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IWK researchers first to look at addressing iron deficiency in preterm infants

Mother's hand holds preemie baby's foot

A study out of the IWK shows that iron deficiency is common in preterm infants despite early iron supplementation. Researchers hope that by addressing iron deficiency, they can improve the neurodevelopmental outcomes of preterm infants

Iron status of very preterm infants during first year of life has not been looked at before. The first of its kind study “Postdischarge Iron Status in Very Preterm Infants Receiving Prophylactic Iron Supplementation after Birth” was recently published in The Journal of Pediatrics.

“In our endeavour to improve the neurodevelopmental outcomes of preterm infants, prevention of iron deficiency is a critical step,” says Dr. Satvinder Ghotra, IWK neonatologist and Medical Director of Perinatal Follow-Up Program of Nova Scotia “That’s why all of our preterm infants are started on prophylactic iron supplements after birth. It is surprising to see that despite this, one-third of our preterm infants develop iron deficiency before six months of life.”

Iron is an essential nutrient required for the growth and development of the central nervous system. Iron deficiency is the most common micronutrient deficiency worldwide and is recognized as a public health problem in Canadian infants and young children.

“The American Academy of Pediatrics suggests routine testing for anemia around one year of age in preterm infants,” says Ghotra. “However, there are no recommendations on checking iron stores. High incidence of iron deficiency noted in our population elicits the need to establish protocols for monitoring of iron stores in high-risk preterm infants.”

“This study clearly demonstrates that iron deficiency is common in Nova Scotia and a significant issue in very preterm infants despite early prophylactic iron supplementation,” says Lisa Morrison, Clinical Dietitian, IWK Perinatal Follow-Up Program. “Too often health care providers stop iron once infants are drinking formula or starting solids. It is my hope health care providers within Nova Scotia will strive to eliminate iron deficiency by meeting iron supplementation recommendations and adjusting iron doses as infants grow during the first year of life.”  

Preterm infants are at high risk of developing iron deficiency due to lower iron stores at birth, rapid post-natal growth, frequent blood sampling and inadequate iron intake.

"This research highlights the importance of monitoring iron stores in this vulnerable patient population,” says Carmen Landry, first year Family Medicine Resident at Dalhousie University. “My hope is that it will improve outcomes for preterm infants and help them reach their full potential."

If not recognised and treated iron deficiency can progress to anemia, which affects the cognitive, motor, and socioemotional growth. Even iron deficiency alone adversely affects the neurodevelopmental outcomes of growing infants. Iron deficiency in infancy may lead to permanent neurodevelopmental impairment.

“The good news is that both iron deficiency and anemia are preventable.,” says Ghotra. “Our group has developed a question and answer based educational resource on prevention and management of iron deficiency in preterm infants for practitioners in the Maritimes. I strongly urge practitioners to use this guide.”

The resource, Expert Consensus Statement on Prevention and Management of Iron Deficiency in Preterm Infants for Practitioners in the Maritimes, is available here as well as through the Reproductive Care Program of Nova Scotia and Atlantic Pediatric Hematology Network.

This study was supported by an IWK project grant and a Dalhousie Faculty of Medicine Gladys Osman Estate studentship and travel award.