Iron supplementation and the risk of bronchopulmonary dysplasia in extremely low gestational age newborns

Independent Medical Monitor, PENUT Trial Consortium, PENUT Co-Investigators, PENUT Research Coordinators, University of Washington Data Coordinating Center, PENUT Executive Committee, Follow Up Committee

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The aim of this study was to determine the relationship between iron exposure and the development of bronchopulmonary dysplasia (BPD).

METHODS: A secondary analysis of the PENUT Trial dataset was conducted. The primary outcome was BPD at 36 weeks gestational age and primary exposures of interest were cumulative iron exposures in the first 28 days and through 36 weeks' gestation. Descriptive statistics were calculated for study cohort characteristics with analysis adjusted for the factors used to stratify randomization.

RESULTS: Of the 941 patients, 821 (87.2%) survived to BPD evaluation at 36 weeks, with 332 (40.4%) diagnosed with BPD. The median cohort gestational age was 26 weeks and birth weight 810 g. In the first 28 days, 76% of infants received enteral iron and 55% parenteral iron. The median supplemental cumulative enteral and parenteral iron intakes at 28 days were 58.5 and 3.1 mg/kg, respectively, and through 36 weeks' 235.8 and 3.56 mg/kg, respectively. We found lower volume of red blood cell transfusions in the first 28 days after birth and higher enteral iron exposure in the first 28 days after birth to be associated with lower rates of BPD.

CONCLUSIONS: We find no support for an increased risk of BPD with iron supplementation.

TRIAL REGISTRATION NUMBER: NCT01378273. IMPACT: Prior studies and biologic plausibility raise the possibility that iron administration could contribute to the pathophysiology of oxidant-induced lung injury and thus bronchopulmonary dysplasia in preterm infants. For 24-27-week premature infants, this study finds no association between total cumulative enteral iron supplementation at either 28-day or 36-week postmenstrual age and the risk for developing bronchopulmonary dysplasia.

Original languageEnglish (US)
JournalPediatric Research
Early online dateJun 20 2022
StateE-pub ahead of print - Jun 20 2022

Bibliographical note

Funding Information:
This work was funded by NINDS U01NS077955 and U01NS077953.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

PubMed: MeSH publication types

  • Journal Article
  • Clinical Trial
  • Research Support, N.I.H., Extramural


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