Iron-Clad Care for Neonates: Precision Iron Supplementation Using Reticulocyte Hemoglobin Values, a Quality Improvement Project.

BACKGROUND: Iron is the most common nutrient deficiency globally, affecting nearly 2 billion people. It may cause long-term neurocognitive impairments and behavioral deficits in premature and low-birthweight neonates. Reticulocyte hemoglobin (Ret-He) is a reliable, valid, low-cost, and minimally invasive phlebotomy laboratory test for assessing iron status and guiding iron dosing. PURPOSE: The overarching aim is to standardize Ret-He use as a guide for precision iron supplementation that may increase the rate of iron sufficiency among infants born at less than 32 weeks of gestational age or 1500 grams within the neonatal intensive care unit. METHODS: The quality improvement project included the creation of an evidence-based algorithm, provider education, and an electronic medical record order set for individualized iron supplementation using Ret-He. The preimplementation data were retrospectively collected through an electronic medical record review. The postimplementation data were prospectively gathered, and all data were analyzed using IBM SPSS Statistics Software. RESULTS: There was a substantial increase in the number of Ret-He levels drawn from 77% to 100%. In the preimplementation group, 81.3% of patients with Ret-He levels at 37 weeks or discharge were iron-sufficient. However, 48.4% of patients did not have Ret-He levels measured. The postimplementation group had an 82.1% rate of iron sufficiency. IMPLICATION FOR PRACTICE AND RESEARCH: Ret-He can be used to guide iron dosing. Further research is needed to determine whether Ret-He values should differ for specific gestational ages or high-risk populations, such as small-for-gestational-age infants. Additional knowledge is needed on maximum iron doses and duration of intake.