700 - Assessing the necessity for Iron deficiency screening at birth: Are we missing critical intervention opportunities?

Geetika Kennady, Thomas Jefferson University/Nemours Children's Health, Woolwich Township, NJ, United States; Rachel Huang, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Katherine C. Bodycot, Sidney Kimmel Medical College, Newark, DE, United States; Alaka Deshpande, Sidney Kimmel Medical College at Thomas Jefferson University, Wilimington, DE, United States; Daniel Bigley, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Emma Archer, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Vani Parthiban, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Rupsa Boelig, Thomas Jefferson University, Philadelphia, PA, United States; Zubair H. Aghai, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States

Background: Iron deficiency(ID) is a global health problem affecting 40% of children between 6-59 months of age. Iron is crucial for brain development and the neonatal brain undergoes rapid development making it vulnerable to adverse neurodevelopmental and neurobehavioral outcomes. Risk factors for neonatal ID include prematurity, small for gestational age (SGA), maternal diabetes, hypertensive disorders of pregnancy (HDP), maternal anemia, obesity, and smoking. The exact prevalence of ID at birth has not been well-studied. The current AAP guidelines do not routinely screen for ID and iron deficiency anemia (IDA) until 9-12 months of age. Hence, there is a need to study the role of screening, and diagnosis of ID at birth.

Objective: To determine the prevalence of ID at birth especially in infants at high risk for ID.

Design/Methods: This is a prospective study using umbilical cord blood samples. Complete blood count (CBC) with reticulocyte count, reticulocyte hemoglobin equivalent (Ret-He), serum ferritin, C-reactive protein (CRP), serum iron, and transferrin saturation (TS) were determined. High-risk groups include infants with one of the risk factors and the No-risk group is infants with no risk factors for neonatal ID. ID is defined as serum ferritin ≤50 ng/ml or TS ≤30%. We excluded non-viable preterm infants ( < 23 weeks) and prenatally known major congenital anomalies. The prevalence of ID in each risk group was determined. The clinical and hematological characteristics were compared using appropriate statistical tests.

Results: A total of 396 infants were enrolled, ID was present in 42 infants (10.6%) at birth. 11.2% of the high-risk infants and 8.1% of the no-risk infants were ID at birth. There was only one infant with IDA in this cohort. The prevalence of ID was 8.3% in prematurity, 10.4% in SGA, 13.5% in maternal diabetes, 12.9% in HDP, and 11.7% in maternal anemia (Table 1). The clinical and hematological parameters of the ID and the non-ID groups are depicted in Table 2 and high-risk and no-risk groups in Table 3. Ret-He and serum iron were lower in the ID group and Serum ferritin was lower in the high-risk group.

Conclusion(s): ID is common in neonates with a prevalence of 10.6% in the cohort and 11.2% in high-risk infants. Prioritizing early screening and identification of ID at birth provides a crucial window for timely treatment, potentially mitigating irreversible neurodevelopmental impairments that are less responsive to later interventions. Larger studies are essential to determine the need for universal vs selective ID screening.

Table 1: Prevalence of Iron deficiency in high-risk infants


Table 2: Clinical and hematological characteristics of iron-deficient and non-iron-deficient infants


Table 3: Clinical and hematological characteristics of high-risk and No-risk group infants