Anemia and Iron Dosing Supplementation Using Reticulocyte-Hemoglobin (Ret-He) in the NICU

Abstract

Abstract Preterm infants are at high risk for iron-deficiency anemia necessitating treatment with a blood transfusion. Research regarding iron utilization and blood transfusions in the NICU has centered on the incidence, physiology, effects, and prevention of anemia in high-risks neonates and the potential to improve neurodevelopmental outcomes. Predictors of blood transfusion in the premature and very or extremely low birth weight infant include gestational age, initial hemoglobin level, phlebotomy losses and low endogenous erythropoietin. Enteral supplementation with iron is the standard of care. Several studies have addressed the ideal iron supplementation dosing for preterm infants comparing 2 to 4mg/kg/day of enteral iron until 8 weeks postnatal age. Higher iron dosing has been utilized in trials using erythropoietin supplementation. Ret-Hemoglobin (Ret-He) has emerged as a marker for iron sufficiency in preterm infants. With supplementation, there appears to be improved iron storage, less anemia, and a potential positive effect on neurodevelopment.