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Description
EBP
Practice Problem: In a level 4 neonatal intensive care unit (NICU), no standardized method existed for identifying and treating iron deficiency (ID) in preterm or low birth weight (LBW) infants. Common practice was to adjust iron supplementation based on hematocrit levels, though this was not based on any formal protocol or guideline. ID of the brain in neonates may be associated with neurologic and developmental deficits. Thus, it is prudent to identify and treat early. In a recent survey, providers reported a lack of familiarity with biomarkers for early identification of ID.
Literature/Evidence: A comprehensive review of the literature utilizing PubMed was completed. This revealed that traditional hematological methods of monitoring for ID, such as hematocrit, may be poor indicators of brain iron status. Reticulocyte hemoglobin (Ret-He) is supported in the literature as a highly valuable method for early detection of ID in neonates. Recent benchmarking data revealed that approximately 40% of surveyed NICUs are using Ret-He to identify ID and about half have a standardized protocol for monitoring and treating ID.
Practice Change: Based on the evidence, an algorithm was created to provide guidelines for monitoring and treating ID using Ret-He levels. Education regarding use of the algorithm was provided to physicians, advanced practice providers, bedside nurses and dietitians.
Implementation/Pilot Testing: Routine ordering of Ret-He for eligible patients was trialed for 7 weeks, and the proposed algorithm was followed.
Outcomes/ Results: 32 patients met inclusion criteria during the pilot period. Ret-He orders were placed for 94% (30) of these patients. There were 6 occurrences of low Ret-He with hematocrit >30%, indicating early detection of ID. Iron supplementation was adjusted per the algorithm.
Recommendations/Conclusions: Review of published work, benchmarking data and pilot testing support the use of a standardized guideline with routine checking of Ret-He as best practice for identification and treatment of ID in preterm and LBW infants.
Publication Date
9-27-2024
Keywords
EBP, Evidence-Based Pracitce, Clinical Nurition, NICU
Disciplines
Pediatric Nursing
Recommended Citation
Mills, Rachel, "Ironing Out the Details: Early Detection and Treatment of Iron Deficiency in a Level 4 NICU" (2024). 2024. 33.
https://scholarlycollection.childrens.com/nursing-anf2024/33
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
