Prescribing -. Infants in the iron age

The ideal iron intake for low birthweight infants is not yet known, and so a survey was done of current supplements used in 57 neonatal units in the United Kingdom. Gestational age was used as a criterion by 28 units, with 22 units giving supplements to infants of < 36 weeks' gestation, 4 units to those of < 35 weeks' gestation, and 1 each to infants of < 34 and 32 weeks' gestation. Birthweight was used as a criterion by 13 units, with thresholds from 1500-2500g, and 11 units used a combination of age and weight as criteria. Supplements were started by 3 units at 14 days postnatally, 11 at 21 days, 24 at 28 days, 9 at 42 days and 2 units at 8 and 10 weeks, respectively. 47 units prescribed constant doses (54-4923 /lg/ day) of iron irrespective of weight or age. Other units adjusted doses according to postnatal age (n = 1) or bodyweight (5). 21 units recommended that supplements be continued for 6 months, 6 units until 1 year, and 19 units until introduction of mixed feeds or full weaning. However, many units were not able to check whether these recommendations were being followed in the community. Sodium ironedetate was used by 24 units, polysaccharide-iron complex was used by 9 units, ferrous sulphate by 8, ferrous fumarate by 6 fld ferrous succinate by 3 units. Ferrous glycine flphate and ferric ammonium citrate were used oy 2 and 1 units, respectively.

The authors concluded that there is considerable variation in the practice of routine iron supplementCition, despite consistent recommendations. 'Detailed evaluation of these different policies with more prolonged infant follow .. up would be needed before the clinical implications of this variability in iron supplementation are known.' Barclay SM, Lloyd OJ, Duffty P, Aggett PJ. Iron supplements for preterm or low birthweight infants. Archives of Diseases in Childhood 64: 1621· 1622, Nov 1989 1745

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