339 - Iron deficiency at the time of discharge in very low birth weight infants: Impact of delayed cord clamping.

Poster Number: 339
Publication Number: 339.122

Geetika Kennady, Thomas Jefferson/ Nemours/ ChristianaCare, Swedesboro, NJ, United States; Faraz A. Afridi, MD Anderson, Princeton, NJ, United States; Dana Neumann, Nemours Children's Hospital, Wilmington, DE, United States; Barbara Amendolia, Cooper Medical School of Rowan University, Hammonton, NJ, United States; Nicole Kilic, Cooper University Hospital, Cherry Hill, NJ, United States; Vishwanath Bhat, The Children's Regional Hospital at Cooper, Camden, NJ, United States; Vineet Bhandari, The Children's Regional Hospital at Cooper, Camden, NJ, United States; Zubair Aghai, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States

Background: Iron deficiency, even in the absence of anemia, is associated with neurocognitive impairment. It is crucial to identify infants who are iron deficient. Preterm infants are at high risk for iron deficiency due to low iron stores at birth, high growth velocity in the first few months of life, low levels of erythropoietin and small circulating blood volume relative to iatrogenic blood loss. Reticulocyte hemoglobin content (CHr) is a reliable early indicator of iron deficiency. Delayed cord clamping (DCC) can improve iron status at discharge in VLBW infants.

Objective: This study is aimed at utilizing CHr to evaluate the iron status at discharge in VLBW preterm infants from two tertiary care NICUs. We also evaluated the impact of DCC on CHr at discharge.

Design/Methods: Retrospective analysis on all VLBW infants from two tertiary NICUs born between 04/2017- 05/2020 who survived and had CHr performed close to discharge. In preterm infants, the cut off value for a low CHr is < 29 pg. The CHr at discharge and number of infants with low CHr were compared to infants who received DCC and those who did not. Infants with a positive newborn screen for Barts hemoglobin (Hb Barts) were excluded.

Results: A total of 315 VLBW infants met the inclusion criteria (Table 1). The median (IQR) hemoglobin and hematocrit prior to discharge were 10 gm/dl (9-11.3) and 29.7% (27.1-33.3), respectively. The median (IQR) CHr prior to discharge was 30.8 pg (28.4-39). In 99 infants (31.4%), the CHr was low prior to discharge. DCC was performed in 46.7 % of infants. Hemoglobin at birth, discharge and CHr at discharge were significantly higher in infants who received DCC (Table 2). DCC also reduced the need for blood transfusion and the number of infants with low CHr at discharge. Fifteen infants were Hb Bart positive (4.8%), with a median CHr of 23.9 pg (22.7 to 29.7). In infants with Hb Barts, 14 infants (93.3%) had CHr < 29 pg and only one infant had CHr above 29 pg (i.e, 29.7 pg).Conclusion(s): Approximately 31.4 % VLBW infants had lower CHr near the time of discharge suggesting they were iron deficient. DCC improved iron status at discharge in VLBW infants. CHr content can be used to direct iron supplementation in VLBW infants to potentially improve their iron status and long-term neurocognitive outcomes. Quality improvement projects to increase DCC in VLBW infants can also improve their iron status at discharge.
Geetika KennadyGeetika job CV.pdf
Table 2: Comparison of infants who received delayed cord clamping (DCC) and no DCC.