18 Prevalence of iron deficiency among extreme preterm neonates based on Reticulocyte-Hemoglobin levels: a single center cross-sectional study
Notice bibliographique
Résumé
Abstract Background Extreme preterm neonates are at risk of developing iron deficiency due to multiple factors including lack of third trimester placental iron accretion and frequent blood sampling. The true prevalence of iron deficiency in this cohort is not known due to lack of valid markers. Compared to Hemoglobin (Hb) derived from the entire red blood cell population (lifespan 120 days), Hb derived for reticulocytes (lifespan 3 days) is a real-time indicator of functional iron available for erythropoiesis during the previous 3-4 days. Reticulocyte-Hemoglobin (Ret-Hb) levels lower than 29pg can indicate iron deficiency in preterm neonates < 32 weeks gestation with 85% sensitivity and 73% specificity. Objectives This study aims to measure the prevalence and risk factors of iron deficiency at term equivalent age among extreme preterm neonates based on Ret-Hb levels. Design/Methods A single center retrospective chart review of neonates born at <= 29 weeks gestation between June 2016 to December 2019. All neonates received routine iron supplementation from 2 weeks postnatal age at 3-4mg/kg/day (birth weight <1Kg) or 2-3mg/kg/day (birth weight>1Kg) to a maximum of 15mg elemental iron as ferrous sulfate or iron fortified formula. Hb, Reticulocyte count, Ret-Hb, Immature reticulocyte fraction (IRF) and mean corpuscular volume (MCV) was measured at 4 weeks postnatal age, 36 weeks corrected gestation, and at discharge. Iron deficiency at term equivalent age was defined as Ret-Hb levels <= 29pg. Results Among 387 eligible neonates, 187 who had hematological parameters available at term equivalent age were included. The study cohort had a mean gestation of 25.7 (1.6) weeks, birth weight of 863 (220) g, mean SNAPPEII score of 29.2 (19), and gestational age at discharge of 42.7 (7.2) weeks. The prevalence of iron deficiency among neonates < 24 weeks, 24-25 + 6 weeks, 26-27 + 6 weeks, and >=28 weeks was 35.7%, 18.4%, 27.7%, and 15.6% respectively. Male infants were more likely to have iron deficiency at term equivalent [Table 1]. The neonates with iron deficiency had higher rates of necrotising enterocolitis [14% versus 8%], laparotomy [14% versus 10%] and postnatal steroids [69% versus 57%] compared to neonates without iron deficiency, however not statistically significant. Ret-Hb levels at 4 weeks postnatal age showed a positive correlation with Ret-Hb levels [Slope 0.58, R2 squared 0.02] and MCV levels [Slope 0.75, R2 0.11] at discharge [Figure 1]. Contrary to changes in Hb levels and reticulocyte counts, Ret-Hb levels, MCV and IFR progressively decrease from 4 wks postnatal age to discharge. Conclusion Despite routine standardized iron supplementation, extreme preterm neonates may have iron-limited erythropoiesis indicated by low Ret-Hb levels at term equivalent age. Lower levels of Ret-Hb at 4 weeks postnatal age was associated with low IRF and low MCV at discharge although Hb levels may remain within acceptable range. Future studies would need to elucidate the impact of iron deficiency at corrected term on long-term outcome. Guidelines should consider incorporating Ret-Hb levels in the workup of anemia of prematurity.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».