18 Prevalence of iron deficiency among extreme preterm neonates based on Reticulocyte-Hemoglobin levels: a single center cross-sectional study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".