Early versus Late Enteral Prophylactic Iron Supplementation in Preterm Infants: A Randomized Controlled Trial

Background: Iron deficiency is commonly encountered in preterm infants and there is controversy about its timing of supplementation. This study was aimed to evaluate the effect of early versus late iron supplementation on iron status and anthropometry of admitted preterm newborns in the neonatal intensive unit (NICU) of a tertiary care hospital. Methodology: This Randomized Controlled Trial was conducted in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Twenty-one preterm in early group and nineteen in late group were included in the study. Iron supplementation was introduced at 2 weeks of age in early intervention (EI) group and 6 weeks of age in lateintervention (LI) group. Sample for CBC, red cell indices, S. ferritin and C-reactive protein was pre-intervention sample at 2 weeks in EI group and at 6 weeks in LI group and follow up sampling was done at 12 weeks in both groups. The intervention was used that ferric hydroxide polymaltose at a dose of 2 mg/kg/day of elemental iron per oral once daily mixed with expressed breast milk. Same drugs of same manufacture company with same batch number were provided to the babies. Weight, length and head circumference were measured at birth, 2 weeks and 12 weeks of age in early group and at birth,6weeks and 12 weeks in late group. Result: Mean gestational age and mean birth weight (gm) was 33.52±1.91 and 33.48±1.46, weeks and 1622.86±438.73 g and 1753.16±401.76 g in early and late group respectively. Female outnumber the male in early group &male outnumber the female in late group, p value was statistically significant. Comparison of red cells parameters and S. ferritin between early and late group neonates at 12 weeks showed that mean S. Ferritin (ng/ml) was significantly higher in early group (92.75±47.33 ng/mL) as compared with late group (56.95±35.06 ng/mL), (p value 0.01). At 12 weeks of age, anthropometry showed mean weight (p=0.695), mean length (p=0.291) and mean OFC(p=0.983) in Early and Late groups were not statistically significant. Conclusion: Early iron supplementation at 2 weeks of age in preterm newborn result in significantly higher serum ferritin level than late iron supplementation group but hemoglobin, red cell indices, anthropometry did not differ significantly in between early & late iron supplementation groups.