Question:
A 1.4 kg preterm infant presents with anemia and marked reticulocytosis at 6 weeks of life. Which nutrient deficiency is the most likely cause?
A 1.4 kg preterm infant presents with anemia and marked reticulocytosis at 6 weeks of life. Which nutrient deficiency is the most likely cause?
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Iron Supplementation in Preterms:
$\bullet$ Dose: $2\text{--}4\text{ mg/kg/day}$ of elemental iron.
$\bullet$ Timing: Start at $2\text{--}4\text{ weeks}$ of life in all infants born $<37$ weeks or weighing $<2.5\text{ kg}$ and continue until 12 months.
$\bullet$ Dose: $2\text{--}4\text{ mg/kg/day}$ of elemental iron.
$\bullet$ Timing: Start at $2\text{--}4\text{ weeks}$ of life in all infants born $<37$ weeks or weighing $<2.5\text{ kg}$ and continue until 12 months.
Updated On: Sep 3, 2026
- Iron
- Copper
- Zinc
- Vitamin B12
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The Correct Option is A
Solution and Explanation
Concept:
Preterm infants are born with significantly reduced body stores of iron because approximately two-thirds of fetal iron accretion occurs during the third trimester of pregnancy.
Anemia in low-birth-weight preterm infants results from early iron depletion combined with rapid postnatal growth and iatrogenic phlebotomy blood losses.
Explanation:
• Preterm infants weighing $<1.5\text{ kg}$ (Very Low Birth Weight, VLBW) exhaust their meager transplacental iron stores by $6\text{ to }8\text{ weeks}$ of life due to rapid post-natal body growth and expanded blood volume.
• Iron deficiency is the most prevalent nutritional deficiency leading to early-onset microcytic anemia in preterm infants if prophylactic iron supplementation is not initiated by 2--4 weeks of chronological age.
• In response to declining hemoglobin levels and tissue hypoxia, endogenous erythropoietin secretion increases, stimulating active erythropoiesis in the bone marrow that manifests with marked reticulocytosis.
• Copper deficiency can also produce anemia and neutropenia but typically manifests later ($>3\text{--}6\text{ months}$) with associated skeletal changes (osteopenia, cupping of metaphyses).
• Vitamin B12 deficiency causes megaloblastic anemia with inappropriately low reticulocyte counts.
• Standard guidelines recommend daily enteral elemental iron supplementation ($2\text{--}4\text{ mg/kg/day}$) for all VLBW infants starting at 2 to 4 weeks of life through the first year.
Final Answer:
Iron deficiency is the most common nutrient deficiency causing anemia with compensatory reticulocytosis in very low birth weight preterm infants.
Preterm infants are born with significantly reduced body stores of iron because approximately two-thirds of fetal iron accretion occurs during the third trimester of pregnancy.
Anemia in low-birth-weight preterm infants results from early iron depletion combined with rapid postnatal growth and iatrogenic phlebotomy blood losses.
Explanation:
• Preterm infants weighing $<1.5\text{ kg}$ (Very Low Birth Weight, VLBW) exhaust their meager transplacental iron stores by $6\text{ to }8\text{ weeks}$ of life due to rapid post-natal body growth and expanded blood volume.
• Iron deficiency is the most prevalent nutritional deficiency leading to early-onset microcytic anemia in preterm infants if prophylactic iron supplementation is not initiated by 2--4 weeks of chronological age.
• In response to declining hemoglobin levels and tissue hypoxia, endogenous erythropoietin secretion increases, stimulating active erythropoiesis in the bone marrow that manifests with marked reticulocytosis.
• Copper deficiency can also produce anemia and neutropenia but typically manifests later ($>3\text{--}6\text{ months}$) with associated skeletal changes (osteopenia, cupping of metaphyses).
• Vitamin B12 deficiency causes megaloblastic anemia with inappropriately low reticulocyte counts.
• Standard guidelines recommend daily enteral elemental iron supplementation ($2\text{--}4\text{ mg/kg/day}$) for all VLBW infants starting at 2 to 4 weeks of life through the first year.
Final Answer:
Iron deficiency is the most common nutrient deficiency causing anemia with compensatory reticulocytosis in very low birth weight preterm infants.
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