新生児に対する鉄剤投 与のガイドライン 2017

1 2017 1 4 8 1950 (EBM) 2003 Fenton 2013 Minds 2014 2 P1 P2 P3 P4 P5

2 P7 P7 P8 P9 P12 P12 P12 P12 P13 P13 P13 P14 P15 P15 P15 CQ1 P16 CQ2 P19 CQ3 P24 CQ4 P26 CQ5 P29 CQ6 P31 CQ7 P35 CQ8 P38 P39 P39 P39 3 50 4 CQ1 1-1 C 1-2 C CQ2 2 100ml/kg/ R 2-3mg/kg/ 6mg/kg/ C 2-1 2-2 CQ3 3

3 C CQ4 4 C CQ5 5 C CQ6 6 C CQ7 7 CQ8 8 D 5 AAP American Academy of Pediatrics ABR Auditory Brainstem Responses AOP Anemia of prematurity BPD Bronchopulmonary Dysplasia BW Birth Weight CBCL Child Behavior Checklist CHr Reticulocyte Hemoglobin Content CLD Chronic Lung Disease CQ Clinical Question CRP C-Reactive Protein C EBM Evidence Based Medicine ELBWI Extremely Low Birth Weight Infant GA Gestational Age Hb Hemoglobin Hct Hematocrit ID Iron Deficiency IDA Iron Deficiency Anemia IQ Intelligence Quotient IM Intramuscular Injection IVH Intraventricular

4 Hemorrhage LBWI Low Birth Weight Infant MA Meta Analysis MCH Mean Corpuscular Hemoglobin MCHC Mean Corpuscular Hemoglobin Concentration MCV Mean Corpuscular Volume MDI Mental Development Index NEC Necrotizing Enterocolitis NICU Neonatal Intensive Care Unit NNT Number Need to Treat PICO Patient Intervention Control Outocome PDI Physical Development Index PO Per Os PVL Periventricular Leukomalacia OR Odds Ratio RCT Randomized Controlled Trial Ret Reticulocyte 6 RD Risk Difference RDW Red Cell Distribution Width rHuEPO Recombinant Human Erythropoietin ROP retinopathy of prematurity ROS Reactive Oxygen Species RR Relative Risk SR Systematic Review sTfR Soluble Transferrin Receptor TfR-1 Transferrin Receptor TIBC Total Iron Binding Capacity UIBC Unsaturated Iron Binding Capacity VLBWI Very Low Birth

5 Weight Infant WPPSI-III Wechsler Preschool and Primary Scale of Intelligence WPPSI 3 ZnPP Zinc Protoporphyrin 95%Cl 95% Confidence Interval 95% 7 1) 25 85% (1) VLBWI Hb Hb 4 8 ELBWI 2 4 8 1950 2) 2-1) (3) 23 63 g/L 41 171 g/L (4) IUGR (4) 5 (5) 2-2) 70 80% C (6) 2-3) (7) (7) (7) C 119 251 g/100mL (8) (9) 800 g/mL 10mg/100g 1 (10) 45 100 10 (11) (12) 2-4)

6 8 1 2 3 1 (pinocytosis) (7) (7) (13) (14) (7) (7) 2-5) ID IDA 1 ID IDA (15) ID IDA (16) ID ( ) 5 Hb 11g/dL MCV 74fL (CHr) (RDW) 14% ( 6 ) ZnPP/heme 80 mol/mol ( 6 ) IDA ( ) 3 +CRP 40 g/L( 2 ) 20 g/L( 4 ) 10 g/L( 6 ) 5 g/L( 9 ) (TfR-1) 11 g/L (TfS) 10% 3) 1mL/kg 1mg/kg (17) 10 20mL/kg 5 20mg/kg 9 4) 4-1) (5)(18)(19) ID 37 75 g/L) (20)

7 ID (21)(22)(23) 76 g/L 5 (5) 6 ID ABR ID (25) 4-2) (25) Fenton NEC ROP PVL CLD 1 1. Rao R, Georgieff ML. Iron therapy for preterm infants. Clin ;36:27-42. 2. Lundstr m U, Siimes MA, Dallman what age does iron supplementation become necessary in low-birth-weight infants? J Pediatr. 1977;91:878-83. 3. Oski FA, Naiman JL. The hematologic aspects of the maternal-fetal relationship. in Hematologic problems in the newborn. Eds Oski FA, Naiman JL, WB Saunders ;32-55. 4. Lozoff B, Georgieff MK.

8 Review Iron deficiency and brain development. Semin Pediatr Neurol. 2006;13:158-65. ID IDA Hb MCV 10 5. T. Tamura, Goldenberg, J. Hou, et al. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr. 2002;140:165-70. 6. Oski FA. Iron requirements of the premature infants, in Viitamin and mineral requirements, ed Tsang RD, Marcel Dekker, New York. 1985;9-21. 7. Andrews NC. Disorders of iron metabolism. N Engl J Med. 1999;341:1986-95. 8. Yamawaki N, Yamada M, Kan-no T, et al. Macronutrient, mineral and trace element composition of breast milk from Japanese women.

9 J Trace Elem Med Biol. 2005;19:171-81. 9. Lonnerdal B. Effects of milk and milk components on calcium, magnesium, and trace element absorption during infancy. Physiol Rev. 1997;77:643-69. 10. Saarinen UM, Siimes MA, Dallman PR. Iron absorption in infants : Hemogrobin bioavailability of breast milk iron as indicated by the extrinsic tag method of iron absorption and by the concentration of serum ferritin. J Pediatr. 1977;91:36-39. 11. Lonnerdal B. Trace element nutrition of infants molecular approaches. J Trace Elem Med Biol. 2005;19(1):3-6. 12. Celada A,Busset R,Gutierrez J et al. No correlation between ironconcentration in breast milk and maternal iron stores. Helv Paediatr Acta. 1982;37:11-6. 13. Kuiper-Kramer EP, Baerts W, Bakker R et al. Evaluation of the iron status of the newborn by soluble transferrinreceptors in serum. Clin Chem Lab Med.

10 1998;36:17-21. 14. Olivares M, Walter T, Cook JD, et al. Usefulness of serum transferrin receptor and serum ferritin in diagnosis of iron deficiency in infancy. Am J Clin Nutr. 2000;72:1191-95. 15. Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0 3 years of age). Pediatrics 2010;126:1040-50. 16. Hernell O , Fewtrell MS, Georgieff MK et al. Summary of Current Recommendations on Iron Provision and Monitoring of Iron Status for Breastfed and Formula-Fed Infants in Resource-Rich a