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Early iron supplementation in very low birth weight infants--a randomized controlled trial
Mari Jeeva Sankar1, Renu Saxena, Kalaivani Mani
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Early iron supplementation for very low birth weight (VLBW) infants did not improve iron status or hematological parameters by two months. Standard iron practices remain comparable for these preterm infants.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Nutritional Science
Background:
- Very low birth weight (VLBW) infants are at high risk for iron deficiency due to limited iron stores and rapid growth.
- Optimal timing for iron supplementation in VLBW infants is crucial to prevent anemia and support development.
Purpose of the Study:
- To determine if early iron supplementation (at 2 weeks) improves serum ferritin and hematological parameters at 2 months in VLBW infants.
- To compare the efficacy of early versus standard (8 weeks) iron initiation in preterm VLBW infants.
Main Methods:
- Randomized controlled trial involving preterm VLBW infants receiving at least 100 mL/kg/day oral feeds by day 14.
- Intervention group received early iron (3-4 mg/kg/day orally from 2 weeks); control group received no iron until 60 days.
- Serum ferritin and hematological parameters were assessed at 60 days; morbidities were prospectively recorded.
Main Results:
- No significant differences were observed in serum ferritin or hematocrit levels at 60 days between the early iron and control groups.
- The magnitude of serum ferritin decline from baseline was also similar between groups.
- Rates of blood transfusions and common neonatal morbidities did not differ between the early iron and control groups.
Conclusions:
- Early iron supplementation initiated at 2 weeks of age does not offer advantages over standard practice (starting iron at 8 weeks) for VLBW infants.
- Current standard iron supplementation protocols appear adequate for maintaining iron status and hematological parameters in this population by two months of age.
Aim:
To evaluate if supplementing iron at 2 weeks of age improves serum ferritin and/or haematological parameters at 2 months of life in very low birth weight (VLBW) infants.
Methods:
Preterm VLBW infants who received at least 100 mL/kg/day of oral feeds by day 14 of life were randomized to either 'early iron' (3-4 mg/kg/day orally from 2 weeks) or 'control' (no iron until 60 days) groups. Infants were followed up fortnightly and all morbidities were prospectively recorded. Serum ferritin was measured at 60 days by enzyme immunoassay method.
Results:
Forty-six infants were included in the study; primary outcome was available for 42 infants.There was no difference in either serum ferritin (mean: 50.8 vs. 45.3 microg/L; adjusted difference in means: 5.8, 95% CI: -3.0, 14.6; p = 0.19) or haematocrit (32.5 +/- 5.3 vs. 30.8 +/- 6.3%; p = 0.35)at 60 days between the early iron and control groups. The magnitude of fall in serum ferritin from baseline to the end of study period was also not different between the groups (4.9 vs. 13.8 microg/L; difference in means: 8.8; 95% CI: -0.3, 17.9; p = 0.06). The requirement of blood transfusions (9.5 vs. 13%; p = 0.63) and a composite outcome of common neonatal morbidities (19% vs. 21.7%; p = 0.55) were also not different between the two groups.
Conclusion:
Supplementing iron at 2 weeks of age in preterm VLBW infants did not improve either serum ferritin or the haematological parameters at 2 months when compared to the standard practice of starting iron from 8 weeks of age.
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