- Prophylaxis and treatment of iron deficiency anemia
- PO; with feeds
Doses are expressed in elemental iron
Goal is to initiate iron supplementation between DOL 15 and 21 in all LBW (<2.5 kg) infants who have reached full enteral feeds.
- A supplement of 3 mg/kg/day to be started in all infants with BW < 2 kg who are receiving > 50% EBM/PHDM
- A supplement of 2 mg/kg/day to be started in all infants with BW 2-2.5 kg who are receiving > 50% EBM/PHDM
- No supplement will be started in infants receiving iron-fortified formula; infants with a BW <2 kg will be started on premature infant formula to ensure adequate iron intake.
- preterm/term: 4 - 6 mg/kg/day
Discontinuation of Fe supplementation (see chart below for additional info on monitoring and adjusting dose):
- Infants with a birth weight of 2.0 kg to 2.5 kg, should receive an iron supplement of 1-2 mg/kg/day for the first 6 months of age.
- Infants with a birth weight less than 2.0 kg, should receive an iron supplement of 2-3 mg/kg/day for the first year of age.
- GI: mild gastrointestinal upset, constipation (rare), dark stools
- CBC, Reticulocyte count
- Ferritin: goal is a level between 101 and 224 ug/L. See table below for dose adjustment and monitoring.
|Initial Ferritin Testing||
Around 4 weeks of age or after at least 2 weeks of iron supplementation (try to batch with other blood work as applicable).
Consider delaying if the patient is septic, unstable or recently transfused*.
|Serum Ferritin level||≤ 35ug/L||36-100ug/L||101-224ug/L||225-299ug/L||≥300ug/L|
|Iron supplementation||Increase Fe by 2mg/kg/day to maximum of 5mg/kg/day total**.||Increase Fe by 1mg/kg/day||Continue with same dose||Decrease Fe by 1mg/kg/day||D/C Fe supplementation|
|Blood work frequency||Every 2 weeks||Every 3 weeks||Every 3 weeks||Every 3 weeks||2 weeks after D/C. If <300, resume Fe supp. But at a lower dose than previous.|
Goal at discharge or term corrected (whichever comes first): Continue with the same supplementation if ferritin is between 100-224 and can stop routine testing of ferritin levels. Long term follow up per CPS guidelines.
*Serum ferritin level should not be done within one week of PRBC transfusion
**Dosage should not exceed 5-6mg/kg/day for longer than 2 weeks from enteral and supplemental sources combined
- 75 mg of ferrous sulfate = 15 mg elemental iron = 1 mL Fer-In-Sol drops
- Iron content of common feeds for premature infants:
- EBM (Expressed Breast Milk) with Abbott® HMF (TOH Human Milk Fortifier) supplies negligible iron.
- EBM with Enfamil® HMF (CHEO human milk fortifier) supplies approximately 2 mg/kg/day of iron
- Formulas at 20 kcal/oz supply approximately 2mg/kg/day of iron
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