Reticulocyte-Hemoglobin Content as Marker for Iron Status in Preterm Neonates

Abstract Background Reticulocyte indices and reticulocyte hemoglobin provide a direct real time measure of hemoglobinization in newly produced erythrocytes, without perturbation by inflammation. It has been a reliable indicator of iron availability for Hb synthesis in children and adults. Aim of the Work To assess the average RET-Hb values in premature neonates soon after birth, to assess its value as marker of iron deficiency (ID) and to correlate these levels with the need for early iron supplement and/or blood transfusion. Patients and Methods This is a prospective observational study conducted at Neonatal Intensive Care Unit (NICU), Ain Shams University Children Hospital from March 2022 till September 2022. Results The study included 22 females (44.0%) and 28 males (56.0%) with mean gestational age of 31.84±1.60 weeks. The mean HGB level on admission was 16.76 ± 2.16 mg/dL, with 24.0% of neonates having an HGB level <15 mg/dL and the mean Ret-HB level for preterm neonates was 31.70 ± 2.68 pg/cell. The median serum ferritin level was 168 (IQR: 125 – 225) ng/mL and ferritin was positively correlated with Ret-Hb. Almost 58% (n = 29) required iron supplements in the first 2-4 weeks of life and 64% of neonates required packed red cell transfusion during their hospitalization. Ret-Hb at a cut off level of ≤ 30.4 pg/cell can predict early enteral iron supplement among the studied group at the cut off level with sensitivity of 52.4%, specificity of 75.9% and with a cut off level < 30.8pg/cell can predict the need for blood transfusion among the studied group with sensitivity of 56.25% and specificity of 83.33%. Conclusion Ret-Hb levels in preterm neonates was significantly correlated with ferritin levels. Ret-Hb could be a reliable marker of iron deficiency and helps in early enteral iron supplement for this age group but normal reference ranges should be standardized.