• Ferrous sulphate is available in a solution labelled 150mg/5ml, which provides 6mg of elemental iron per ml.

Dose and Administration

Prophylaxis

1. 0.5ml/kg/day (3mg/kg/day of elemental iron) in one or two divided doses.

• All infants with a birthweight<1800g or a gestation at birth <32 weeks
  • Infants outside these criteria should be discussed with a specialist first.
• Commence at 4 weeks of age or on discharge, whichever occurs earliest.

Treatment

1. 1ml/kg/day (6mg/kg/day of elemental iron) in two divided doses.

Indications

1. Prophylaxis for iron deficiency anaemia in low birthweight infants with reduced body iron stores.
2. Treatment of documented iron deficiency anaemia.

Contraindications and Precautions

1. Peptic ulcer.
2. Haemolytic anaemias.

Clinical Pharmacology

Iron is an integral part of haemoglobin. Although the major portion of iron in the body is in the form of haemoglobin, a small amount is also stored in tissues as haemosiderin and ferritin, and in blood it is bound to transferrin, a carrier protein.

The intestine is the primary site for both absorption and excretion of iron. Food and antacid decrease the absorption of iron.

Iron is rigidly conserved in the body. Most of the iron released from breakdown of haemoglobin in the liver is reused.

Possible Adverse Effects

1. Gastrointestinal disturbance:
   • Nausea, vomiting, constipation.
   • Dark stools (green or black).
   • Erosion of gastric mucosa.
2. In preterm infants may cause increased red cell haemolysis and haemolytic anaemia because of low serum values of vitamin E.
3. Lethargy.
4. Hypotension.
5. Acute toxicity: gastrointestinal disturbances worsened, CNS disorders (lethargy), pallor, cyanosis, shock.

Special Considerations

1. Monitor Hb, PCV, reticulocytes.
2. Vitamin C may increase iron absorption.