Serum non-protein bound Iron:a useful prognostic marker of neonatal asphyxia

Four million infants suffer from birth asphyxia allover the world each year; of them, one million dies and a similar number will develop serious sequelae; including hypoxic ischemia encephalopathy [HIE]. A better understanding of the pathogenesis of this event and its early identification is highly required. The role of non-protein bound iron [NPBI], lactate, and other laboratory and clinical criteria as diagnostic and prognostic markers were studied. This study included 25 asphyxiated neonates and 25 healthy matched neonates as a control group. Both groups were subjected to clinical assessment, routine laboratory tests, serum lactate and NPBI measurements. Clinical follow-up was done every three months till the age of 1 year. Developmental screening test was done every six months using Denver Developmental Screening Test [DDST]. Serum lactate levels were found to be significantly higher in the HIE group compared to the control group [t = 15.13, P < 0.001].HIE group [were divided into mild [10], moderate [7] and severe [8]] according to sarnat classification and there was a significant elevation in serum lactate levels in severe HIE in comparison to mild cases [P< 0.05]. Statistical analysis of serum NPBI levels in control group and HIE group revealed that there was a significant increase of NPBI in HIE group in comparison to control group [t= 7.02 P < 0.001, t= 9.89 P < 0.001, t= 13.3 P < 0.001 for mild, moderate, and severe subgroups respectively]. One way anova test revealed a significant elevation of the level of NPBI with the increase of severity in the studied subgroups [mild, moderate and severe] indicating that there is a correlation between the level of NPBI and the severity of the clinical presentation of HIE [F= 52.37, P < 0.001]. ROC curve was used to test the performance and clinical value of NPBI for predicting neurodevelopment outcome, and it indicated reliable performance for NPBI [ROC area under curve was 0.95]. We found a significant negative correlation coefficient between the level of NPBI and pH [r = -0.5794, P< 0.001], Na[+][r = -0.06084, P< 0.05], Ca[++[r = -0.7511, P < 0.001], Apgar score at 1 minute [r = -0.5766, P < 0.001], Apgar score at 5 minute,[r = -0.5248, P < 0.001] and pO-2[--] [r = -0.2668, P < 0.05]. A positive correlation coefficient was found between the level NPBI and HCO3 [r = 0.3568, P < 0.05], urea [r = 0.2681, P < 0.05], creatinine [r = 0.5552, P < 0.001], p[co][2] [r = 0.6053, P < 0.001], lactate [r = 0.5927, P < 0.001], and K[+] [r = 0.0855, P < 0.05]. All HIE cases devoid of neurological complications [manifested by seizures] had a normal development m contrast to HIE cases which complained from seizures [75%, 9 of 12 cases] after 6 months, and [81.8%, 9 of 11 cases] after 12 months had developmental delay tested by DDST. All of neurologically complicated cases [presented with seizures] had a significant elevation of the serum level of NPBI [P < 0.001. Serum NPBI assay may be a reliable early indicator of infra and extra-uterine oxidative stress and brain injury, with a prognostic value regarding HIE. use of free iron scavengers may be indicated of those cases with increased NPBI and eventual threat of HIE occurrence with its catastrophic complications

Tratamiento de la anemia por deficiencia de hierro empleando proteína férrica en población pediátrica / Treatment iron deficiency anemia usingferric protein in pediatric population

Para evaluar la efectividad y la seguridad de la formulación farmacéutica de proteína férrica disponible en Venezuela para el control de la anemia por deficiencia de hierro, se desarrolló un estudio abierto en población pediátrica entre las edades de 1 a 9 años, 49 pacientes cumplieron 4 semanas de tratamiento, 45 acudieron a la visita de 8 semanas y 31 al control de las 12 semanas. La proteína férrica administrada oralmente a 2 mg/Kg de peso dos veces al día, indujo mejoría clínica y de laboratorio a partir de las 4 semanas de tratamiento. A las 4,8 y 12 semanas de tratamiento se demostró incremento significativo (p<0.001) de los valores de glóbulos rojos (3,9 + 0,3 vs. 5,1 + 0,3 x 10 elevado a la 6/ml), de hemoglobina (10,1 + 0,30 vs. 12,7 + 0,29 g/dl) y de hematocrito (32,4 por ciento + 1,2 vs. 37,8 por ciento + 0,64) así como del volumen corpuscular medio (62,7 + 5,5 vs. 83,4 + 1,7 mm3). La concentración de hierro sérico (73,2 + 6,8 vs. 123,4 + 12,8 mg/dl) y de ferritina (15,6 + 9,5 ng/ml) también aumentó significativamente (p<0.001). En ningún caso se requirió suspensión y/o reducción de la dosis. Los valores de ALT, AST, urea y creatina se mantuvieron dentro de rangos normales durante todo el período de seguimiento. Nuestros resultados confirman que la formulación farmacéutica de proteína férrica administrada por vía oral a la población pediátrica es efectiva y segura para el tratamiento de la anemia por deficiencia de hierro

Stimulation of iron uptake and Hb synthesis in iron deficient reticulocytes.

The effect of inhibitors and intermediates of heme synthesis, inhibitor of globin synthesis, and some iron proteins on in vitro iron uptake and haemoglobin synthesis by reticulocytes of iron deficient subjects was investigated in this study. Lead, INH, ALA, mesoprophyrin, ferritin and albumin substantially increased iron uptake by iron deficient reticulocytes, while cycloheximide and glycine depressed it. The results showed that it is possible to stimulate iron uptake and Hb synthesis in iron deficiency by substances other than iron; the most effective and remarkable of them was ferritin.