My son is 14 weeks old, 6 weeks old adjusted age (he was 8 weeks early). Due to being premature and therefore more likely to have low iron, we had his iron levels checked through a blood draw. His hemaglobin came back at 8.5, but his ferritin levels were normal. It is my understanding that normal ferritin levels mean that he has normal iron stores, and therefore is not low on iron but the low hemoglobin indicates his body is not using the iron it has. Is this correct? The pediatrician recommended we start my son on iron supplements but is that really THE best course of action? What can cause low hemoglobin when ferritin levels are normal?
There is nothing to worry about. This is a normal physiologic process that occurs in all newborns but in premature infants, the drop in Hgb occurs a little earlier and is greater. Preemies drop their Hgb to about 8 gm/dL around the 4-8 week mark. Full term infants drop to an average of 11.5 gm dL, by 6-10 weeks. This phenomenon is called nadir. The drop does not occur because of lack of iron stores, instead the production of red blood cells drops off to allow the infant to adapt to life outside the uterus. This is referred to as the reticulocyte production and it drops from 6-10% down to < 1%, by 5 days of age. Your baby's Hgb actually reflects that he is starting to climb back up from his lowest point. Your pediatrician should have explained this to you so as not to cause you undue worry. Give your son the iron, as prescribed. Good luck and enjoy your little miracle.
If it is a normal occurance, then why does he need the supplemental iron? I am okay with giving it to him if he needs it, but if he doesn't need it then I don't want to. If he was older I would be less hesitant but he still very young with an open gut. If th levels are going back up on their own, what good will the supplemental iron do? What harm is there if I don't give it to him and we keep a close eye on his levels to make sure they aren't going down?
ETA: I'd also be interested in reading more about what you are talking about if you happen to have any resources available. Thanks!
Great questions. Your first question about whether the iron supplementation is required really depends on what your are feeding your son. Is he breastfed or receiving formula? Breast fed babies generally require no extra iron supplementation. Some formulas have iron but some don't. Most pediatricians will prescribe iron if your baby is receiving a formula that does not contain iron.
The second issue is that preemies are more prone to iron deficiency anemia. The fetus receives its iron stores from his mother during the last trimester of pregnancy. If the baby comes too early, then he did not receive that store of iron that should maintain them through their first 6 months. Once babies start to eat solids, they often will take a iron supplementation. Solid baby foods are often low in iron.
I would, definitely, voice your concerns to your pediatrician and make a decision together. I don't know all of your baby's medical history but your doctor does and he would have a much better idea of what your little guy needs. If you would rather take a wait and see attitude, let you MD know.
If you want to read more about the natural drop in Hgb in infants, just type these into a search engine and you will get many hits. All the best.
Thanks.. I tried to do a quick search and didn't come up with much but I will tweak my keywords and try again. He is exclusively on breastmilk, which I know has much more bioavailable iron than formulas or supplements. His ped, unfortunately, seems to think breastmilk has no iron and all breastfed babies need iron supplements to begin with, so we are butting heads on that. It is hard to get a real answer out of him regarding our situation when he thinks all babies need supplemental iron regardless of their lab results. I brought him evidence-based articles with cited sources on the bioavailability of iron in breastmilk and that most breastfed babies don't need supplemental iron, but he's still stuck in the "all breastfed babies need supplemental iron" mentality. Very frustrating.
Maybe you need to find a new pediatrician. Maybe this doctor's philosophies are not really in line with your own. You will be seeing your pediatrician for many years and you need someone that you can work with.
I would post some of the links for articles on nadir etc, but I don't think it is allowed. Against the posting rules. Try searching "nadir in newborns", "physiologic drop of Hgb in newborns", or "normal iron levels in the newborn and premature infant". I think you will find plenty to read.
Thanks for your help. A couple other things that I thought were unrelated, but now I'm not so sure.. he had intestinal surgery the day he was born. I'm starting to find that possibly surgery can lower the hemoglobin value? But it seems like that wouldn't still be a factor 14 weeks later. Maybe I'm wrong. The other thing is, he has swollen lymph nodes in his neck that have been there since shortly after we brought him home from the hospital, so about 10 weeks. Two different doctors just said it was fine and nothing to worry about, but now I'm seeing some links between low hemoglobin and enlarged lymph nodes. Any insights on that?