Pitfalls of iron supplementation in parenteral nutrition admixtures for children with intestinal failure

Background: Pediatric patients with intestinal failure are at increased risk for iron deficiency. Supplementation is not routinely included in parenteral nutrition solutions. There is currently limited research related to the safety of iron supplementation in parenteral nutrition and for intravenous forms used in patients with intestinal failure. Current American Society for Parenteral and Enteral Nutrition and ESPGHAN guidelines promote the use of enteral iron, acknowledging the risks of using iron supplementation within parenteral nutrition admixtures.

Methods: We review a patient case and the current available literature related to iron in parenteral nutrition.

Results: Five major concerns are identified: peroxidation reactions, incompatibility, hypersensitivity, infection risk, and iron overload.

Conclusion: We propose an argument against the preferential use of iron supplementation within parenteral nutrition in children with intestinal failure when enteral supplementation or intermittent parenteral infusion may be sufficient.