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Nutrition and Disease

Erythrocyte Iron Incorporation but Not Absorption Is Increased by Intravenous Iron Administration in Erythropoietin-Treated Premature Infants^1–3,

John A. Widness^*,4, Robert E. Serfass^**, Nadja Haiden, Steven E. Nelson^*, Kenneth A. Lombard and Arnold Pollak

^* Department of Pediatrics, University of Iowa, College of Medicine, Iowa City, IA; Division of Neonatology, Department of Pediatrics, Medical University of Vienna, Vienna, Austria; ^** Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX; and Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME

⁴ To whom correspondence should be addressed. E-mail: john-widness{at}uiowa.edu.

Because critically ill premature infants experience significant iron loss due to phlebotomy and have high iron needs for growth, Fe absorption and incorporation studies are clinically important. A prospective, controlled, randomized, open 21-d study was conducted in infants with birth weight <1300 g and gestational age < 31 wk to assess the efficacy of combining intravenous (IV) sucrose iron (Fe) with erythropoietin (EPO) for increasing Fe absorption, RBC Fe incorporation, and erythropoiesis. Three clinically stable groups were enrolled at 3–4 wk of age: Control, EPO [2100 U EPO/(kg·wk)]; and IV Fe+EPO [2 mg IV sucrose Fe/(kg·d) plus 2100 U EPO/(kg·wk)]. All subjects received 9 mg/(kg·d) of oral Fe polymaltose. Subjects were not allowed RBC transfusions. Indicators of iron status and erythropoiesis were assessed before and 18 d after treatment. On d 4, tracer doses of oral polymaltose ⁵⁷Fe and IV sucrose ⁵⁸Fe were administered, and stool and blood samples were collected for Fe absorption and incorporation determinations. Compared with the Control group, the EPO group demonstrated greater hemoglobin (Hb) concentration and reticulocyte count, but no difference in Fe incorporation. In contrast, the IV Fe+EPO group demonstrated greater total Fe incorporation, Hb concentration, plasma ferritin, and reticulocyte count compared with the Control and EPO groups. Absorption of ⁵⁷Fe and nonisotopic polymaltose Fe did not differ among the groups (range: 48–58%, and 41–47%, respectively). We conclude that IV sucrose Fe administered in combination with EPO to very-low-birth weight premature infants significantly increases RBC Fe incorporation and erythropoiesis more than EPO alone, but without increasing iron absorption.

KEY WORDS: • anemia • iron status • erythropoietin • stable isotope

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