Investigation Of Iron Intake And Prevention Effect Of Iron-fortified Parenteral Nutritin For Premature Infants

Extrauterine growth restriction (EUGR) is common in very pretermin fants. Theincidence in very low birth weight infants（VLBW） ranges between43%and97%invarious centers, with a wide variability due to the use of different reference growthcharts and nonstandard nutritional strategies. Growth failure in VLBW infants resultsfrom the complex interaction of many factors, including Endocrine abnormalities,central nervous system damage, difficulties in suck and swallow coordination, andadministration of drugs that affect nutrient metabolism; however, inadequate proteinand energy intake--especially during the first weeks of life disconsidered largelyresponsible for this state. First-week protein and energy intake are associated with18-monthDevelopmental outcomes in very preterm infants. Many studies have demonstrated thatmalnutrition at a vulnerable period of brain development is related to a decreasednumber of brain cells as well as deficits in behavior, learning, and memory. Nutritionstatus have been improved tipically due to widespread administration of PN forpremature infants in24h after birth, however, enteral energy intake still far less thanadequate for growth and development needs because of immaturity of digestive tract.Iron intake for preterm infants mainly comes from formula feeding, iron intake islimited in the first-week of life. About eighty percent of iron present in a healthy termneonate is accumulated during the third trimester, so compared to term births preterminfants have a lower level of total body iron and Hb concentrations. Preterm infantsare at a higher risk for ID because of rapid increase in blood volume and red bloodcell count attributed to rapid growth, a short life span of fetal erythrocytes, transitionalfailure to increase endogenous EPO in response to anemia, iatrogenic bleeding, etc.Incidence of anemia reported domestic and overseas was as high as60%-80%, andabout50%of VLBWI newborns need to receive RBC transfusion therapy in the firsttwo weeks. A multi-center study conducted in shanghai find that the incidence ofanemia in VLBWI was77%, in ELBWI was as high as92%, and16.1%infantsreceived RBC transfusion therapy. Anemia in premature infants not only affects growth and development, but also have long-term impact on the future cognition,movement, learning ability and behavioral development, and most of mental harmsnor reversible even though after iron supplementation. So it is important to provideiron supplements to prevent occur of ID or IDA. Currently, start time for ironsupplementation in preterm infants remains controversial, ranging from14days to10weeks. Enteral iron supplementation is a safe and effective method, but preterminfants prone to bloating, vomiting, bloody diarrhea, NEC bacause of immaturedigestive tract, so premature infants can’t tolerate oral or enteral iron, plus the lack ofsuitable preterm children’s oral iron preparations, thus oral iron is limited in preterminfants. Numerous clinical studies have shown that intravenous iron can effectivelyimprove the body Hb and iron storage indicators, but due to allergies, infections andother adverse reactions that may result, making its clinical application is limited. Inrecent years, multi-frequency low-dose intravenous iron is in a wide range of clinicalapplications due to its safety and effectiveness, while PN is one of the mostcommonly used therapies in preterm newborns, so iron-fortified PN with intravenousiron will be a good approach to increase iron storage for preterm infants. The purposeof this project is to investigate enteral iron and energy intake in preterm newborns bya retrospective study and to find out the efficacy and safety of iron fortified PNthrough a clinical randomized, double-blind, controlled study to provide a crediblescientific basis for clinical prevention and treatment of anemia in preterm children.1Investigation of enteral iron and energy intake inpremature newbornsObjiective: The aim of this study was to investigate the enteral iron and energyintake of premature infants within the first weeks of life and to explore the risk factorswhich associated with oral iron intake for premature infants.Methods: This was a retrospective study, medical data of enteral iron intake of208premature infants who were recruited in72hours after birth to NICU formjanuary2012to december2013of our hospital were collected. Datas for clinicalinformations, intakes of formula milk, oral iron supplementation, starte time forformula feeding, fasting or sugar water feeding days were collected and daily iron and energy intake was also calculated.Results: N=204preterm infants were analysed. Oral feeding averagely delayedto5.0±2.6d due to enteral feeding intolerance. Mean intake of iron and energy fromthe digestive tract in the1w、2w、3w、4w and discharge was0.2±0.3(0.0-2.1)mg/kg.d，13.2±14.8(0.0-94.5) kcal/kg.d;0.9±0.7(0.0-2.7) mg/kg.d，46.0±32.6(0.2-127.1) kcal/kg.d;1.2±1.0（0.0-3.2）mg/kg.d，62.2±38.1（1.3-146.1）kcal/kg.d;1.5±1.1（0.0-3.5）mg/kg.d，71.3±38.2（0.3-156.5）kcal/kg.d；2.2±1.1（0.0-3.7）mg/kg.d，105.3±32.1（0.0-168.0）kcal/kg.d, respectively, and the percentageof the recommanded iron and energy intakes was10%,11%;45%,38.3%;60%,51.8%;75%,59.4%;110%,87.8%, respectively. the smaller the BW the lower enteraliron and calory intake（p <0.05）in the first two weeks after birth. the prevalence ofanemia for prematurity in our study was70.1%, of which63.8%took place in the firsttwo weeks, and anemia infants gain less iron from enteral route than non-anemiainfants（p <0.05）.Conclution: Oral iron intake from formula or oral iron agents does not providean adequate supply of iron for premature infants during the neonatal period especiallyin the first2weeks after birth.2Efficacy and Safety of iron fortified parenteral nutritionfor anemia in preterm newborns： a randomized,double-blind controlled study.Objiective: The purpose of this study was to evaluate the effect of Intravenousiron（iron saccharate）on anemia and lipid peroxidation in AIO parenteral nutritionadmixtures for preterm infants.Methods: A randomized, controlled, double-blind trial lasting more than7dayswas conducted. Preterm newborns with BW less than2000g and recruited in NICU ofour hospital in48hours after birth were assigned randomly into three groups: controlgroup (PN), FE-1group (PN+200ug/kg.d) and FE-2group (PN+400ug/kg.d). Preterminfants were further divided into three groups based on the duration of PN for threegroups, i.e.,≤10d (7–10d),≤14d (7–14d) and≤21d (7–21d), in order to establish the optimum time for iron supplementation in preterm infants with a BW of less than2,000g. The primary endpoints of this study were the tests of red blood cellparameters and iron storage indicators, the secondary endpoints were Oxidative stressindicators.Results: After intervention, RBC, HB, HCT, MCV, MCH, TIBC and UIBC weremarkedly decreased (p <0.01) while SI, ferritin were significantly elevated (p <0.01)in three groups. There was a tendency of improvement for RBC parameters and ironstorage indicators in FE-1group, but with no significant difference (p>0.05)compared with the control group except TIBC and UIBC were lower in FE-1group (p<0.05). Indicators for HB, HCT, SI and ferritin in FE-2group were significantlyhigher than control group (p <0.05), while TIBC and UIBC were significantly lower(p <0.05). In the subgroup of PN duration≦14days, RBC parameters and iron storageindicators were improved in FE-2group compared with the control group.8-isoprostane and MDA were no statistical difference among three groups (p>0.05).Conclution: In this randomized, controlled, double-blind trial, iron fortified AIOparenteral nutrition admixtures is effective and safe for preterm infants. Werecommend that the time of intravenous iron used for premature infants should bemore than14days.