PT  - JOURNAL ARTICLE
AU  - Kling, Pamela J.
TI  - Iron Nutrition, Erythrocytes, and Erythropoietin in the NICU: Erythropoietic and Neuroprotective Effects
AID  - 10.1542/neo.21-2-e80
DP  - 2020 Feb 01
TA  - NeoReviews
PG  - e80--e88
VI  - 21
IP  - 2
4099  - http://neoreviews.aappublications.org/content/21/2/e80.short
4100  - http://neoreviews.aappublications.org/content/21/2/e80.full
SO  - NeoReviews2020 Feb 01; 21
AB  - Abbreviations:AAP: American Academy of PediatricsDCC: delayed cord clampingECC: early cord clampingEpo: erythropoietinESA: erythrocyte-stimulating agentESPGHAN: European Society for Pediatric Gastroenterology, Hepatology, and NutritionID: iron deficiencyLGA: large for gestational ageNNT: number needed to treatRBC: red blood cellSGA: small for gestational ageUSPSTF: US Preventive Services Task ForcePrematurity, 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.