Koletzko B, Poindexter B, Uauy R (eds): Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. World Rev Nutr Diet. Basel, Karger, 2014, vol 110, pp 121–139 (DOI: 10.1159/000358462)
Nutritional Care of Premature Infants: Microminerals Magnus Domellöf Division of Pediatrics, Department of Clinical Sciences, Umea University, Umea, Sweden Reviewed by Christoph Fusch, Department of Pediatrics, McMaster University, Hamilton, Ont., Canada; Alexandre Lapillonne, Paris Descartes University, APHP Necker Hospital, Paris, France
Abstract Microminerals, including iron, zinc, copper, selenium, manganese, iodine, chromium and molybdenum, are essential for a remarkable array of critical functions and need to be supplied in adequate amounts to preterm infants. Very low birth weight (VLBW) infants carry a very high risk of developing iron deficiency which can adversely affect neurodevelopment. However, a too high iron supply in iron-replete VLBW infants may induce adverse effects such as increased infection risks and impaired growth. Iron needs are influenced by birth weight, growth rates, blood losses (phlebotomy) and blood transfusions. An enteral iron intake of 2 mg/kg/day for infants with a birth weight of 1,500–2,500 g and 2–3 mg/kg/ day for VLBW infants is recommended. Higher doses up to 6 mg/kg/day are needed in infants receiving erythropoietin treatment. Regular monitoring of serum ferritin during the hospital stay is advisable. Routine provision of iron with parenteral nutrition for VLBW infants is not recommended. Less certainty exists for the advisable intakes of other microminerals. It appears prudent to provide enterally fed VLBW infants with daily amounts per kilogram body weight of 1.4–2.5 mg zinc, 100–230 μg copper, 5–10 μg selenium, 1–15 μg manganese, 10–55 μg iodine, 0.03–2.25 μg chromium, and 0.3–5 μg molybdenum. © 2014 S. Karger AG, Basel Future scientific findings may justify deviations from these suggested ranges.
Microminerals, including iron, zinc, copper, selenium, manganese, iodine, chromium and molybdenum, are essential for a remarkable array of critical functions in humans. On the other hand, several of these elements can also be toxic at high concentrations. Therefore, it is important to carefully define requirements in order to avoid both deficiencies and adverse effects.
Preterm infants are at high risk of iron deficiency (ID), which may have adverse effects on brain development and function. However, in contrast to most other nutrients, there is no mechanism for excretion of iron from the human body and iron is a high-
Downloaded by: UCLA Biomedical Library 128.97.90.221 - 4/30/2014 12:07:33 PM
Iron
Iron overload: S-ferritin, µg/l Iron deficiency: S-ferritin, µg/l Anemia: Hb, g/l
Newborn
2 months
4 months
6–24 months
>300
Nutritional Care of Premature Infants: Microminerals Magnus Domellöf Division of Pediatrics, Department of Clinical Sciences, Umea University, Umea, Sweden Reviewed by Christoph Fusch, Department of Pediatrics, McMaster University, Hamilton, Ont., Canada; Alexandre Lapillonne, Paris Descartes University, APHP Necker Hospital, Paris, France
Abstract Microminerals, including iron, zinc, copper, selenium, manganese, iodine, chromium and molybdenum, are essential for a remarkable array of critical functions and need to be supplied in adequate amounts to preterm infants. Very low birth weight (VLBW) infants carry a very high risk of developing iron deficiency which can adversely affect neurodevelopment. However, a too high iron supply in iron-replete VLBW infants may induce adverse effects such as increased infection risks and impaired growth. Iron needs are influenced by birth weight, growth rates, blood losses (phlebotomy) and blood transfusions. An enteral iron intake of 2 mg/kg/day for infants with a birth weight of 1,500–2,500 g and 2–3 mg/kg/ day for VLBW infants is recommended. Higher doses up to 6 mg/kg/day are needed in infants receiving erythropoietin treatment. Regular monitoring of serum ferritin during the hospital stay is advisable. Routine provision of iron with parenteral nutrition for VLBW infants is not recommended. Less certainty exists for the advisable intakes of other microminerals. It appears prudent to provide enterally fed VLBW infants with daily amounts per kilogram body weight of 1.4–2.5 mg zinc, 100–230 μg copper, 5–10 μg selenium, 1–15 μg manganese, 10–55 μg iodine, 0.03–2.25 μg chromium, and 0.3–5 μg molybdenum. © 2014 S. Karger AG, Basel Future scientific findings may justify deviations from these suggested ranges.
Microminerals, including iron, zinc, copper, selenium, manganese, iodine, chromium and molybdenum, are essential for a remarkable array of critical functions in humans. On the other hand, several of these elements can also be toxic at high concentrations. Therefore, it is important to carefully define requirements in order to avoid both deficiencies and adverse effects.
Preterm infants are at high risk of iron deficiency (ID), which may have adverse effects on brain development and function. However, in contrast to most other nutrients, there is no mechanism for excretion of iron from the human body and iron is a high-
Downloaded by: UCLA Biomedical Library 128.97.90.221 - 4/30/2014 12:07:33 PM
Iron
Iron overload: S-ferritin, µg/l Iron deficiency: S-ferritin, µg/l Anemia: Hb, g/l
Newborn
2 months
4 months
6–24 months
>300
