Development and Validation of A Screening Tool to Assess Iron Deficiency Anemia in the Preterm Infant

Abstract

Iron deficiency anemia is a common clinical concern for premature infants because fetal iron accretion occurs during the last weeks of pregnancy. To compound this problem, frequent blood sampling and low-iron alimentation are routine during the early neonatal period. Assessment of anemia based upon the established biochemical parameters may be inappropriate or lack specificity due to acuity of illness in this population. Early detection of anemia is important as this could potentially impact tolerance to feedings, attainment of enteral volume goal and weight gain. Recognizing the need to assess severity of anemia without additional blood sampling, we developed a multi-factorial Neonatal Iron Deficiency Assessment Tool (NIDAT).Participants for this were selected randomly through a medical record review. The study included infants 24–35 weeks gestational age at birth and a minimum of 21 days old at the time of collection (n=31). Data were analyzed using SAS statistical package. To test the internal characteristics of the measure, principle component analyses were conducted. The first analyses indicated that all but one item loaded significantly (>0.30). After the item was deleted, analyses were conducted again with successful results. A reliability analysis was then performed using Cronbach's alpha. A high internal consistency of the scale was demonstrated (a=.77). Average item-to-total correlation was 0.53(.31–.84). Based on a 3-point likert scale with the remaining 13 items, a total score obtained from the NIDAT was used to assign a risk range for iron deficiency. These findings support the internal reliability of the NIDAT and demonstrate the process involved in the initial validation of this new screening tool. Additional research is underway to establish concurrent validity.The NIDAT could potentially impact feeding regimens and outcomes by providing information leading to the determination of the optimal age/time to maximize iron therapy.