1-028 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page
Iron Supplementation
Prospective Randomized Trial of Early Versus Late Enteral Iron Supplementation in Infants With a Birth Weight of Less Than 1301 Grams. Franz AR, Mihatsch WA, Sander S, et al. Pediatrics 2000; 106:700-6.
This study was designed to determine whether early enteral iron supplementation (EI) would prevent iron deficiency in infants with a birth weight < 1301 grams. Infants were randomly assigned to receive 2-6 mg/kg/d of enteral iron supplementation as soon as enteral feedings of > 100 cc/kg/d were tolerated (EI) or at 61 days of life (late iron[LI] group). Erythropoietin was not administered. Iron deficiency was defined by any one of the following criteria: ferritin <12 ug/L; transferrin saturation < 17%; or increase in absolute reticulocyte counts by > 50% one week after the onset of enteral iron supplementation. Ferritin at 61 days was not different between the groups. Infants in the LI group were more often iron deficient (26/65 vs 10/68) and received more blood transfusions after 14 days of life. No adverse effects of EI were noted.
Comment. This study calls into question the validity of the 1985 AAP Committee on Nutrition recommendation that iron supplementation in premature babies begin at 2 months of age or when the infant reaches a weight of 2 kg. It appears that earlier enteral iron supplementation is probably safe and can limit the need for late blood transfusions (after 14 days of life) in premature babies. If you combine this strategy with delayed cord clamping to reduce the need for early blood transfusions (reviewed in reference # 1-024 of this publication), we now have two effective new strategies for reducing blood product exposure in premature babies.
Andrew B. Kairalla MD