, Long J, Widness J, Georgieff M. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations. Neonatology. 2007;92:73–82.
14. Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126:1040–50.
15. World Health Organization. Iron Deficiency Anaemia: Assessment, Prevention and Control, A guide for program managers. Geneva:WHO; 2001. p. 3-69.
16. Ziegler EE, Nelson SE, Jeter JM. Iron supplementation of breastfed infants. Nutr Rev. 2011;69:71–7.
17. Domellof M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M, et al. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014;58:119–29.
18. Sweet DG, Savage G a, Tubman R, Lappin TR, Halliday HL. Cord blood transferrin receptors to assess fetal iron status. Arch Dis Child Fetal Neonatal Ed. 2001;85(1):F46-8.
19. Mills RJ, Davies MW. Enteral iron supplementation in preterm and low birth weight infants. Cochrane database Syst Rev. 2012;3:CD005095.
20. Domellof M, Hernell O. Iron-deficiency anaemia during the first two years of life. Scand J Nutr. 2002;46:20–30.
21. Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan RI. Riset Kesehatan Dasar (RISKESDAS) 2013. Jakarta: Kementerian Kesehatan RI; . p. 1–384.
22. Domello M. Iron-deficiency anaemia during the first two years of life. 2002;46:20–30.
23. Rao R, Georgieff M. Iron therapy for preterm infants. Clin Perinatol. 2009;36:27–42.
24. Windiastuti E. Klasifikasi anemia pada anak dan bayi. In: Abdulsalam M, Trihono P, Kaswandan N, Endyarn B, editors. Pendekatan praktis pucat: masalah kesehatan yang terabaikan pada bayi dan anak. Jakarta: Departemen Ilmu Kesehatan Anak FKUI RSCM; 2007. p. 4–9.
25. World Health Organization. Assessing the iron status of populations: including literature reviews: report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level. Geneva: WHO; 2007.p 3-108.
26. Center of Diasease Control. Recommendations to prevent and control iron deficiency in the United States. MMWR. 1998;47:1–36.
27. Lundström U. Iron deficiency anaemia. Gut. 1994;35:864–5.
28. Kazal L. Prevention of iron deficiency in infants and toddlers. Am Fam Physician. 2002;66:1217–24.
29. Long H, Yi JM, Hu PL, Li ZB, Qiu WY, Wang F, et al. Benefits of iron supplementation for low birth weight infants: a systematic review. BMC Pediatr. 2012;12:99.
30. Torsvik IK, Markestad T, Ueland PM, Nilsen R, Midttun O, Bjørke Monsen A-L. Evaluating iron status and the risk of anemia in young infants using erythrocyte parameters. Pediatr Res [Internet]. 2013;73:214–20.
31. Yang Z, Lönnerdal B, Adu-Afarwuah S, Brown KH, Chaparro CM, Cohen RJ, et al. Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: Comparison of data from 6 studies. Am J Clin Nutr. 2009;89:1433–40.
32. Mukhopadhyay K, Yadav RK, Kishore SS, Garewal G, Jain V, Narang A. Iron status at birth and at 4 weeks in preterm-SGA infants in comparison with preterm and term-AGA infants. J Matern Neonatal Med. 2012;25:1474–8.
33. Ziaei S, Hatefnia E, Togeh G. Iron Status in Newborns Born to Iron-Deficient Mothers. Iran J Med Sci. 2003;28:62–4.