{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:20:30Z","timestamp":1790079630580,"version":"4.0.1"},"reference-count":37,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Objective: To implement a neonatal iron deficiency (ID) guideline as part of a neuroprotective strategy using reticulocyte hemoglobin content (RET-He) for neonates born &lt;33 weeks postmenstrual age (PMA) and small for gestational age (SGA) neonates \u226533 weeks PMA, to achieve \u226580% screening rate by June 2024. Methods: An interdisciplinary team conducted a quality improvement initiative in a level III neonatal intensive care unit (NICU) from April 2022 to August 2024. RET-He is a validated, sensitive marker of early iron deficiency reflecting recent iron supply for erythropoiesis and providing a more reliable measure than ferritin. The primary outcome was RET-He screening at 30 \u00b1 7 days for neonates &lt;33 weeks PMA or pre-discharge for SGA neonates \u226533 weeks PMA. Exclusion criteria were death or transfer before eligibility. Process measures included ID screening failure rate (RET-He level &lt; 29 pg). Results: Of 345 eligible neonates, P-chart analysis showed screening rates for premature neonates &lt;33 weeks PMA declined during PDSA 1\u20132, before improving to 85.9% in PDSA 3. ID screening failure was 12.6% at one month, increasing to 32.1% at two months. For SGA neonates \u226533 weeks PMA, screening rates remained low, peaking at 36% in PDSA 3, with a 2.2% failure rate. Conclusions: Implementation of a RET-He based ID guideline improved screening rates for premature neonates but was less effective for SGA neonates. Despite improved guideline adherence, ID prevalence remained high at NICU discharge, indicating a further need to improve nutritional prevention and treatment strategies.<\/jats:p>","DOI":"10.3390\/nu17213391","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:50:19Z","timestamp":1761785419000},"page":"3391","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Iron Deficiency Prevention, Screening, and Treatment: A Quality Improvement Initiative Introducing Reticulocyte Hemoglobin in a Level III Neonatal Intensive Care Unit"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5205-7349","authenticated-orcid":false,"given":"Narmin","family":"Javadova","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, University of Wisconsin, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6098-2646","authenticated-orcid":false,"given":"Pamela J.","family":"Kling","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, University of Wisconsin, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Norlin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, University of Wisconsin, Madison, WI 53792, USA"},{"name":"Neonatology, UnityPoint Health\u2014Meriter Hospital, 202 S. Park St., Madison, WI 53715, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5228-6501","authenticated-orcid":false,"given":"Whitley N.","family":"Hulse","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, University of Wisconsin, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1111\/j.1753-4887.2011.00432.x","article-title":"Long-term Brain and Behavioral Consequences of Early Iron Deficiency","volume":"69","author":"Georgieff","year":"2011","journal-title":"Nutr. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3389\/fphys.2019.00463","article-title":"Iron Metabolism and Brain Development in Premature Infants","volume":"10","author":"Wang","year":"2019","journal-title":"Front. 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