Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain.
Pediatr Blood Cancer. 2024 Jan;71(1):e30734. doi: 10.1002/pbc.30734. Epub 2023 Oct 25.
Anemia is extremely common among patients admitted to pediatric intensive care. Alternative treatments to transfusions such as intravenous iron must be considered. There are no published data for a prospective intravenous (IV) iron study focused in the critically ill children. The objective is to examine the safety and efficacy of intravenous iron sucrose infusion to manage anemia in pediatric critical care. A secondary objective is to examine the effect of different dose regimens of iron sucrose (3, 5, and 7 mg/kg dose).
Prospective investigation of intravenous iron sucrose utilization at a tertiary pediatric intensive care unit between October 2017 and November 2022.
In all 115 patients received a total of 616 infusions of IV iron. Transferrin saturation index (TSI) was the most common altered iron deficiency biomarker (91.8%). After IV iron treatment, hemoglobin showed a significant increase within a 30-day follow-up (9.2 vs. 11.6 g/dL, p < .001). There was also a significant improvement in TSI and serum iron (p < .001). Iron deficit replacement was higher in the 7 mg/kg dose group (94%) compared to 85.9% in the 5 mg/kg regimen and 77.5% in the lower dose group (p = .008), requiring less doses and a shorter time. Very few mild adverse reactions were reported (1.3% of infusions), with no differences between groups. The most frequent adverse effect was gastrointestinal in three cases. There were no anaphylaxis-like or other serious/life-threatening adverse effects.
This is the first study to evaluate intravenous iron therapy in pediatric critical care, providing preliminary evidence of safety and efficacy of IV iron sucrose. The 7 mg/kg dose regimen showed higher iron deficit replacement in a shorter time, which could be beneficial in critically ill children.
贫血在儿科重症监护病房的患者中极为常见。必须考虑替代输血的治疗方法，如静脉内铁剂。目前尚无针对危重症儿童的前瞻性静脉（IV）铁剂研究的发表数据。本研究旨在评估静脉注射蔗糖铁输注治疗儿科重症监护贫血的安全性和有效性。次要目标是研究不同剂量蔗糖铁（3、5 和 7mg/kg 剂量）方案的效果。
2017 年 10 月至 2022 年 11 月，对一家三级儿科重症监护病房静脉注射蔗糖铁利用情况进行前瞻性调查。
所有患者共接受了 616 次 IV 铁输注。转铁蛋白饱和度指数（TSI）是最常见的改变铁缺乏生物标志物（91.8%）。静脉铁治疗后，30 天随访时血红蛋白显著增加（9.2 与 11.6g/dL，p<.001）。TSI 和血清铁也有显著改善（p<.001）。7mg/kg 剂量组的铁缺乏替代率（94%）高于 5mg/kg 方案（85.9%）和较低剂量组（77.5%）（p=.008），需要更少的剂量和更短的时间。仅报告了极少数轻度不良反应（1.3%的输注），各组之间无差异。最常见的不良反应是胃肠道反应，有三例。没有发生过敏样或其他严重/危及生命的不良反应。
这是第一项评估儿科重症监护中静脉铁治疗的研究，为静脉注射蔗糖铁的安全性和有效性提供了初步证据。7mg/kg 剂量方案在更短的时间内显示出更高的铁缺乏替代率，这可能对危重症儿童有益。
