University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Does premature infant formula support the iron needs for premature infants to avoid iron deficiency anemia?

Clinical Bottom Lines

1. Both term and premature infant formulas provide adequate iron for premature infants; iron fortified formulas containing between 0.81mg/kg and 1.5mg/kg (0.5mg/dl and 0.9mg/dl) iron would support the iron needs for preterm infants.
2. There is no need to give additional iron supplements in premature infants >32wks.
3. Iron deficiency without anemia occurred at the same rate as premature infants receiving recommended iron doses.

Summary of Key Evidence

1. 78 infants; Preterm >32wks and BW 1250g-1500g.¹
2. Randomized (not blinded) into 3 groups.
3. The hemoglobin concentration was never less than the lower limit of normal when compared to the Preterm reference range.
4. There was evidence of anemia from 38 weeks to 2 months corrected age when compared to Term reference ranges during the physiologic nadir.
5. There is evidence of iron deficiency most commonly between 4-8 months, but is not significantly different from reference range preterm infants on iron supplementation.
6. No infants were both iron deficient and anemic at the same time.

Additional Comments

• This article is relevant to premature infants >32wks and >1250g and may not be applicable to those infants outside these parameter.
• Standard of Care-Currently the American Academy of Pediatrics recommends 2mg/kg/day (1.2mg/dl) of iron for premature infants.²
  

Citation

1. Griffin IJ, Cooke RJ, Reid MM, McCormick KP, Smith JS. Iron nutritional status in preterm infants fed formulas fortified with iron. Arch Dis Child Fetal Neonatal Ed 1999;81:F45-9.
2. Committee on Nutrition. Iron fortification of infant formula. Pediatrics 1999;104:119-23.
3. Halliday HL, Lappin TR, McClure BG. Do All Pre-term Infants Need Iron Supplements? Ir Med J. 1983;76:430-2.

CAT Author: Kristin Schultz, MD

CAT Appraisers: Francis McBee Orzulak, MD

Date appraised: September 13, 2006