title: Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate whether preterm very low birth weight (VLBW) infants receiving early iron (EI) supplementation (2 mg/kg/day elemental iron) at 2 weeks postnatal age have improved serum ferritin levels compared with late iron (LI) supplementation at 6 weeks postnatal age.
  
  
  METHODS
  Single-blinded parallel-group interventional randomised controlled trial.
  
  
  METHODS
  Tertiary care centre in southern India.
  
  
  METHODS
  Randomised at 2 weeks postnatal age to EI and LI groups and evaluated at 2, 6 and 12 weeks postnatal age.
  
  
  RESULTS
  The primary outcome was serum ferritin level at 12 weeks, and the secondary outcomes were the incidence of neonatal morbidities, haemoglobin level, anthropometric parameters and blood transfusion requirements.
  
  
  RESULTS
  Of the 104 babies randomised, outcomes were analysed in 46 and 47 babies in EI and LI groups, respectively. Serum ferritin level was significantly higher (p<0.001) at 12 weeks (82±5 vs 63±3 ng/mL) in the EI group. Haemoglobin (10.1±0.4 vs 9.2±0.4 g/dL) and mean corpuscular haemoglobin concentration (31±0.5 vs 29.4±0.5 g/dL) were also significantly (p<0.001) higher at 12 weeks in the EI group. There was a significant decrease of ferritin in the LI group and significant increase in ferritin in the EI group at 6 weeks compared with 2 weeks. There were no significant differences in the incidences of neonatal morbidities (necrotising enterocolitis, periventricular leukomalacia, retinopathy of prematurity), anthropometric parameters and blood transfusion requirements between the two groups.
  
  
  CONCLUSIONS
  EI supplementation in preterm VLBW infants improves serum ferritin and haemoglobin levels.
  
  
  BACKGROUND
  CTRI/2013/01/003277.
authors.affiliation: Departments of Pediatrics and Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), , Pondicherry, India.
authors.forename: Rojo
authors.initials: R
authors.lastname: Joy
authors.forename: Sriram
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: Adhisivam
authors.initials: A
authors.lastname: Bethou
authors.forename: Medha
authors.initials: M
authors.lastname: Rajappa
authors.forename: P H
authors.initials: PH
authors.lastname: Ananthanarayanan
authors.forename: B Vishnu
authors.initials: BV
authors.lastname: Bhat
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002097:C-Reactive Protein / Q000032:analysis; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D004750:Enteral Nutrition; D005260:Female; D005293:Ferritins / Q000097:blood*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007118:Immunoassay; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development / Q000378:metabolism*; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight / Q000254:growth & development / Q000378:metabolism*; D007501:Iron / Q000008:administration & dosage*; D008297:Male
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron
keywords: Neonatology; Nutrition