Formula-Fed Preterm Infants More Likely to Have Iron Deficiency

infant: infantFormula-fed very preterm infants are more likely to have iron deficiency even though they have higher iron intake than breastfed infants, according to a new Canadian study. Preterm infants are at increased risk of developing iron deficiency, which is associated with developmental and behavioral problems later in life. Breastfed infants, in particular, are considered at increased risk of iron deficiency because breast milk has a low iron content, compared with standard infant formula. “Just because infants are on iron-rich formula, we should not assume all of their iron needs are being met, since iron from the formula may not have the same absorption as iron from breast milk,” said Grace Power, a third-year medical student at Dalhousie University in Nova Scotia, Canada. “These findings suggest we might need to rethink some of the guidelines for iron supplementation.” Iron supplementation is consistently recommended for breastfed preterm infants. Canadian Pediatric Society guidelines issued in 2019 recommend that breastfed preterm infants receive iron supplementation of 2-3 mg/kg/day. Formula-fed preterm infants tend to receive that amount and, therefore, the guidelines do not suggest they need iron supplementation. But “the guidelines lack strong scientific evidence and are based on clinical opinion,” said Power at a press briefing during the 2022 American Society of Hematology Annual Meeting (Abstract 3663s). She noted that the American Academy of Pediatrics provides no recommendations on iron supplementation in formula-fed preterm infants. “Recommendations for iron supplementation for formula-fed preterm infants are not very clear. There is very little research looking at how feeding type relates to iron deficiency in preterm infants,” said Power. Study Details Abstract 3663 Power and colleagues set out to investigate how the type of feeding influences the iron status of very preterm infants at 4-6 months corrected age. They conducted a retrospective population-based cohort study to analyze health records from 392 very preterm infants, born before 31 weeks gestation, in Nova Scotia from 2005 to 2018. All preterm infants born in the province are followed through a single medical center, therefore the dataset is considered to be representative of the general Canadian population in terms of patient demographics and health care protocols. Of the 392 infants, 285 infants were exclusively fed iron-rich formula and 107 infants were partially or exclusively breastfed. Researchers extracted data on feeding practices, iron intake from formula and iron supplements, and iron levels in the blood taken at 4 and 6 months of age, with ages corrected for prematurity by subtracting the number of weeks early each infant was born from the actual age. The results show that formula-fed infants had a significantly higher daily iron intake than breastfed infants, but 36.8 percent of formula-fed infants and 20.6 percent of breastfed infants were iron-deficient, suggesting that higher iron intake in formula does not always translate into higher iron stores in the blood. Formula-fed infants who were born earlier, those who were born smaller, and those who had received blood transfusions were found to be at greater risk for iron deficiency than other formula-fed infants. Power noted that 80 percent of formula-fed infants failed to receive at least 2 mg/kg/day from formula alone. One likely explanation is the different chemical composition of breast milk. Breast milk contains lactoferrin, which aids iron absorption. Therefore, iron from breast milk may be better absorbed than iron from formula. “Most of formula-fed very preterm infants failed to receive at least 2 mg/kg/day from formula alone, contradicting the supposition of the Canadian Pediatric Society guidelines,” Power stated. “Despite higher iron intake overall, iron deficiency was more prevalent in formula-fed infants than in breastfed infants. This suggests a need to revisit recommendations on iron supplementation in formula-fed very preterm infants.” Clinically, physicians should consider the individual risk for iron deficiency when deciding whether and how to supplement these infants with iron. “We should not assume a one-size-fits-all approach to iron supplementation,” said Power. She suggested that preterm babies could benefit from closer monitoring, especially those who are exclusively fed formula. “If iron stores are checked in time and infants are regularly supplemented with iron as needed, we can still prevent iron deficiency,” Power concluded. Mark L. Fuerst is a contributing writer.

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