Skip to main content
SpringerLink
Log in

Iron deficiency and anemia in iron-fortified formula and human milk-fed preterm infants until 6 months post-term

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

An iron intake of >2 mg/kg/d is recommended for preterm infants. We hypothesized that human milk (HM)-fed preterm infants require iron supplementation after discharge, whereas iron-fortified formulae (IFF; 0.8–1.0 mg iron/100 ml) may provide sufficient dietary iron until 6 months post-term.

Methods

At term age, 3 and 6 months post-term, ferritin (μg/l) was measured in 92 IFF-fed infants (gestational age (median (interquartile range)) 30.7 (1.4) weeks, birth weight 1,375 (338) gram) and 46 HM-fed infants (gestational age 30.0 (1.7) weeks, birth weight 1,400 (571) gram). Iron intake (mg/kg/d) between term age and 6 months post-term was calculated.

Results

Iron was supplemented to 71.7 % of HM-fed and 83.7 % of IFF-fed infants between term age and 3 months post-term and to 13 % of HM-fed and 0 % of IFF-fed infants between 3 and 6 months post-term. IFF-fed infants had an iron intake from supplements and formula of 2.66 (1.22) mg/kg/d between term age and 3 months post-term and 1.19 (0.32) mg/kg/d between 3 and 6 months post-term. At 3 and 6 months post-term, the incidence of ferritin <12 μg/l was higher in HM-fed compared to IFF-fed infants (23.8 vs. 7.8 % and 26.3 vs. 9.5 %, P < 0.02).

Conclusion

This observational study demonstrates that ferritin <12 μg/l is more prevalent in HM-fed infants until 6 months post-term. This may be due to early cessation of additional iron supplementation. We speculate that additional iron supplementation is not necessary in preterm infants fed IFF (0.8–1.0 mg iron/100 ml), as they achieve ferritin ≥12 μg/l without additional iron supplements between 3 and 6 months post-term.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

HM:

Human milk

IFF:

Iron-fortified formula

IQR:

Interquartile range

MCV:

Mean corpuscular volume

RDW:

Red cell distribution width

SDS:

Standard deviations score

References

  1. Dallman P, Siimes M, Stekel A (1980) Iron deficiency in infancy and childhood. Am J Clin Nutr 33:86–118

    CAS  Google Scholar 

  2. Rao R, Georgieff M (2009) Iron therapy for preterm infants. Clin Perinatol 36:27–42

    Article  Google Scholar 

  3. Aher S, Malwatkar K, Kadam S (2008) Neonatal anemia. Semin Fetal Neonatal Med 13:239–247

    Article  Google Scholar 

  4. Hall R, Wheeler R, Benson J, Harris G, Rippetoe L (1993) Feeding iron-fortified premature formula during initial hospitalization to infants less than 1,800 grams birth weight. Pediatrics 92:409–414

    CAS  Google Scholar 

  5. Lundström U, Siimes M, Dallman P (1977) At what age does iron supplementation become necessary in low-birth-weight infants? J Pediatr 91(6):878–883

    Article  Google Scholar 

  6. Franz A, Mihatsch W, Sander S, Kron M, Pohlandt F (2000) Prospective randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1,301 grams. Pediatrics 106:700–706

    Article  CAS  Google Scholar 

  7. Lozoff B, Georgieff M (2006) Iron deficiency and brain development. Semin Pediatr Neurol 13:158–165

    Article  Google Scholar 

  8. Hay W (2008) Strategies for feeding the preterm infant. Neonatology 94:245–254

    Article  Google Scholar 

  9. Mills R, Davies M (2012) Enteral iron supplementation in preterm and low birth weight infants (Review). Cochrane Database of Syst Rev 14(3):CD005095

    Google Scholar 

  10. Long H, Yi J, Hu P, Li Z, Qiu W, Wang F, Zhu S (2012) Benefits of iron supplementation for low birth weight infants: a systematic review. BMC Pediatr 12(1):99

    Article  CAS  Google Scholar 

  11. Baker R, Greer F, The Committee on Nutrition (2010) Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 126:1040–1050

    Article  Google Scholar 

  12. Lozoff B, Beard J, Connor J, Felt B, Georgieff M, Schallert T (2006) Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev 64(5):S34–S43

    Article  Google Scholar 

  13. American Academy of Pediatrics (1999) Iron fortification of infant formulas. Pediatrics 104(1):119–123

    Article  Google Scholar 

  14. Siimes M, Jarvenpaa A (1982) Prevention of anemia and iron deficiency in very-low-birth-weigh infants. J Pediatr 101(2):277–280

    Article  CAS  Google Scholar 

  15. Domellöf M (2010) Benefits and harms of iron supplementation in iron-deficient and iron-sufficient children. Nestlé Nutr Instr Workshop Ser Pediatr Program 65:153–165

    Article  Google Scholar 

  16. Amesz E, Schaafsma A, Cranendonk A, Lafeber H (2010) Optimal growth and lower fat mass in preterm infants fed a protein-enriched postdischarge formula. J Pediatr Gastroenterol Nutr 50:200–207

    Article  Google Scholar 

  17. Niklasson A, Albertsson-Wikland K (2008) Continuous growth reference from 24th weeks of gestation to 24 months by gender. BMC Pediatrics 8:8

    Article  Google Scholar 

  18. Fredriks A, van Buuren S, Burgmeijer R, Meulmeester J, Beuker R, Brugman E, Roede M, Verloove-Vanhorick S, Wit J (2000) Continuing positive secular growth change in the Netherlands 1955–1997. Pediatr Res 47(3):316–323

    Article  CAS  Google Scholar 

  19. WHO (2001) Iron deficiency anaemia. Assessment, prevention and control. A guide for programme managers. WHO/NHD/01.3. WHO, Geneva

  20. Domellöf M (2007) Iron requirements, absorption and metabolism in infancy and childhood. Curr Opin Clin Nutr Metab Care 10:329–335

    Article  Google Scholar 

  21. Thorsdottir I, Gunnarsson B, Atladottir H, Michaelsen K, Palsson G (2003) Iron status at 12 months of age-effects of body size, growth and diet in a population with high birth weight. Eur J Clin Nutr 57:505–513

    Article  CAS  Google Scholar 

  22. Wharf S, Fox T, Fairweather-Tait S, Cook J (1997) Factors affecting iron stores in infants 4–8 months of age. Eur J Clin Nutr 51:504–509

    Article  CAS  Google Scholar 

  23. Michaelsen K, Milman N, Samuelson G (1995) A longitudinal study of iron status in healthy Danish infants: effects early iron status, growth velocity and dietary factors. Acta Paediatr 84:1035–1044

    Article  CAS  Google Scholar 

  24. Griffin I, Cooke R, Reid M, McCormick K, Smith J (1999) Iron nutritional status in preterm infants fed formulas fortified with iron. Arch Dis Child Fetal Neonatal Ed 81:F45–F49

    Article  CAS  Google Scholar 

  25. Wang W, Knovich M, Coffman L, Torti F, Torti S (2010) Serum ferritin: past, present and future. Biochim Biophys Acta 1800(8):760–769

    Article  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by an unrestricted research grant from FrieslandCampina, Amersfoort, The Netherlands.

Conflict of interest

A Schaafsma is employed as an independent senior scientist in nutrition by FrieslandCampina, Amersfoort, The Netherlands, and declares no conflict of interest. The other authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pediatrics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    Monique van de Lagemaat, Eline M. Amesz & Harrie N. Lafeber

  2. FrieslandCampina, Amersfoort, The Netherlands

    Anne Schaafsma

Authors
  1. Monique van de Lagemaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eline M. Amesz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Schaafsma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harrie N. Lafeber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monique van de Lagemaat.

Additional information

Clinical trial registration information Study toward the effects of postdischarge nutrition on growth and body composition of infants born less than or equal to 32 weeks gestation and/or less than or equal to 1,500 gram birth weight. Unique identifier: ISRCTN 53695702.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van de Lagemaat, M., Amesz, E.M., Schaafsma, A. et al. Iron deficiency and anemia in iron-fortified formula and human milk-fed preterm infants until 6 months post-term. Eur J Nutr 53, 1263–1271 (2014). https://doi.org/10.1007/s00394-013-0629-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-013-0629-0

Keywords

Search

Navigation