Iron supplementation in parenteral nutrition
Abstract:
Background: Pediatric patients with intestinal failure are at increased risk for iron deficiency. Supplementation is not routinely included in parenteral nutrition solutions. There is currently limited research related to the safety of iron supplementation in parenteral nutrition and for intravenous forms used in patients with intestinal failure. Current ASPEN and ESPGHAN guidelines promote the use of enteral iron, acknowledging the risks of using iron supplementation within parenteral nutrition admixtures.
Methods: We review a patient case and the current available literature related to iron in parenteral nutrition.
Results: Five major concerns are identified: peroxidation reactions, incompatibility, hypersensitivity, infection risk, and iron overload.
Conclusion: We propose an argument against the preferential use of iron supplementation within parenteral nutrition in children with intestinal failure when enteral supplementation or intermittent parenteral infusion may be sufficient.
Clinical relevancy statement: Pediatric patients with intestinal failure are at risk for iron deficiency anemia, anemia due to folate or B12 deficiency, vitamin B6 deficiency, copper deficiency, non-anemic iron deficiency, and anemia of inflammation. Iron status assessment and supplementation for these patients is variable over time. There are several biochemical and physiologic concerns about the safety of adding iron supplementation to parenteral nutrition admixtures. This paper briefly reviews the current available literature. Further research is needed to evaluate best practices for iron supplementation for pediatric patients with intestinal failure.
Reference:
Herdes RE, Oliveira SB, Kocoshis SA, Bernieh A, Namjoshi SS. Pitfalls of Iron Supplementation in Parenteral Nutrition Admixtures for Children with Intestinal Failure. JPEN J Parenter Enteral Nutr. 2022 Jun 22. doi: 10.1002/jpen.2428. Epub ahead of print. PMID: 35730416.