Do Extremely Low Gestational Age Neonates Regulate Iron Absorption via Hepcidin?

Abstract

OBJECTIVES\nTo evaluate whether extremely preterm infants regulate iron status via hepcidin.\n\n\nSTUDY DESIGN\nA retrospective analysis of infants from the Preterm Epo Neuroprotection (PENUT) Trial. Urine hepcidin (Uhep) normalized to creatinine (Uhep/UCr) was evaluated among infants randomized to erythropoietin (Epo) or placebo.\n\n\nRESULTS\nThe correlation (r) between Uhep/UCr and serum markers of iron status (ferritin and zinc protoporphyrin-to-heme ratio (ZnPP/H)) and iron dose was assessed. A total of 243 urine samples from 76 infants born at 24-27 6/7 weeks gestation were analyzed. Median Uhep/UCr was 0.3, 1.3, 0.4 and 0.1 ng/mg at baseline, 2, 4 and 12 weeks, respectively, in placebo-treated infants. Median Uhep/UCr values in Epo-treated infants were not significantly different, with the exception of the 2-week time point (median Uhep/UCr 0.1 ng/mg, p<0.001). A significant association was seen between Uhep/UCr and ferritin at 2 and 4 weeks (r= 0.63, p<0.001 at 2 weeks, r=0.41, p=0.01 at 4 weeks) and ZnPP/H at 2 weeks (r=-0.49, P = .002).\n\n\nCONCLUSIONS\nUhep/UCr values correlate with serum iron markers. Uhep/UCr values vary over time and are affected by treatment with Epo, suggesting that EP neonates can regulate hepcidin and therefore their iron status. Uhep is suppressed in EP neonates, particularly those treated with Epo.