Dose: 10 to 30 mg/kg of ferrous sulfate is equivalent to 2 to 6 mg/kg of elemental iron PO

Frequency: Q Day            

Comments: Term, breast-fed infants do not routinely require iron supplementation. Term, formula-fed infants should not become iron depleted until 4 to 6 months of age, unless there is blood loss. LBW infants who are breast fed will invariably develop iron deficiency unless they receive iron supplementation. Iron stores are generally not depleted until the infant is around 2 months. Though there is no urgency in beginning supplementation, there is controversy as to when iron should be started in these infants. Iron given too early and in too high a dose may interfere with vitamin E metabolism. Current recommendations are to begin iron supplementation between two weeks and one month of age. The dose for infants <2500 grams is 2-3 mg/kg once a day. The dose for infants <1000 grams is 4 mg/kg/day. In formula-fed infants >1500 grams, iron fortified formula should provide sufficient iron, those less than 1500 grams should receive an additional 1-2 mg/kg/day. All LBW infants should receive iron for 6 months to one year. More comments on ferrous sulfate.

Toxicity:  If excessive iron is given and serum levels exceed 300 mcg/dl, early signs of toxicity are diarrhea and vomiting. If this is the result of a single dose (liquid iron will not be seen on an AFP), gastric lavage with 1 to 5% sodium bicarbonate may be effective. Therapy with deferoxamine may be necessary to prevent fulminant hepatic damage.

    Both lactoferrin and transferrin have bacteriostatic properties when they are not saturated with iron. Although in vitro and animal data suggest that iron fortified formulas and oral iron might predispose to infections, epidemiologic support for this hypothesis remains scant. Finally, excessive iron administration may lead to a deficiency of Vitamin E. (Dallman, "Nutritional Anemia of Infancy", Nutrition during Infancy (edited by Tsang and Nichols) Hanley & Belfus, Inc: Philadelphia, page 224, 1988.

Preparation: Ferrous sulfate (Fer-In-Sol infant drops) is available in a 125 mg/ml concentration (25 mg/ml of elemental iron).   Store at room temperature and protect from light.