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Iron supplementation of breastfed infants from an early age

¹ From the Department of Pediatrics, University of Iowa, Iowa City, IA (EEZ, SEN, and JMJ).

² Supported by the National Institutes of Health (grant HD40315) and by Mead Johnson Nutritionals, Evansville, IN, through financial support and donation of the iron-vitamin supplements. The funding sources had no influence on the design or interpretation of the study.

³ Reprints not available. Address correspondence to Ekhard E. Ziegler, Department of Pediatrics, University of Iowa, A-136 MTF, 2501 Crosspark Road, Coralville, IA 52241-8802. E-mail: ekhard-ziegler{at}uiowa.edu.

Background: In breastfed infants, iron deficiency at <6 mo of life, although uncommon, is observed in industrialized countries. Iron supplementation starting at an early age may prevent iron deficiency.

Objective: The study assessed the effect of early iron supplementation of breastfed infants and tested the hypothesis that iron supplementation enhances iron status. Potential adverse effects (tolerance and growth) were monitored.

Design: The prospective, placebo-controlled study involved exclusively breastfed infants who were randomly assigned at 1 mo of age to iron (n = 37) or placebo (n = 38). Iron (7 mg/d as multivitamin preparation with ferrous sulfate) or placebo (multivitamin preparation without iron) was given from 1 to 5.5 mo of age. Complementary foods were allowed at >4 mo. Infants were followed to 18 mo. Blood concentrations of ferritin, transferrin receptor, hemoglobin, and red cell indexes were determined at bimonthly intervals. Stool consistency and color and feeding behavior were recorded.

Results: Iron supplementation caused modest augmentation of iron status during the intervention at 4 and 5.5 mo but not thereafter. Iron supplements were well tolerated and had no measurable effect on growth. One infant developed iron deficiency anemia by 5.5 mo of age. Plasma ferritin and hemoglobin tracked over time.

Conclusion: Early iron supplementation of breastfed infants is feasible and transiently increases iron status but not hematologic status. Iron is tolerated by most infants. The prevalence of iron deficiency anemia is low (3%) among unsupplemented breastfed infants in the first 6 mo of life.

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