Are children on jejunal feeds at risk of iron deficiency?

Abstract

Children on exclusive jejunal feeding may be at risk of iron deficiency due to the feeds bypassing the duodenum, which is the primary site for iron absorption. We describe the biochemical and hematological features of six children on exclusive jejunal feeding who did not receive iron supplementation. At a mean (standard deviation) period of 11 (6.5) mo after commencing jejunal feeds, there was a significant reduction in both serum iron (18.5 g/L vs 9.8 g/L, P = 0.01) and transferrin saturation levels (23.1% vs 13.7%, P = 0.02), suggesting iron deficiency. However, there was no significant change in ferritin, hemoglobin and mean corpuscular volume levels post-commencement of jejunal feeds. This may be the result of small bowel adaptation in response to early iron deficiency. Larger and longer term prospective studies are required to investigate if children on jejunal feeds are at risk of developing iron deficiency.

Keywords: Iron deficiency; Exclusive jejunal feeds; Jejunally fed children

Core tip: Children who are exclusively jejunally fed are prime candidates to develop iron deficiency. We found that serum iron and transferrin saturation levels were significantly reduced at a mean of 6.5 mo post commencement of exclusive jejunal feeds, suggesting that an early iron deficient state was induced. Ferritin levels, haemoglobin and mean corpuscular volumes however were stable during the same period, lending further evidence that the proximal jejunum may have the capacity to adapt to iron deficiency.