Hyperferritinemia among very-low-birthweight infants in Thailand: a prospective cohort study

Objectives: To determine the incidence of hyperferritinemia in VLBW infants, and its association with neonatal morbidity.Study design: Prospective cohort study in a tertiary-level hospital in Bangkok, from March 2022 to January 2023. Serum ferritin (SF) was measured in VLBW infants at one month and repeated monthly for those with hyperferritinemia (SF > 300 ng/mL).Results: Gestational age and birth weight were 29.7 +/- 2.4 weeks (mean +/- SD) and 1100 g (IQR, 830, 1340). Hyperferritinemia was identified in 30.1% (95% CI, 20.8-41.4). After adjustment, only packed red cell transfusion >15 mL/kg was associated with hyperferritinemia (RR 3.1; 95% CI, 1.5-6.4). All elevated SF levels returned to normal within four months. Hyperferritinemia was associated with severe bronchopulmonary dysplasia (RR 2.3, 95% CI, 1.0-5.4) and retinopathy of prematurity (RR 3.5, 95% CI, 1.4-8.6).Conclusion: Hyperferritinemia is common among our VLBW infants, particularly after transfusion, and is associated with severe BPD and ROP.