Iron Absorption and Red Blood Cell Incorporation in Premature Infants Fed an Iron-fortified Infant Formula

This study was designed to identify differences in red blood cell (RBC) incorporation and iron absorption in premature infants between iron provided in a premature infant formula compared with iron provided as a supplement between feedings. We used a triple stable isotope technique in which 13 infants received 57Fe mixed with Enfamil Premature Formula on d 1 of the study, and 54Fe with a multivitamin supplement between meals on d 2. Two weeks later, blood was drawn for isotope analysis and 58Fe was given i.v. The percentage RBC incorporation of the 54Fe and 57Fe was calculated, and the percent absorption of these tracers was estimated by dividing by the percentage of 58Fe identified in RBCs 14 d after its infusion. We found a small, but significantly greater, percentage of RBC incorporation of the 54Fe given as a supplement compared with the 57Fe given in the formula (9.7 +/- 3.8% versus 7.8 +/- 3.1%, p = 0.02). The RBC 57Fe incorporation was closely correlated with the reticulocyte count (r = 0.80, p = 0.001), but not the serum ferritin or the Hb concentration. Approximately 68% of an i.v. dose of 58Fe was incorporated into RBCs. These findings indicate 1) iron is incorporated well into RBCs from preterm infant formula, with only a small increase in incorporation when given as a supplement, and 2) the reticulocyte count, but not the Hb concentration, is a good measure of RBC iron-incorporating capacity.