Iron deficiency in infants: three topics of current interest

Abstract

This discussion will review three somewhat unresolved areas of iron nutrition that are becoming clarified as a result of recent studies. The first is the optimal level of iron fortification for infant formula used by term infants. The studies described favour the use of formulas with intermediate levels of added iron (6–8 mg/l) rather than the high levels (12–13 mg/l) that are widely used in the United States. The second topic of preventing iron deficiency in low birth weight infants emphasizes the importance of starting with premature formulas containing 12–13 mg iron/l or administering 2 mg/kg/day of medicinal iron by about 1 month of age. Very low birth weight infants require as much as 4 mg/kg/day of medicinal iron and have increased iron needs well into their second year. Because of their unusually high risk of developing iron deficiency anaemia, low birth weight infants need to be monitored for anaemia and iron deficiency at regular intervals. Infants breast-fed for more than 6 months are likewise at substantial risk of developing iron deficiency anaemia, even with a diet of iron- and ascorbic-acid-rich foods. Special, iron- and ascorbic-acid-fortified meat and cereal foods used after 4–6 months can be effective. Where these are not available, an alternative is the administration of medicinal iron at a dose of 1 mg/kg/day to a maximum of 15 mg.