A new concern—in utero iron status

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Clinicians caring for preterm infants routinely evaluate the hematocrit/hemoglobin status at birth, track hematocrit/hemoglobin with postnatal age, transfuse as necessary, and supplement with oral iron. Questions remain about how much transfusion is “necessary” and when and how much iron to supplement. In this issue of The Journal, Amin et al have added a new wrinkle to concerns about iron status. They used cord blood ferritin measurements to identify fetal iron status of infants born preterm. Of 80 infants born between 27 and 33 weeks gestation, 44% had latent iron deficiency, which correlated with abnormal auditory neural maturation – a window to brain maturation. Iron deficiency is well known to be a modulator of brain development, and some prenatal conditions (maternal iron deficiency, maternal diabetes, maternal smoking, and pregnancy-induced hypertension) are linked to fetal iron deficits at term. This paper now identifies a new concern – latent iron deficiency in preterms at birth. Should this deficiency as measured by blood ferritin levels be quickly corrected after birth? Most preterm infants do not end up with hearing deficits as children, but the abnormal auditory maturation may simply be an indicator of more generalized abnormalities in brain maturation.