High iron status in very low birth weight infants is associated with an increased risk of retinopathy of prematurity☆,☆☆,★
Section snippets
Methods
VLBW infants admitted within 48 hours of birth to the regional level III neonatal unit in either Christchurch or Dunedin, New Zealand, from October 1993 through October 1994 were eligible for the study after their parents had signed informed consent forms.
All infants in the study were treated in accordance with standard protocols in the neonatal unit. Parenterally fed infants received supplementary trace elements in the form of Ped-El (Kabi Pharmacia, Stockholm, Sweden), 4 ml/kg per day (iron,
Results
Seventy-one infants were enrolled in the study, 59 in Christchurch and 12 in Dunedin: 91% of all eligible VLBW infants born during the study period. Two infants died.
Of the 69 surviving infants, 56 met the criteria for retinopathy screening, and of these infants, 16 were identified with ROP; the highest stage in either eye was stage 1 in four infants, stage 2 in eight infants, stage 3 in two infants, and stage 4 in two infants. Three infants underwent cryotherapy during the study period.
Discussion
We have demonstrated that high erythrocyte transfusion volumes in the first week of life in the VLBW infant are associated with an elevation in serum iron status, which in turn is associated with an increased risk of ROP, independent of gestational age, use of postnatal steroids, days of oxygen therapy, and the CRIB score as a marker of severity of illness. At 7 days of age, elevated values of serum iron and transferrin saturation were correlated with the subsequent development of retinopathy.
Acknowledgements
We are grateful for the assistance received during the study from Mr. David Peart with ophthalmologic examinations and for the skilled advice of Prof. Christine Winterbourn.
References (12)
The CRIB (Clinical Risk Index for Babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units
Lancet
(1993)- et al.
Bleomycin-detectable iron in the plasma of premature and full-term neonates
FEBS Lett
(1992) - et al.
CRIB and SNAP: assessing the risk of death for preterm neonates
Lancet
(1994) - et al.
Retrolental fibroplasia: incidence in different localities in recent years and a correlation of incidence with treatment given the infants
JAMA
(1949) Iron, plasma antioxidants, and the “oxygen radical disease of prematurity.”
Am J Dis Child
(1988)Ischaemia: from acidosis to oxidation
FASEB J
(1993)
Cited by (106)
Primary prevention of ROP and the oxygen saturation targeting trials
2019, Seminars in PerinatologyEffect of packed red blood cell transfusion on IL-8 and sICAM-1 in premature neonates at different postnatal ages
2019, Pediatrics and NeonatologyPharmacokinetics and Pharmacology of Drugs Used in Children
2019, A Practice of Anesthesia for Infants and ChildrenIron-mediated oxidative cell death is a potential contributor to neuronal dysfunction induced by neonatal hemolytic hyperbilirubinemia
2018, Archives of Biochemistry and BiophysicsCitation Excerpt :As suggested by Kaplan et al. [6], hemolytic hyperbilirubinemia is closely associated with bilirubin-induced neurological dysfunction in newborns. Premature infants have a high risk of iron and bilirubin neurotoxicity caused by the shortened lifespan of RBCs, reduced reutilization of iron, weakened defense system, insufficient capacity of iron-binding proteins, and immature conjugative system for bilirubin in the liver [7,8]. Neonatal brain is susceptible to oxidative damage by free radicals due to the high content of polyunsaturated fatty acids (PUFAs) in membranes, insufficient activity of antioxidants (e.g., glutathione peroxidase 4 [GPx4]), and increased supply of redox-active iron [9,10].
- ☆
Supported by the Health Research Council of New Zealand.
- ☆☆
Reprint requests: B. A. Darlow, MD, FRACP, Department of Paediatrics, Christchurch School of Medicine, Christchurch Hospital, Private Bag, Christchurch, New Zealand.
- ★
9/21/80249