Reviewed by clinical practice committee
March 2018
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration


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

NB. If infant is on ≥100ml/kg/day FM85 fortifier or Preterm formula there is sufficient iron for prophylaxis so additional prophylaxis is not needed.


Infants with iron deficiency anaemia.


  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.
  3. Haemochromatosis

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:
  2. In preterm infants may cause increased red cell haemolysis and haemolytic anaemia due to low serum 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.

Link to Parent information pamphlet - Vitadol C and Iron


1 Joy R, Krishnamurthy S, Bethou A, Rajappa M, Ananthanarayanan PH, Bhat BV: Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2014, 99(2):F105-109..
2 Mills RJ, Davies MW. Enteral iron supplementation in preterm and low birth weight infants. Cochrane Database Syst Rev 2012;(3):CD005095.
3 Anabrees J: Early Enteral Prophylactic iron Supplementation May be Preferred in Preterm Very Low Birth Weight Infants. Journal of clinical neonatology 2014, 3(1):14-15.
4 Long H, Yi JM, Hu PL, et al. Benefits of iron supplementation for low birth weight infants: A systematic review.
BMC Pediatr 2012;12:99.
5 Franz AR, Mihatsch WA, Sander S, Kron M, Pohlandt F.Prospective randomized trial of early versus late enteral
iron supplementation in infants with a birth weight of less than 1301 grams. Pediatrics 2000;106(4):700-6.
6 Taylor TA, Kennedy KA. Randomized trial of iron supplementation versus routine iron intake in VLBW infants.