Meeting the Iron Needs of Low and Very Low Birth Weight Infants
Meeting the Iron Needs of Low and Very Low Birth Weight Infants
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DOI：
10.1159/000480741
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发表时间：
2017-01-01
影响因子：
3.9
通讯作者：
Domellof, Magnus
中科院分区：
文献类型：
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作者：
Domellof, Magnus
低出生体重（LBW）定义为出生体重<2，500 g，影响所有新生儿的16%，是神经发育受损以及不良心血管和代谢结果（包括高血压）的风险因素。LBW婴儿包括足月儿、小于胎龄儿和早产儿。大多数LBW婴儿只有轻微的LBW（2，000 - 2，500 g）。新生儿护理方面的最新进展显著改善了极低出生体重婴儿（<1 500 g）的存活率。由于出生时铁储存量低和快速生长引起的铁需求量高，LBW婴儿处于铁缺乏症的高风险中。使用析因方法，估计低体重婴儿的铁需求量为1-2 mg/kg/天，这比足月正常出生体重婴儿的需求量高得多，后者在生命的前6个月几乎不需要膳食铁。在VLBW婴儿中，与新生儿重症监护相关的失血和输血以及促红细胞生成素治疗将极大地影响铁状态和铁需求。出生时脐带夹紧的时间对于从胎盘向新生儿输血的量以及由此产生的全身铁非常重要。低出生体重儿延迟脐带钳夹与输血需求减少、脑室内出血减少和坏死性小肠结肠炎减少相关。随机对照试验表明，需要1-3 mg/kg/天的铁摄入量（轻度LBW为1-2 mg，VLBW为2-3 mg）才能有效预防铁缺乏症。最近有一些证据表明，这些铁摄入量将防止与LBW相关的一些负面健康后果，特别是行为问题和其他神经发育结果，甚至可能是高血压。然而，避免过量的铁摄入也很重要，这与LBW婴儿的不良反应有关。(c)2017 S. Karger AG，巴塞尔
Low birth weight (LBW), defined as a birth weight of < 2,500 g, affects 16% of all newborns and is a risk factor for impaired neurodevelopment as well as adverse cardiovascular and metabolic outcomes, including hypertension. LBW infants include both term, small for gestational age infants and preterm infants. Most LBW infants have only marginally LBW (2,000-2,500 g). Recent advances in neonatal care have significantly improved the survival of very LBW (VLBW) infants (< 1,500 g). LBW infants are at high risk of iron deficiency due to low iron stores at birth and higher iron requirements due to rapid growth. Using a factorial approach, iron requirements of LBW infants have been estimated to be 1-2 mg/kg/day, which is much higher than the requirements of term, normal birth weight infants, who need almost no dietary iron during the first 6 months of life. In VLBW infants, blood losses and blood transfusions related to neonatal intensive care, as well as erythropoietin treatment, will greatly influence iron status and iron requirements. The timing of umbilical cord clamping at birth is of great importance for the amount of blood transfused from the placenta to the newborn and thereby total body iron. Delayed cord clamping of LBW infants is associated with less need for blood transfusion, less intraventricular hemorrhage, and less necrotizing enterocolitis. Randomized controlled trials have shown that an iron intake of 1-3 mg/kg/day (1-2 mg for marginally LBW and 2-3 mg for VLBW) is needed to effectively prevent iron deficiency. There is some recent evidence that these levels of iron intake will prevent some of the negative health consequences associated with LBW, especially behavioral problems and other neurodevelopmental outcomes and possibly even hypertension. However, it is also important to avoid excessive iron intakes which have been associated with adverse effects in LBW infants. (c) 2017 S. Karger AG, Basel