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Iron status in small for gestational age and appropriate for gestational age infants at birth

  • Kim, Hyeon A (Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Park, Sook-Hyun (Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Lee, Eun Joo (Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine)
  • Received : 2018.05.12
  • Accepted : 2018.10.15
  • Published : 2019.03.15

Abstract

Purpose: This study compared the iron statuses of small for gestational age (SGA) and appropriate for gestational age (AGA) infants at birth. Methods: The clinical data of 904 newborn infants admitted to the neonatal intensive care unit were reviewed. Blood samples were drawn from the infants within 24 hours after birth. Serum ferritin level was used as a marker of total iron status. Results: In this study, 115 SGA (GA, $36.5{\pm}2.9weeks$; birth weight [BW], $1,975{\pm}594.5g$) and 717 AGA (GA, $35.1{\pm}3.5weeks$; BW, $2,420.3{\pm}768.7g$) infants were included. The SGA infants had higher hematocrit levels ($50.6%{\pm}5.8%$ vs. $47.7%{\pm}5.7%$, P<0.05) than the AGA infants. No difference in serum ferritin level (ng/mL) was found between the groups (mean [95% confidence interval]: SGA vs. AGA infants, 139.0 [70.0-237.0] vs. 141.0 [82.5-228.5]). After adjusting for gestational age, the SGA infants had lower ferritin levels (147.1 ng/mL [116.3-178.0 ng/mL] vs. 189.4 ng/mL [178.0-200.8 ng/mL], P<0.05). Total body iron stores were also lower in the SGA infants than in the AGA infants (185.6 [153.4-211.7] vs 202.2 [168.7-241.9], P<0.05). Conclusion: The SGA infants had lower ferritin and total body iron stores than the AGA infants. The SGA infants affected by maternal hypertension who were born at late preterm had an additional risk of inadequate iron store. Iron deficiency should be monitored in these infants during follow-up.

Keywords

References

  1. Zamora TG, Guiang SF 3rd, Widness JA, Georgieff MK. Iron is prioritized to red blood cells over the brain in phlebotomized anemic newborn lambs. Pediatr Res 2016;79:922-8. https://doi.org/10.1038/pr.2016.20
  2. de Deungria M, Rao R, Wobken JD, Luciana M, Nelson CA, Georgieff MK. Perinatal iron deficiency decreases cytochrome c oxidase (CytOx) activity in selected regions of neonatal rat brain. Pediatr Res 2000;48: 169-76. https://doi.org/10.1203/00006450-200008000-00009
  3. Kuzawa CW. Fetal origins of developmental plasticity: are fetal cues reliable predictors of future nutritional environments? Am J Hum Biol 2005;17:5-21. https://doi.org/10.1002/ajhb.20091
  4. Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev 2006;64(5 Pt 2):S34-43. https://doi.org/10.1301/nr.2006.may.S34-S43
  5. Radlowski EC, Johnson RW. Perinatal iron deficiency and neurocognitive development. Front Hum Neurosci 2013;7:585. https://doi.org/10.3389/fnhum.2013.00585
  6. Tamura T, Goldenberg RL, Hou J, Johnston KE, Cliver SP, Ramey SL, et al. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr 2002;140:165-70. https://doi.org/10.1067/mpd.2002.120688
  7. Rao R, Georgieff MK. Neonatal iron nutrition. Semin Neonatol 2001; 6:425-35. https://doi.org/10.1053/siny.2001.0063
  8. Strauss RG. Anaemia of prematurity: pathophysiology and treatment. Blood Rev 2010;24:221-5. https://doi.org/10.1016/j.blre.2010.08.001
  9. Sweet DG, Savage GA, Tubman R, Lappin TR, Halliday HL. Cord blood transferrin receptors to assess fetal iron status. Arch Dis Child Fetal Neonatal Ed 2001;85:F46-8. https://doi.org/10.1136/fn.85.1.F46
  10. Saha B, Jeeva Sankar M, Gupta S, Agarwal R, Gupta N, Deorari A, et al. Iron stores in term and late preterm small for gestational age and appropriate for gestational age neonates at birth and in early infancy. Indian J Pediatr 2016;83:622-7. https://doi.org/10.1007/s12098-015-1960-7
  11. Mukhopadhyay K, Yadav RK, Kishore SS, Garewal G, Jain V, Narang A. Iron status at birth and at 4 weeks in term small-for-gestation infants in comparison with appropriate-for-gestation infants. J Matern Fetal Neonatal Med 2011;24:886-90. https://doi.org/10.3109/14767058.2010.536866
  12. Lee JJ, Kim MH, Ko KO, Kim KA, Kim SM, Kim ER, et al. The study of growth measurements at different gestatioal ages of Korean newborn the survey and statistics. J Korean Soc Neonatol 2006;13:47-57.
  13. Siddappa AM, Rao R, Long JD, Widness JA, Georgieff MK. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations. Neonatology 2007;92:73-82. https://doi.org/10.1159/000100805
  14. Oski FA. Iron deficiency in infancy and childhood. N Engl J Med 1993;329:190-3. https://doi.org/10.1056/NEJM199307153290308
  15. Rao R, Georgieff MK. Iron in fetal and neonatal nutrition. Semin Fetal Neonatal Med 2007;12:54-63. https://doi.org/10.1016/j.siny.2006.10.007
  16. Sweet DG, Savage G, Tubman TR, Lappin TR, Halliday HL. Study of maternal influences on fetal iron status at term using cord blood transferrin receptors. Arch Dis Child Fetal Neonatal Ed 2001;84:F40-3. https://doi.org/10.1136/fn.84.1.F40
  17. 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. https://doi.org/10.1542/peds.2009-3624
  18. Beard J dR, Shaw M, Rao R, Georgieff M. Diagnosis of iron deficiency in infancy. Lab Med 2007;38:103-8. https://doi.org/10.1309/7KJ11RX758UKLXXM
  19. Cook JD, Skikne BS. Iron deficiency: definition and diagnosis. J Intern Med 1989;226:349-55. https://doi.org/10.1111/j.1365-2796.1989.tb01408.x
  20. Chockalingam UM, Murphy E, Ophoven JC, Weisdorf SA, Georgieff MK. Cord transferrin and ferritin values in newborn infants at risk for prenatal uteroplacental insufficiency and chronic hypoxia. J Pediatr 1987;111:283-6. https://doi.org/10.1016/S0022-3476(87)80088-4
  21. Rayman MP, Barlis J, Evans RW, Redman CW, King LJ. Abnormal iron parameters in the pregnancy syndrome preeclampsia. Am J Obstet Gynecol 2002;187:412-8. https://doi.org/10.1067/mob.2002.123895
  22. Georgieff MK, Petry CD, Mills MM, McKay H, Wobken JD. Increased N-glycosylation and reduced transferrin-binding capacity of transferrin receptor isolated from placentae of diabetic women. Placenta 1997;18:563-8. https://doi.org/10.1016/0143-4004(77)90011-X
  23. Nunes MD, Assis AM, Pinheiro SM, Medrado FE. Erythrocyte indices and serum ferritin in newborns. Rev Bras Hematol Hemoter 2010;32: 365-70. https://doi.org/10.1590/S1516-84842010000500008
  24. Teramo KA, Widness JA. Increased fetal plasma and amniotic fluid erythropoietin concentrations: markers of intrauterine hypoxia. Neonatology 2009;95:105-16. https://doi.org/10.1159/000153094
  25. Akkurt MO, Akkurt I, Altay M, Coskun B, Erkaya S, Sezik M. Maternal serum ferritin as a clinical tool at 34-36 weeks' gestation for distinguishing subgroups of fetal growth restriction. J Matern Fetal Neonatal Med 2017;30:452-6. https://doi.org/10.1080/14767058.2016.1174997
  26. McCarthy EK, Kenny LC, Hourihane JOB, Irvine AD, Murray DM, Kiely ME. Impact of maternal, antenatal and birth-associated factors on iron stores at birth: data from a prospective maternal-infant birth cohort. Eur J Clin Nutr 2017;71:782-7. https://doi.org/10.1038/ejcn.2016.255

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