Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial

Joy, Rojo; Krishnamurthy, Sriram; Adhisivam, B; Rajappa, Medha; Ananthanarayanan, Palghat Hariharan; Bhat, B. Vishnu

doi:10.1136/archdischild-2013-304650

Cited by 27 publications

(25 citation statements)

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“…Infants started at 2 weeks also needed significantly fewer red blood cell transfusions than those started at 4 weeks. In a recent study, Joy et al 59 compared initiation of iron supplementation at 2 weeks and at 6 weeks. At 12 weeks of age, infants started on iron early showed significantly higher serum ferritin and better hematologic indicators of iron status.…”

Section: Age At Start Of Supplementationmentioning

confidence: 99%

Balancing Benefits and Risks of Iron Fortification in Resource-Rich Countries

Krebs

Domellöf

Ziegler

2015

The Journal of Pediatrics

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or the last 25 years, the American Academy of Pediatrics (AAP) has endorsed the use of iron-fortified infant formulas, noting "no role for the use of low-iron formulas." The rationale for these policies was the recognition that the increase in the use of iron-fortified formulas, accounting for 80% of all formula sold in 1985, was responsible for the declining prevalence of iron-deficiency anemia in US infants. 1 These recommendations were also based on the absence of evidence of discernible adverse effects. Controlled trials had reported no differences in gastrointestinal symptoms, such as colic, constipation, diarrhea, regurgitation, and fussiness, among infants receiving low-iron vs iron-fortified formulas. 2,3 Likewise, evidence was lacking to support another theoretical concern of clinically significant interactions with other micronutrients, specifically zinc and copper. In 1999, the AAP took an even stronger stand and recommended that low iron formulas be removed from the market entirely, 4 for reasons similar to those of the 1989 policy. Further, it was recommended that the minimum iron content for all term infant formulas be at least 4 mg/L. 4 Currently, standard, term infant formulas on the market are all ironfortified and contain 4-12 mg/L of iron, even though there are some regional differences. In the US, the AAP recommends that infant formulas have an iron content of 10-12 mg/L 5 ; in Europe, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends 4-8 mg/L. 6 In the recommendations, the contrast in the iron exposure of formula-fed infants vs breastfed infants has primarily focused on the better bioavailability of the iron in breast milk. Although an absorption efficiency of approximately 50% is often quoted, some studies have actually reported absorption in the range of 12%-16%, 7,8 making that bioavailability distinction much less potent. This also suggests that absorption of substantial amounts of dietary iron simply is not critical during the early months of life in healthy infants of normal birth weight. Among all the compositional differences between human milk and formula, the differences in iron content are the most extreme. Virtually all mammalian milks are low in iron, with the exception of rodents, in which postnatal growth is extremely rapid. It seems implausible that this conserved biological pattern is without purpose. It is also clear that iron deficiency occurs in breastfed infants only after the very early months of life. The practical challenge is to identify when the birth iron endowment is exhausted, at which point the infant needs a source of iron from the diet. This article will discuss the potential advantages of a low iron intake for the infant and the potential adverse effects of drastically altering this, especially in the first 6 months of life. From the outset, two realities must be acknowledged. First, iron deficiency (especially without anemia) in infants remains common, particularly in high-risk groups, including older normal breastfed i...

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Section: Age At Start Of Supplementationmentioning

confidence: 99%

Balancing Benefits and Risks of Iron Fortification in Resource-Rich Countries

Krebs

Domellöf

Ziegler

2015

The Journal of Pediatrics

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“…Supplements were chosen based on AAP recommendations and current trends with preterm infants . Supplements were tested in their pure form (no alterations) and in combination with the ready‐to‐feed preterm formulas.…”

Section: Methodsmentioning

confidence: 99%

“…Supplements were chosen based on AAP recommendations and current trends with preterm infants. [7][8][9][10][11] Supplements were tested in their pure form (no alterations) and in combination with the ready-to-feed preterm formulas. Doses were 0.4 mL/1 fl oz formula for saline, 0.3 mL/1 fl oz formula for ferrous sulfate, 0.5 mL/1 fl oz formula for vitamin D, and 0.5 mL/1 fl oz formula for multivitamin.…”

Section: Sample Preparation and Osmolality Testingmentioning

confidence: 99%

“…1,5,6 In the convalescing preterm infant population, providers frequently supplement and modify the nutrient composition of feedings with additives to enhance caloric density and ensure proper growth and nutrition. [7][8][9][10][11] In addition, modifications to the feeding thickness are frequently used to treat premature infants with gastroesophageal reflux disease (GERD) or dysphagia (immature sucking ability, sucking-swallowing-breathing incoordination, aspiration, feeding intolerance). [12][13][14][15][16][17][18][19][20][21][22][23] However, thickening feeds also come with risks, such as necrotizing enterocolitis (NEC) or infection.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Additives for Reflux or Dysphagia Management on Osmolality in Ready‐to‐Feed Preterm Formula: Practice Implications

Levy

Osborn

Hasenstab

et al. 2018

J Parenter Enteral Nutr

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“…Joy et al (38) randomly assigned 93 infants weighing <1500 g who were to receive 2 mg/kg/day of elemental iron starting at two or six weeks of age. There was no significant difference in the need for transfusion or the number of transfusions per infant in either study.…”

Section: Does Enteral Iron Supplementation Reducementioning

confidence: 99%