Serum Ferritin as an Indicator of Neonatal Anaemia
International Blood Research & Reviews, Volume 14, Issue 4,
Page 8-16
DOI:
10.9734/ibrr/2023/v14i4312
Abstract
Introduction: Haemoglobin levels are usually used to diagnose neonatal anaemia. By the time haemoglobin levels drop, body iron is depleted. Serum ferritin is the standard measure for assessment of iron levels in neonates and detects iron deficiency earlier than haemoglobin levels.
Aims: To determine the prevalence of low haemoglobin and ferritin levels amongst term and preterm newborn babies. To determine the value of serum ferritin in the diagnosis of low iron stores amongst term and preterm newborns.
Methodology: This was a cross sectional descriptive study carried out at the Neonatal Intensive Care Unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria between June and December 2014. The study included 140 newborns of all birth weights delivered at the UNTH. These were categorized into preterm (gestational age <37 completed weeks) and term (gestational age ≥37 completed weeks. Babies with C-reactive protein levels > 10mg/dl, who were intra-uterine growth restricted, and whose mothers had conditions associated with low iron stores were excluded from the study. Anthropometric measurements were done for all subjects. Haemoglobin estimation and ferritin assay were carried out and the prevalence of neonatal anaemia was determined using each of these.
Results: The range of haemoglobin concentration in the study population was 12.22g/gl – 22.80g/dl. The mean serum haemoglobin concentrations were 15.69mg/dl ± 1.58 and 16.45 ± 1.92 in the preterm and term babies respectively (t = 2.557, P = .0116). The prevalence of low haemoglobin concentrations amongst both preterm and term babies was zero= .024). The range of serum ferritin level in the study population was 20.6µg/l - 296µg/l. The mean serum ferritin levels were 63.13µg/l ± 23.93 and 133.67µg/l ± 50.14 in the preterm and term babies respectively (t = 10.623, P < .001). The prevalence of low serum ferritin in the study population was 22.14%, but was higher in preterm than term babies 35.7% vs 8.6%: (OR – 5.926, 95% C.I OR = 2.248 – 15.619)(P<.001).
Conclusion: Serum ferritin assay is more useful than haemoglobin as an indicator of anaemia during the neonatal period.
- Anaemia
- ferritin
- iron
- prevalence
- indicator
How to Cite
References
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization (WHO/NMH/NHD/MNM/11.1); 2011.
Available:http://www.who.int/vmnis/indicators/haemoglobin pdf, accessed [Nov 30, 2013]).
Walter AW(ed), Perinatal Anemia. MSDS Manual. Merck & Co, Inc., Rahway, NJ, USA Last review/revision Dec; 2022. Available:https://www.msdmanuals.com/professional/pediatrics/perinatal-hematologic-disorders/perinatal-anemia. Accessed: April 30, 2023.
Alqahtany FS. Anaemia of the newborn: A review. Eur J Mol Clin Med. 2020;07(02): 3590.
WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO; 2020.
Beard J, deRegnier RA, Shaw M, Rao R, Georgieff M. Diagnosis of iron deficiency in infancy. Lab Med 2007;38:103–108.
Domellöf M, Hernell O, Dewey KG, Lönnerdal B, Cohen RJ. The Diagnostic Criteria for Iron Deficiency in Infants Should Be Reevaluated, J Nutr. 2002; 132(12):3680-6. Available:https://doi.org/10.1093/jn/132.12.3680.
Cook JD, Finch CA, Smith NJ, Evaluation of the iron status of a population. Blood. 1976;48:449-455.
Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI et al. HEmoglobin MEasurement (HEME) Working Group. Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review. Ann N Y Acad Sci. 2019;1450(1):126–46.
Addo OY, Yu EX, Williams AN, Young MF, Sharma AJ, Mei Z et al. Evaluation of hemoglobin cutoff levels to define anemia among healthy individuals. MDAMA Network Open. 2021;4(8):e2119123. DOI:10.1001/jamanetworkopen.2021.19123
Linderkamp O, Zilow EP, Zilow G. Kritische Hämoglobinwerte bei Neugeborenen, Säuglingen und Kindern [The critical hemoglobin value in newborn infants, infants and children]. Beitr Infusionsther. 1992;30:235-46; discussion 247-64. German. PMID: 1284712.
Siddappa AM, Rao R, Long JD, Widness JA, Georgieff MK. The assessment of newborn iron stores at birth: A review of the literature and standards for ferritin concentrations. Neonatology. 2007;92: 73–82.
Cheng C, Juul S. Iron balance in the neonate. Neoreviews 2011;12:148-158.
Rao R, Georgieff MK. Iron in fetal and neonatal nutrition. Semin Fetal Neonatal Med. 2007;12: 54–63.
WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, (WHO/NMH/NHD/MNM/11.2); 2011.
Available:http://www.who.int/vmnis/indicators/serum_ferritin pdf, accessed May 05, 2020
American Academy of Family Physician. Avoid using hemoglobin to evaluate patients for iron deficiency in susceptible populations. Instead, Use ferritin. Available:https://www.aafp.org/pubs/afp/collections/choosing-wisely/432.html Accessed: May 09, 2023.
Joy Y. Zhang, Jing Wang, Qinsheng Lu, Meizhen Tan, Ru Wei, Gendie E. Lash; Iron stores at birth in a full-term normal birth weight birth cohort with a low level of inflammation. Biosci Rep. 2020; 40(12): BSR20202853.
Available:https://doi.org/10.1042/BSR20202853
Kim H, Park S, Lee E. Iron status in small for gestational age and appropriate for gestational age infants at birth. Clin Exp Pediatr. 2019;62(3):102-107. DOI: https//doi.org/10.3345/kjp.2018.06653
Sweet DG, Savage G, Tubman TRJ, Lappin TRJ, Halliday HL. Study of maternal influences on fetal iron status at term using cord blood transferrin receptors. Arch Dis Child Fetal Neonatal Ed 2001; 84: F40–F43.
Siddappa AM, Georgieff MK, Wewerka S, Worwa C, Nelson CA, deRegnier RA. Iron deficiency alters auditory recognition memory in newborn infants of diabetic mothers. Pediatr Res. 2004; 55:1034-41.
World Health Organization/Centers for Disease Control and Prevention. Assessing the iron status of populations: a report of a joint World Health Organization/Centers for Disease Control technical consultation on the assessment of iron status at the population level. Geneva; 2004 April.
Available:http://whqlibdoc.who.int/publications/2004/9241593156_eng.pdf. Accessed January 4, 2008.
Chen X, Scholl TO, Stein TP. Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: The Camden study Diabetes Care. 2006;29: 1077–1082.
Whitley E, Ball J. Statistics review 4: Sample size calculations. Critical Care. 2002;6:335–341.
Carpani G, Marini F, Buscaglia M, Sinigaglia E, Moroni G. Red cell and plasma ferritin in normal fetuses at different ages of gestation. Eur J Haematol. 1992;49:260–262.
le Cessie S, Verhoeff FH, Mengistie G, Kazembe P, Broadhead R, Brabin B. Changes in haemoglobin levels in infants in Malawi: effect of low birth weight and fetal anaemia. Arch Dis Child Fetal Neonatal Ed. 2002;86:F182-F187.
Adediran A, Gbadegesin A, Adeyemo T, Akinbami A, Osunkalu V, Ogbenna A, et al. Cord blood haemoglobin and ferritin concentrations in newborns of anaemic and non-anaemic mothers in Lagos, Nigeria. Nig Med J. 2013; 54(1):22-26. DOI: 10.4103/0300-1652.108889.
Tiruneh T, Shiferaw E, Enawgaw B. Prevalence and associated factors of anemia among full-term newborn babies at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a cross-sectional study. Ital J Pediatr. 2020; 46(1):1.DOI: 10.1186/s13052-019-0764-1
Eslami Z, Ghilian R, Abbasi F. Evaluation of hemoglobin concentration of cord, capillary and venous sampling in neonates. Iran J Ped Hematol Oncol. 2012;2(4):159-63. Epub 2012 Sep 22.
Kalteren W, Mebius M, Verhagen E, Tanis J, Kooi E, Bos A. Neonatal hemoglobin levels in preterm infants are associated with early neurological functioning. Neonatology. 2011;118(5): 593-9.
Available:https://doi.org/10.1159/000518655
Hasanbegovic E, Cengic N, Hasanbegovic S, Heljic J, Lutolli I, Begic E. Evaluation and treatment of anemia in premature infants. Med Arch. 2016;70(6): 408-412. DOI: 10.5455/medarh.2016.70.408-412
Banerjee, J., Asamoah, F.K., Singhvi, D. et al. Haemoglobin level at birth is associated with short term outcomes and mortality in preterm infants. BMC Med. 2015;13:16. Available:https://doi.org/10.1186/s12916-014-0247-6
Jopling J, Henry E, Wiedmeier SE, Christensen RD. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics. 2009;123(2):e333-7. DOI: 10.1542/peds.2008-2654. PMID: 19171584
Centers for Disease Control and Prevention (CDC). Recommendations to prevent and control iron deficiency in the United States. Morb. Mortal. Wkly. Rep. 1998;47:1–29.
Uneke CJ, Duhlinska DD, Ujam TN. Effects of Maternal Plasmodium falciparum malaria and HIV infection on birth weight in southeastern Nigeria. Mcgill J Med. 2009;12(2):42. PMID: 21152333; PMCID: PMC2997242.
West B, Arthur A, Aitafo J, Omunakwe H. Prevalence, Associated Factors and Outcome of Newborns with Anaemia as Seen in Rivers State University Teaching Hospital, Nigeria. Arch Curr Res Int. 2021;21(4):23-24.
DOI: 10.9734/ACRI/2021/v21i430241
Brabin BJ, Kalanda BF, Verhoeff FH, Chimsuku LH, Broadhead RL. Risk factors for fetal anaemia in a malarious area of Malawi. Ann Trop Paediatr. 2004;24: 311–21
Lee S, Guillet R, Cooper EM, WestermanM, Orlando M, Kent T, et al. Prevalence of anemia and associations between neonatal iron status, hepcidin, and maternal iron status among neonates born to pregnant adolescents. Pediatr Res. 2016;79(1):42–48.
Kalteran WS, Horst HJH, de Vetten L, KooiEM, Bos AF. Perinatal anemia is associated with neonatal and neurodevelopmental outcomes in infants with moderate to severe perinatal asphyxia. Neonatology. 2018;114(4): 315-322.Available:https://doi.org/10.1159/000490369
Augusta de Sá S, Willner E, Aguiar DuraesPereira T, Rosse de Souza V, TelesBoaventura G, Blondet de Azeredo V. Anemia in pregnancy: impact on weight and in the development of anemia in newborn. Nutrcion Hospitalaria. 2015; 32(5):103-105. DOI: 10.3305/nh.2015.32.5.9186
Al-Naseem A, Sallam A, Choudhury S, Thachil J. Iron deficiency without anaemia: a diagnosis that matters. Clin Med J. 2021;21(2):107-113. DOI: 10.7861/clinmed.2020-0582
Collard KJ. Iron homeostasis in the neonate. Pediatrics 2009;4:1208-1216.
Rao R, Georgieff MK. Iron therapy for preterms. Clin Perinatol. 2009;36:27-42.
Siddappa AM, Georgieff MK, Wewerka S, Worwa C, Nelson CA, deRegnier RA. Iron deficiency alters auditory recognition memory in newborn infants of diabetic mothers. Pediatr Res. 2004;55:1034-41.
Adediran A, Gbadegesin A, Adeyemo TA, Akinbami A, Osunkalu VO, Ogbenna AA, et al. Haemoglobin and ferritin concentrations in cord blood in a tertiary health centre in Nigeria. Nig Q J Hosp Med. 2011;21(4):284-9.
PMID: 23175892.
Chew EC, Lam JC. Diagnosis and management of iron deficiency anaemia in children - A clinical update. Proceedings of Singapore Healthcare. 2012;21:278-295.
Shao J, Rao R, Georgiff MK, Kaciroti N, Felt BT, Zhao Z, et al. Maternal serum ferritin concentration is positively associated with newborn iron stores in women with low ferritin status in late pregnancy. J Nutr. 2012;142: 2004-2009.
Baker RD, Frank R. The Committee on Nutrition. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0 −3 years of age). Pediatrics. 2010;126:1040 - 1050.
Kawamura M, Nishida H. The usefulness of serial C-reactive protein measurements in managing neonatal infection. Acta Pediatr. 1995;84:10-13.
Benitz W, Han M, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics. 1998;102:41.
Kocabaş E, Sarıkçıoğlu A, Aksaray N, Seydaoğlu G, Seyhun Y, Yaman A. Role of procalcitonin, C-reactive protein, interleukin-6, interleukin- 8 and tumor necrosis factor-α in the diagnosis of neonatal sepsis. Turk J Pediatr. 2007;49: 7-20.
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