Reticulocyte hemoglobin concentration for screening iron deficiency in very low birth weight preterm neonates

Abstract

Background

Preterm and low birth weight infants are at risk of iron deficiency. Reticulocyte hemoglobin concentration may be useful as a screening test to diagnose iron deficiency in preterm neonates.

Objective

To evaluate the accuracy and establish the reticulocyte hemoglobin concentration cutoff value for iron deficiency diagnosis in very low birth weight preterm neonates.

Method

This study was conducted between May 2018 and March 2019 at Chiang Mai University Hospital. Preterm infants born at gestational age ≤34 weeks and birth weight ≤1500 g were enrolled. Blood samplings were obtained within the first 48 h of life. Iron deficiency was defined by using two or more of these following parameters: mean corpuscular volume <100 fL, transferrin saturation <16% and serum ferritin <30 µg/L. Neonatal anemia was defined as hemoglobin <15 g/dL. The optimum reticulocyte hemoglobin concentration cutoff values were performed by using predictive values and receiving operation characteristic analysis.

Result

Fifty-seven preterm neonates were enrolled. Nine (15.7%) and three (5.3%) neonates had iron deficiency and iron deficiency anemia, respectively. The reticulocyte hemoglobin concentration cutoff value of <29 pg showed the optimum accuracy to diagnose iron deficiency in very low birth weight preterm neonates with sensitivity, specificity, positive and negative predictive values of 89%, 79%, 42% and 97%, respectively.

Conclusion

Reticulocyte hemoglobin concentration can be used as a screening parameter to diagnose iron deficiency for VLBW preterm neonates. The optimum cutoff value which provided the acceptable accuracy was <29 pg.

Keywords:

• anemia
• iron deficiency
• reticulocyte hemoglobin concentration
• preterm
• very low birth weight

Acknowledgments

The authors thank Dr.Pimlak Charoenkwan, a pediatric hematologist at the Department of Pediatrics, Faculty of Medicine, Chiang Mai University for her suggestion in sample size calculation and data analysis.

Authors’ contribution

Pomrop M contributed to conceptualizing and designing the study, acquisition and analysis of the data, draft the manuscript. Manopunya S contributed to conceptualizing and designing the study, analysis and interpretation the data and extensive revision the manuscript. Tantiprabha W, Khuwuthyakorn V and Kosarat S contributed to assistant the study design and critically revision the manuscript. Natesirinilkul R contributed to conceptualizing and critically revision the manuscript. All authors approved the final manuscript as submitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).