677 - Title: Serum Ferritin and Reticulocyte Hemoglobin Equivalent as Biomarkers for Iron Deficiency in Neonates Born to Iron-Depleted Mothers

Publication Number: 677.6744

Reeta Bora, Assam Medical College, Dibrugarh, Dibrugarh, Assam, India; Shruti Kashyap, Assam Medical College and Hospital, Dibrugarh, Assam, India

Background:

Background: Iron deficiency (ID) in infancy, even without anemia, is associated with long-term neurocognitive impairment. Screening for ID by measuring hemoglobin (Hgb) delays detection. Serum-ferritin level may be affected by inflammation. Reticulocyte hemoglobin equivalent(RET-He) reflects real-time bone-marrow iron status.

Objective: Present study evaluated whether Ret-He can detect ID earlier than serum ferritin and whether cord blood RET-He can predict neurodevelopmental outcome(NDO) at 6months of age in infants born in a population with high prevalence of ID.

Design/Methods: This hospital-based Case-Control Study was performed in newborn-unit of northeast-India over one year period. Anemic (Hgb < 110g/L and non-anemic (Hgb >110g/L) term expectant mothers attending labour-room and their neonates were enrolled. RET-He, complete hemogram& iron profile were determined in cord blood, ,48-72hrs, 6 weeks & 6 months age in exclusively breastfed infants. Ages-and-Stages Questionnaire-3 was used for neurodevelopmental assessment at 6months.

Results: Among 111neonates compared to infants of non-anemic mothers(n=64) mean cord RET-He(11.2+0.5pg) was significantly lower in infants of anemic mothers(n=47)(9.3 +1.4 pg), and also at rest of 3 timepoints, (p < 0.001). Cord RET-He < 10.6 pg was the strongest determinant of anemia at 6m (sensitivity,86%; specificity,69%). Cord blood & 48-72 hr RET-He were best predictors of impairment in communication & gross motor skills, respectively, at 6m age.

Conclusion(s): Cord and 48 hrs RET-He values in non-anemic group was lower than Western normative data, probably due to high prevalence of ID in study population. Serum-ferritin is a poor predictor of anaemia and Neuro developmental outcome. RET-He is an early marker of ID & neurodevelopment outcome in infants. In neonates born to iron depleted population, using RET-He as a biomarker for early detection of ID to decide iron supplementation can be an area for research.

Table 1.
Maternal and neonatal demographic profile

Table 2:
Cord blood haematological parameters in infants of anemic and non anemic mothers

Fig 1
ROC curve to predict anemia at infant's six months of age. Cord RET-He <10.6 pg was the strongest determinant of anemia at 6m (sensitivity,86%; specificity,69%).