| Objective:To find changes of iron metabolism indexes in preterm infants after red blood cells transfusion（RBCT）within 6 months after birth,then to evaluate iron overload and iron deficiency.Aims to provide reference for iron supplement in premature infants.Methods:A prospective controlled study was conducted.The infants who were admitted to the NICU of the Affiliated Hospital of Guizhou Medical University within 24 hours after birth with gestationnal age（GA）<37W from november 1,2020 to august 31,2021 and systematically followed up after discharge to 6 months of age were included in the study while the research group received RBCT during hospitalization and the control group did not receive RBCT treatment.According to whether RBCT was performed,they were divided into reserch group（RBCT group）and control group（non-RBCT group）.It was divided into G1 group（GA<28W group）,G2group（28W≤GA<32W）and G3 group（32W≤GA<37W）by GA.The study group was divided into T1 group（RBCT 1 time）,T2 group（RBCT 2 times）and T3group（RBCT≥3 times）according to RBCT times.Peripheral venous blood was collected half an hour before morning feeding at 1 week after birth,1 week after RBCT,3 months and 6 months of age to detect blood cell analysis,serum iron（SI）,total iron binding capacity（TIBC）,and serum Ferritin（SFer）.General data of the infants were collected:gender,gestational age,birth weight,feeding milk,iron supplementation or not;Iron metabolism indexes including SI,SFer and TIBC were icluded.Statistical methods:SPSS 26.0 statistical software was used for data processing;Enumeration data is represented by number of cases and percentage,andχ2 test or fisher’s exact tests were used for comparison between groups.The measurement data in accordance with normal distribution were expressed as mean±standard deviation（?x±s）,independent sample T test was used for comparison between two groups,and one-way ANOVA was used for comparison between multiple groups.The measurement data that did not conform to normal distribution were represented by M(P25,P75),and rank-sum test was used for comparison between groups.Logisitic was further used for multivariate analysis,and P<0.05 was statistically significant.Results:1.General conditions:A total of 71 premature infants were included in the study,including 43 males（43/71,60.56%）and 28 females（28/71,39.44%）;Birth weight（BW）was 880～3230g,with an average BW of 1733.10±539.71g.GA 26+6W～36+6W,average GA32.19±2.77W;There were 35 cases in RBCT group and 36 cases in non-RBCT group.Compared with the two groups,the GA and BW of T group were lower than those of non-RBCT group,and the difference was statistically significant（P<0.05）.There were no significant differences in gender,iron supplementation and feeding milk（P>0.05）.2.Changes and comparison of iron metabolism indexes within 6 months after bith between the study group and the control group:（1）In non-RBCT group,SI and SFer gradually decreased with age,while TIBC gradually increased with age,and there was statistical significance among all groups（P<0.05）.（2）In RBCT group:there was no statistical significance at1week,3 months and 6 months of age in SI,P>0.05;TIBC:increased gradually with the increase of age,and the difference at each time point was statistically significant（P<0.05）.SFer:it was significantly lower at 6 months of age than at 1week and 3 months of age,with statistical significance（P<0.05）.（3）comparison between RBCT group and non-RBCT group:there were no significant differences in SI,SFer and TIBC between the two groups at 1 week and 3 months of age,P>0.05;6 months of age:SI and SFer in T group were higher than those in non-RBCT group,TIBC in RBCT group was lower than that in non-RBCT group,the difference was statistically significant（P<0.05）.3.Changes in iron metabolism indexes of premature infants with RBCT after 1week of RBCT:SI and SFer increased gradually with the increase of RBCT number,and the difference between groups was statistically significant（P<0.05）.There was no significant difference in TIBC between groups with different RBC infusion times（P>0.05）.4.The influence of different RBCT times on iron metabolism index within 6 months after birth in premature infants:1 week after birth:There was no statistical significance in SI,SFer and TIBC with different RBCT times,P>0.05;3 months of age:SFer in≥3 RBCT group was significantly higher than that in RBCT 1 time group and RBCT 2 times group,the difference was statistically significant（P<0.05）.6 months of age:There was no statistical significance in SI,SFer and TIBC among different RBCT times（P>0.05）.5.Comparison of RBCT status and iron metabolism indexes in different gestational ages:（1）RBCT status in different gestational ages groups:the lower the gestational age,the higher the RBCT rate,the G1 group:100%,G2 group:75.00%,G3 group:21.62%,the difference among the three groups was statistically significant,P<0.05;（2）there was no statistical significance in SI,SFer and TIBC of gestational age at 1w postnatal,P>0.05;3 months of age:SFer gradually decreased with the increase of gestational age,and the pair comparison showed statistical significance（P<0.05）,while SI and TIBC showed no statistical significance.6months of age:SI in G1 and G2 groups was higher than that in G3 group,and the difference between G2 and G3 groups was statistically significant（P<0.05）.There was no significant difference in SFer and TIBC among different gestational age groups.6.71 cases of iron overload,iron deficiency and iron deficiency anemia in 6months of premature infants:There were 10 cases of iron overlod（IOL）,7 cases of iron deficiency（ID）and 3 cases of iron deficiency anemia（IDA）.Multivariate analysis showed that the number of RBCT was the main risk factor of Iron overload.Conclusions:1.The amount of iron stored in preterm infants gradually decreases with age,and the amount of iron stored in preterm infants with red blood cell transfusion at 6months is higher than that in preterm infants without red blood cell transfusion.2.Premature infants of different gestational ages have the same iron content at birth;3.Preventive iron supplementation is recommended for premature infants who have not received red blood cell transfusion.Individualized iron supplements in red blood celltransfusion premature infants is recommended by dynamic monitoring of iron metabolism indexes.Caution should be exercised against iron overload in patients with≥3 red blood cell transfusions. |
