INTRAVENOUS IRON ADMINISTRATION TO VERY-LOW-BIRTH-WEIGHT NEWBORNS RECEIVING TOTAL AND PARTIAL PARENTERAL-NUTRITION

Background: Intravenous iron supplements are not routinely administere d to very-low-birth-weight newborns receiving total parenteral nutriti on because of the possible increased risk of infection and because iro n needs may be met with blood transfusions. Methods: To assess the ben efits of a prudent IV iron supplement (200 to 250 mu g/kg/d), 26 very- low-birth-weight newborns (birth weight, 1005 +/- 302 g; gestational a ge, 28 +/- 2.3 weeks; mean +/- SD) were randomly allocated to receive total parenteral nutrition without iron (No-Iron) or with iron supplie d as iron dextran (Iron). These newborns were followed at baseline (2 to 3 days after birth) and at weeks 1 to 4 each sampling time, urine s amples, fecal samples (rarely), unused total parenteral nutrition solu tions, blood products, and a blood sample (1 mL) were collected. Resul ts: 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 diag nostic purposes (44 +/- 16 mL), or number of septic events (n = 16). T here 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. C onclusions: A. total iron intake of 400 mu g/kg/d, half of which was p rovided by IV iron, is not sufficient to maintain iron balance or to m eet fetal accretion rates (1000 mu g/kg/d) in very-low-birth-weight ne wborns receiving total parenteral nutrition. Furthermore, endogenous i ron from blood transfusions does not provide an adequate supply of iro n.