Iron supplementation for preterm infants receiving restrictive red blood cell transfusions: reassessment of practice safety

J Perinatol. 2010 Nov;30(11):736-40. doi: 10.1038/jp.2010.33. Epub 2010 Mar 11.


Objective: To reassess iron supplementation practice safety in very low birth weight (VLBW) preterm infants receiving restrictive red blood cell transfusions during initial hospitalization.

Study design: Iron status, including hemoglobin (Hb), serum iron, ferritin, and soluble transferrin receptor (sTfR) levels and reticulocyte count of transfused (n=236) and non-transfused (n=166) preterm infants at ≤24 h and 2, 4 and 8 weeks were recorded. As per protocol, a restrictive blood transfusion policy and supplementation of 5 mg kg(-1) per day of iron polymaltose complex from 4 weeks and 25 mg(-1) per day of vitamin E from 2 weeks were imposed for all infants. Normative reference cord-blood ferritin value of preterm infants was used for comparison. Vitamin E levels and incidence of morbidities associated with prematurity were recorded.

Result: At ≤24 h, the characteristics and iron status of both groups were similar. At 2, 4 and 8 weeks, the transfused group had significantly higher Hb, iron and ferritin levels; sTfR levels were lower at 4 and 8 weeks (all indices, P<0.05). At 8 weeks, the median ferritin levels of our transfused group were lower than that of normative reference cord-blood value (115 (50th percentile) vs 79 (43 to 107) μg l(-1), respectively). Vitamin E levels and the incidence of morbidities associated with prematurity of the transfused and non-transfused groups were not different (both indices, P>0.18).

Conclusion: Adding iron supplementation to preterm infants receiving restrictive blood transfusions has shown to be a judicious and safe practice in terms of iron status for VLBW preterm infants.

MeSH terms

  • Biomarkers, Pharmacological / blood*
  • Erythrocyte Transfusion / adverse effects*
  • Follow-Up Studies
  • Humans
  • Infant Nutritional Physiological Phenomena / drug effects*
  • Infant, Newborn
  • Infant, Premature* / blood
  • Infant, Premature* / growth & development
  • Infant, Very Low Birth Weight / blood
  • Infant, Very Low Birth Weight / growth & development
  • Iron* / administration & dosage
  • Iron* / adverse effects
  • Iron* / metabolism
  • Nutrition Assessment
  • Nutritional Status / drug effects
  • Trace Elements / administration & dosage
  • Trace Elements / adverse effects
  • Trace Elements / metabolism
  • Vitamin E / administration & dosage
  • Vitamin E / adverse effects
  • Vitamin E / metabolism
  • Vitamins / administration & dosage
  • Vitamins / adverse effects
  • Vitamins / metabolism


  • Biomarkers, Pharmacological
  • Trace Elements
  • Vitamins
  • Vitamin E
  • Iron