Early plasma ferritin concentrations are not associated with time to red cell transfusions in extremely and very preterm neonates: a prospective single-site observational study.

Abstract

Objective: To assess the relationship between plasma ferritin concentrations and (1) antenatal factors and (2) requirement for red cell transfusion.

Study design: This single-site prospective study recruited infants in the first week of life who were born <32 weeks' corrected gestational age and did not receive a red cell transfusion prior to sampling. Ferritin concentrations were assessed on discard plasma taken as part of routine neonatal investigations in the first week of life (median day of life=3, IQR 2-5 days). Reasons for delivery, placental histology and demographics were recorded.

Results: Plasma ferritin concentrations were not significantly associated with birth weight or gestational age in this cohort of extremely/very preterm neonates (n=114: n=26, <28 weeks' corrected gestational age; n=88, 28-32 weeks' corrected gestational age). Neonates exposed to chorioamnionitis had an increased ferritin concentration versus those who were not. Neonates exposed to pre-eclampsia had a significantly lower ferritin concentration than those who were not. Early ferritin concentration was not associated with time to transfusion in a time to event analysis.

Conclusions: Plasma ferritin concentrations in very/extremely preterm neonates are variable and associated with the intrauterine environment. Ferritin concentration was not predictive of time to transfusion in this cohort and was not significantly different at smaller birth weight or earlier gestation. This is important for considerations of iron storage in very preterm neonates and its developmental consequences.