No Extra Iron Needed for Tiny Tots

Iron supplements for underweight premature babies does not appear helpful

January 20, 2013 / Author:  / Reviewed by: Chris Galloway, M.D.

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(dailyRx News) When very tiny premature babies are born, they are usually given iron supplements based on pediatricians' recommendations. But there's no proof that the iron is necessary.

A recent study aimed to find out whether babies born under 3.3 pounds did any better when they received iron supplements.

The researchers found that the iron supplements did not make a difference for these babies.

Comparing babies who did and did not receive iron supplements showed no difference in their deaths, need for transfusions or red blood cell count.

"Attend all prenatal appointments."

The study was led by Tiffany A. Taylor, MD, and Kathleen A. Kennedy, MD, MPH, both in the Department of Pediatrics, at The University of Texas Health Science Center within Houston Medical School.

Dr. Taylor and Dr. Kennedy randomly divided 150 premature babies weighing less than 3.3 pounds into two groups. The babies were enrolled if they were eating at least 120 mL/kg per day of food before they reached the age of 32 weeks past their mother's last period.

Measuring babies' ages from their mothers' last period is one way to measure preemies' age since they are born before their mothers reach full term (38-40 weeks) in pregnancy.

One group of 76 babies received 2 mg/kg per day of an iron supplement. The other group of 74 babies received a placebo in the form of a multivitamin (without iron) each day.

Each baby received the supplements until 36 weeks past their mother's last period or until they were discharged from the hospital, if that was before the 36th week.

The researchers measured how many transfusions the babies received and the percentage of red blood cells in their blood at end of the study. One baby in each group died.

A total of 47 babies in the iron supplementation group received transfusions, and 53 of the babies in the control (multivitamin) group received transfusions.

There was no major difference in the number of transfusions that the babies received regardless of which group they were in.

There was also no major difference in the red blood cell density of the babies in both groups.

The babies receiving iron supplements had an average of 29.2 percent red blood cells in their blood. The babies in the multivitamin group had an average of 28.3 percent red blood cells in their blood.

The researchers did not discover any short-term side effects from the iron supplementation. However, they determined that the iron supplements did not make a difference in the baby's survival, number of transfusions or red blood cell count.

Girija Natarajan MD, FAAP, medical director of the NICU at DMC Children's Hospital of Michigan and dailyRx Contributing Expert said "This study has several strengths and it addresses a relatively under-investigated question. The control infants were given standard iron-fortified feedings, as is current practice, transfusions were taken into account and the center had a standardized relatively liberal transfusion protocol. 

"It is possible, though, that larger doses or more prolonged therapy or longer follow-up may have detected an effect. Indeed, previous studies in low birth weight (2-2.5 kg) infants have shown beneficial effects of 2 mg/kg iron supplementation on anemia at 6 months of age and on behavioral outcomes later in childhood" she concluded.

"There is no evidence from clinical trials to support giving more than 2 mg/kg per day of iron to these infants," the researchers wrote. "If future trials are undertaken, a larger sample size or longer duration of treatment is recommended."

The study was published January 21 in the journal Pediatrics. The research did not use any external funding, and the authors declared no conflicts of interest.

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Review Date: 
January 20, 2013
Last Updated:
January 29, 2013