Anemia, Hepcidin, and Vitamin D in Healthy Preterm Infants: A Pilot Study

Abstract

Objective The etiology of anemia in premature neonates is multifactorial and may involve anemia of inflammation mediated by hepcidin. Hepcidin expression is suppressed by vitamin D. We aimed to investigate the interrelationship between hepcidin, anemia, and vitamin D status in preterm infants.

Study Design Preterm infants aged 1 to 5 weeks were prospectively recruited at the neonatal intensive care unit of the Dana Dwek Children Hospital. Blood counts and serum levels of hepcidin, ferritin, iron, 25-hydroxyvitamin D [25(OH)D] and C-reactive protein (CRP) were measured and compared between anemic and nonanemic preterm infants.

Results Forty-seven preterm infants (mean ± standard deviation gestational age at birth 32.8 ± 1.1 weeks, 66% males) were recruited. In total, 36% of the preterm infants were vitamin D deficient [25(OH)D < 20 ng/mL] and 15% were anemic. Hepcidin levels were significantly higher in anemic premature infants than in the nonanemic group (55.3 ± 23.9 ng/mL vs. 30.1 ± 16.3 ng/mL, respectively, p < 0.05). No differences were found in iron, ferritin, 25(OH)D, and CRP levels between anemic and nonanemic premature newborn infants. A positive correlation was found between hepcidin and ferritin (R ² = 0.247, p = 0.02) and a negative correlation was found between 25(OH)D and CRP (R ² = 0.1, p = 0.04). No significant correlations were found between 25(OH)D and hepcidin, iron, ferritin, or CRP.

Conclusion Anemia of prematurity was associated with high hepcidin serum levels. The exact mechanisms leading to anemia and the role of vitamin D warrant further investigation.

Key Points

• Hepcidin levels were significantly higher in anemic premature infants.

• A positive correlation was found between hepcidin and ferritin.

• Negative correlation was found between 25(OH)D and CRP.

Keywords

preterm infants - vitamin D - serum hepcidin - anemia

Note

This study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving research study participants were approved by the Helsinki ethics committee. Written informed consent was obtained from all participants.

Authors' Contributions

D.M. and R.L. conceptualized and designed the study and reviewed and revised the manuscript. H.M.L. and Y.K. designed the data collection instruments, collected data, performed the initial analyses, and drafted the initial manuscript, reviewed, and revised the manuscript. V.D. performed the Hepcidin analysis and supervised data collection. A.H. and A.O. conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publication History

Received: 14 January 2021

Accepted: 11 March 2021

Article published online:
03 May 2021

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