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

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.

KEYWORDS

Preterm infants - iron supplementation - morbidities associated with prematurity - iron polymaltose complex

REFERENCES

• 1 Roth P. Anemia in preterm infants.  Pediatr Rev. 1996;  17 370
• 2 American Academy of Pediatrics Committee on Nutrition . Nutritional needs of low-birth-weight infants.  Pediatrics. 1985;  75 976-986
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 17 Buonocore G, Perrone S, Bracci R. Free radicals and brain damage in the newborn.  Biol Neonate. 2001;  79 180-186
• 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
• 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