EVALUATION OF UMBILICAL CORD SERUM FERRITIN IN APPARENTLY HEALTHY PRETERM BABIES AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU

Abstract

Preterm delivery denies the newborn child the benefits of the intrauterine environment that are
needed to bring the baby to full maturity. One of such benefits is the accretion of iron, which occurs
maximally and progressively in the third trimester of pregnancy. Iron deficiency has negative
effects on growth, behaviour, cognition and immunity. Early detection of depleted iron stores and
timely iron supplementation can be beneficial. Iron stores can be assessed in the newborn, with a
great degree of accuracy, using serum ferritin. The prevalence of low serum ferritin amongst
preterm babies has been widely investigated in Europe and America. These studies show a wide
variation in serum ferritin levels. However, there is paucity of data on ferritin levels in preterms in
African and Nigerian literature.
Therefore, this study sought to determine the prevalence of low serum ferritin in apparently healthy
preterm babies delivered at UNTH, Enugu, using umbilical cord blood. It also sought to determine
the relationship between serum ferritin and gestational age, and birth weight, in preterm neonates.
Finally, it sought to determine the relationship between serum ferritin and gender in preterm
neonates delivered at UNTH Enugu.
Subjects were enrolled consecutively over a seven month period (June to December, 2014) until
the sample size was reached. Interviewer administered questionnaires were used to obtain
information from the mothers. The information collected were age, place of abode, education and
occupation, and the last menstrual period. Other information obtained included the presence of
risk factors for low maternal iron stores. Mothers who had none of these risk factors then had their
haemoglobin estimated. For those mothers whose haemoglobin was adequate, umbilical cord
blood of their neonates was obtained at delivery and assayed for haemoglobin, CRP and ferritin.

CRP was considered elevated at levels of more than or equal to 10mg/dl, while low serum ferritin
was serum ferritin less than 35µg/l. Data was collated and analysed using Statistical Package for
Social Sciences (SPSS) Version 20. Relationships between continuous variables were determined
using correlation and linear regression analysis. Means of continuous variable were compared
using student’s t-test, while associations between categorical variables were determined using chi
square and logistic regression analysis as applicable. All tests considered significant at p<0.05.
Results were presented using a combination of prose, tables, charts and scatter diagrams.
A total of 140 neonates were recruited into the study. There was a wide range in serum ferritin
levels in preterms (7µg/l -149.6µg/l). The mean serum ferritin was significantly lower in preterm
babies (63.13µg/l±23.93) compared with term babies (133.67µg/l)(p<0.001, t = 10.62). In
addition, a significantly higher proportion of preterms (35.7%) than term babies (8.6%) had low
serum ferritin levels (p<0.001). Also, there was a significant relationship between ferritin levels
and gestational age in preterm babies. The study also showed that a significant relationship exists
between serum ferritin and birth weight in preterms (r2 = 0.262). However, there was no statistical
significant difference in mean serum ferritin between males and females.
It is concluded that there is a wide range of serum ferritin levels in preterms. In addition, the
prevalence of low serum ferritin is high in preterms, and this increases with severity of prematurity
and lower birth weight. It is thus recommended that serum ferritin be routinely assayed in all
preterm and low birth weight neonates, and if found to be low, iron supplementation be considered.

EVALUATION OF UMBILICAL CORD SERUM FERRITIN IN APPARENTLY HEALTHY PRETERM BABIES AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU