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American Academy of Pediatrics
Article

Iron Nutrition, Erythrocytes, and Erythropoietin in the NICU: Erythropoietic and Neuroprotective Effects

Pamela J. Kling
NeoReviews February 2020, 21 (2) e80-e88; DOI: https://doi.org/10.1542/neo.21-2-e80
Pamela J. Kling
*Department of Pediatrics, University of Wisconsin, Madison, WI
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  • Abbreviations:
    AAP:
    American Academy of Pediatrics
    DCC:
    delayed cord clamping
    ECC:
    early cord clamping
    Epo:
    erythropoietin
    ESA:
    erythrocyte-stimulating agent
    ESPGHAN:
    European Society for Pediatric Gastroenterology, Hepatology, and Nutrition
    ID:
    iron deficiency
    LGA:
    large for gestational age
    NNT:
    number needed to treat
    RBC:
    red blood cell
    SGA:
    small for gestational age
    USPSTF:
    US Preventive Services Task Force
  • Abstract

    Prematurity, maternal diabetes, maternal smoking, being medically underserved, and small size for gestational age are common characteristics of neonates in the NICU and can predispose them to develop congenital iron deficiency. Iron is critical for organ development. In the fetus and newborn, iron is prioritized for red blood cell production, sometimes at the expense of other tissues, including the brain. It is critical to optimize iron levels in newborns to support erythropoiesis, growth, and brain development. Available studies support improved neurodevelopmental outcomes with either iron supplementation or delayed umbilical cord clamping at birth. Erythropoietic doses of erythropoietin/erythrocyte-stimulating agents may also improve neurocognitive outcomes. However, the literature on the effect of liberal red blood cell transfusions on long-term neurodevelopment is mixed. Understanding age-specific normal values and monitoring of iron indices can help individualize and optimize the iron status of patients in the NICU.

    • Copyright © 2020 by the American Academy of Pediatrics

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    NeoReviews
    Vol. 21, Issue 2
    1 Feb 2020
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    Iron Nutrition, Erythrocytes, and Erythropoietin in the NICU: Erythropoietic and Neuroprotective Effects
    Pamela J. Kling
    NeoReviews Feb 2020, 21 (2) e80-e88; DOI: 10.1542/neo.21-2-e80

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    Iron Nutrition, Erythrocytes, and Erythropoietin in the NICU: Erythropoietic and Neuroprotective Effects
    Pamela J. Kling
    NeoReviews Feb 2020, 21 (2) e80-e88; DOI: 10.1542/neo.21-2-e80
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    • Article
      • Abstract
      • Education Gaps
      • Objectives
      • Role of Iron in Development
      • Erythrocyte Endowment and Iron
      • Erythropoietin and Iron
      • Screening for and Treating Iron Status
      • Conclusion
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      • References
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