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

Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada

Wayne L. Andrews, MD

Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada

Michael S. Hall, MD

Merlee S. Rodway, RN

Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada, Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada

Mary Keith, MSc

Ursula C. McCloy, MSc

Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada, Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada

J. Derek Matthew, MD

Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada

David R. Long, MD

Departments of Pediatrics and Biochemistry, Memorial University of Newfoundland, St. John's, Canada

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)

Journal of Parenteral and Enteral Nutrition, Vol. 19, No. 2, 114-118 (1995)
DOI: 10.1177/0148607195019002114


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