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. 2023 Nov;43(11):1368-1373.
doi: 10.1038/s41372-023-01751-z. Epub 2023 Aug 18.

Serum ferritin values in neonates <29 weeks' gestation are highly variable and do not correlate with reticulocyte hemoglobin content

Timothy M Bahr  1   2 , Sylvia Tan  3 , Emily Smith  3 , Sandra S Beauman  4 , Kurt R Schibler  5 , Cathy A Grisby  5 , Jean R Lowe  4 , Edward F Bell  6 , Abbot R Laptook  7 , Seetha Shankaran  8 , David P Carlton  9 , Carrie Rau  10 , Mariana C Baserga  10 , John Flibotte  11 , Kristin Zaterka-Baxter  3 , Michele C Walsh  12 , Abhik Das  3 , Robert D Christensen  10   13 , Robin K Ohls  10 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations

Serum ferritin values in neonates <29 weeks' gestation are highly variable and do not correlate with reticulocyte hemoglobin content

Timothy M Bahr et al. J Perinatol. 2023 Nov.

Abstract

Objectives: To compare serum ferritin and RET-He values among extremely low gestational age neonates ELGANs with other markers of iron-deficient erythropoiesis.

Study design: This is a secondary analysis of the NICHD Darbepoetin Trial. Study data from placebo recipients who had a serum ferritin, a RET-He, and a mean corpuscular volume (MCV) measurement within a 24-hour period were analyzed for correlation.

Results: Mixed linear regression models showed no association between ferritin and RET-He at both early (β = 0.0016, p = 0.40) and late (β = -0.0001, p = 0.96) time points. Positive associations were observed between RET-He and MCV at baseline, early, and late time points (p < 0.01, =0.01, <0.001, respectively), while ferritin was not associated with MCV at any time point.

Conclusions: Our study shows that RET-He is better correlated with MCV as a marker of iron-limited erythropoiesis than ferritin. The results suggest that ferritin is limited as a marker of iron sufficiency in premature infants.

Study identification: FDA IND Number 100138; ClinicalTrials.gov number NCT03169881; NRN ID number NICHD-NRN-0058 (Darbe).

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
Scatter plots showing the relationship between simultaneous obtained RET-He and serum ferritin concentration measurements in neonates born at less than 29 weeks gestation who did not receive darbepoetin alpha. A regression line is drawn for on each plot. (A) Paired values obtained at or before 27 days of life (r=−0.24, β=0.0016, p=0.41); (B) paired values obtained on or after 28 days of life (r=−0.16, β=−0.0001, p=0.96).
Figure 2.
Figure 2.
Scatter plots showing the relationship between simultaneous obtained RET-He and MCV, a red blood cell index where low values are associated with iron-limited erythropoiesis. (A) RET-He vs. MCV at enrollment (<24 hours of life; r=0.25, β=0.14, p<0.01); (B) RET-He vs. MCV at 11-17 days of life (r=0.32, β=0.12, p=0.01). (C) RET-He vs. MCV at 38-45 days of life (r=0.39, β=0.17, p<0.01).
Figure 3.
Figure 3.
Scatter plots showing the relationship between simultaneous obtained serum ferritin concentration and MCV, a red blood cell index where low values are associated with iron-limited erythropoiesis. (A) serum ferritin concentration vs. MCV at 11-17 days of life (r=−0.25, β=−6.49, p=0.01). (B) serum ferritin concentration vs. MCV at 38-45 days of life (r=−0.55, β=−12.8, p<0.01).
Figure 4.
Figure 4.
Scatter plots showing the relationship between cumulative iron dose administered (mg/kg) and (A) RET-He in the first 27 days of life (r=0.32, β=0.12, p<0.01) or (B) serum ferritin concentrations in the first 27 days of life (r=−0.67, β=−0.95, p<0.001). The cumulative iron dose plotted is the cumulative iron dose administered from birth through the day the laboratory value (RET-He or serum ferritin) was obtained.
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