Non Breast-Milk-Fed Very Preterm Infants Are at Increased Risk of Iron Deficiency at 4–6-Months Corrected Age: A Retrospective Population-Based Cohort Study

• Published in: Nutrients Vol. 16; no. 3; p. 407
• Main Authors: Power, Grace, Morrison, Lisa, Kulkarni, Ketan, Barr, Hudson, Campbell-Yeo, Marsha, Singh, Balpreet, Stratas, Alexandra, Landry, Carmen, Higgins, Michelle, Ghotra, Satvinder
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 30.01.2024
• Subjects: Anemia; blood serum; Blood tests; Blood transfusions; Cohort analysis; cohort studies; Drug dosages; Ferritin; Gestational age; Hemoglobin; Infants (Premature); Iron; Iron deficiency anemia; Multiple births; Newborn babies; Nova Scotia; Pediatrics; Premature babies; Regression analysis; risk; Standard deviation; therapeutics; Canada; Nova Scotia; Nova Scotia Canada; preterm; breast-fed; iron deficiency; formula-fed
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu16030407

Iron supplementation is routinely recommended for breast-milk-fed preterm infants. However, the Canadian Pediatric Society recommends no additional iron supplementation for preterm infants fed primarily with iron-rich formula. Other pediatric societies don’t provide specific guidance on supplemental iron for formula-fed preterm infants. This study investigated how feeding type influences iron status of very preterm infants at 4–6-months corrected age (CA). A retrospective cohort study was conducted using a population-based database on all very preterm infants (<31 weeks gestational age) born in Nova Scotia, Canada from 2005–2018. Information about feeding type, iron intake from formula, supplemental iron therapy and iron status at 4–6-months CA was extracted. Iron deficiency (ID) was defined as serum ferritin <20 and <12 µg/L at 4-and 6-months CA, respectively. Of 392 infants, 107 were “breast-milk-fed” (exclusively or partially) and 285 were “not breast-milk-fed” (exclusively fed with iron-rich formula) at 4–6-months CA. Total daily iron intake was higher in the non-breast-milk-fed group (2.6 mg/kg/day versus 2.0 mg/kg/day). Despite this, 36.8% of non-breast-milk-fed infants developed ID versus 20.6% of breast-milk-fed infants. ID is significantly more prevalent in non-breast-milk-fed infants than breast-milk-fed infants despite higher iron intake. This suggests the need to revisit recommendations for iron supplementation in non-breast-milk-fed preterm infants.