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21 - Iron

Published online by Cambridge University Press:  05 August 2012

David H. Adamkin
Affiliation:
University of Louisville Medical Center
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Summary

There has been increased interest in iron deficiency, with data suggesting that mental and developmental test scores are lower in infants with iron deficiency anemia and that iron therapy sufficient to correct the anemia is insufficient to reverse the behavioral and developmental disorders in many infants. This indicates that certain ill effects are persistent depending on the timing, severity, or degree of iron-deficiency anemia during infancy.

Iron stores in the preterm infant are lower than in the term baby because these stores are relatively proportional to body weight. Iron depletion occurs at the time the infant doubles her/his birth-weight and thus iron therapy should begin by two to four weeks of life in the preterm infant when enteral feedings are tolerated. VLBW infants may need as much as 4–6 mg/kg per day, with about 2 mg/kg per day provided by iron-fortified formula and the remainder as iron supplementation at 2–4 mg/kg per day. A higher dose is also necessary for infants being given erythropoietin. Although premature infant formulas, both with and without iron fortification, are manufactured with ample amounts of vitamin E and a polyunsaturated fatty acid-to-E ratio of 6.0 or greater, premature infants on human milk and receiving supplemental iron should also be supplemented with 4 to 5 mg (6 to 8 IU) of vitamin E per day. This can be readily accomplished by use of an oral multivitamin with iron.

To avoid the risk of iron toxicity related to immature antioxidant systems in VLBW infants, the AAP and other organizations do not recommend using iron prior to two weeks of age.

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Publisher: Cambridge University Press
Print publication year: 2009

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  • Iron
  • David H. Adamkin
  • Book: Nutritional Strategies for the Very Low Birthweight Infant
  • Online publication: 05 August 2012
  • Chapter DOI: https://doi.org/10.1017/CBO9780511605444.023
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  • Iron
  • David H. Adamkin
  • Book: Nutritional Strategies for the Very Low Birthweight Infant
  • Online publication: 05 August 2012
  • Chapter DOI: https://doi.org/10.1017/CBO9780511605444.023
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Iron
  • David H. Adamkin
  • Book: Nutritional Strategies for the Very Low Birthweight Infant
  • Online publication: 05 August 2012
  • Chapter DOI: https://doi.org/10.1017/CBO9780511605444.023
Available formats
×