Intravenous Iron Administration to Very-Low-Birth-Weight Newborns Receiving Total and Partial Parenteral Nutrition

Abstract

Background: Intravenous iron supplements are not routinely administered to very-low-birth-weight newborns receiving total parenteral nutrition because of the possible increased risk of infection and because iron needs may be met with blood transfusions. Methods: To assess the benefits of a prudent IV iron supplement (200 to 250 μg/kg/d), 26 very-low-birth-weight newborns (birth weight, 1005 ± 302 g; gestational age, 28 ± 2.3 weeks; mean ± SD) were randomly allocated to receive total parenteral nutrition without iron (No-Iron) or with iron supplied as iron dextran (Iron). These newborns were followed at baseline (2 to 3 days after birth) and at weeks 1 to 4 thereafter. At each sampling time, urine samples, fecal samples (rarely), unused total parenteral nutrition solutions, blood products, and a blood sample (1 mL) were collected. Results: There were no differences between the two groups in anthropometric measurements, hematologic or biochemical parameters, number or amount of blood transfusions (2.3 ± 1.9), amount of blood removed for diagnostic purposes (44 ± 16 mL), or number of septic events (n = 16). There was no difference between the groups for the total iron excreted; however, the Iron group retained more iron. Iron balance was negative for all but 10 newborns (No-Iron, 3; Iron, 7) throughout the study. Conclusions: A total iron intake of 400 μg/kg/d, half of which was provided by IV iron, is not sufficient to maintain iron balance or to meet fetal accretion rates (1000 μg/kg/d) in very-low-birth-weight newborns receiving total parenteral nutrition. Furthermore, endogenous iron from blood transfusions does not provide an adequate supply of iron. (Journal of Parenteral and Enteral Nutrition 19:114-118, 1995)