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Timing of Iron Supplementation in Very Low Birth Weight Infants

This study has been completed.
Indian Council of Medical Research
Information provided by:
All India Institute of Medical Sciences, New Delhi Identifier:
First received: May 21, 2008
Last updated: NA
Last verified: May 2008
History: No changes posted
To examine if early iron supplementation (starting oral iron at 14 days of life) would improve the nutritional iron status(measured by serum ferritin) of very low birth weight infants at postnatal age of 60 days, when compared to the standard regime of starting iron at 2 months of life.

Condition Intervention
Nutritional Status
Drug: Elemental iron

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: New Versus Standard Enteral Iron Supplementation Regime in Very Low Birth Weight Infants - A Randomized Controlled Trial

Resource links provided by NLM:

Further study details as provided by All India Institute of Medical Sciences, New Delhi:

Primary Outcome Measures:
  • Serum ferritin [ Time Frame: 60 days postnatal age ]

Secondary Outcome Measures:
  • Composite outcome of neonatal morbidities that include chronic lung disease [CLD], necrotizing enterocolitis [NEC-any stage], periventricular leucomalacia [PVL], and retinopathy of prematurity [ROP] requiring treatment [ Time Frame: Till the end of study period (2 months) ]
  • Hematologic and anthropometric parameters [ Time Frame: at 60 days of age ]
  • Requirement of blood transfusion [ Time Frame: till the end of study period ]

Enrollment: 46
Study Start Date: May 2006
Study Completion Date: January 2007
Primary Completion Date: November 2006 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Starting oral iron at day 14 of life (Early Iron group)
Drug: Elemental iron
Iron in the dose of 3-4 mg/kg/day (of elemental iron) PO once daily mixed with expressed breast milk from 14 days of life till the end of study period
Other Name: 'Tonoferon' drops, East India Co
No Intervention: 2
No iron supplementation till 60 days of life (Control group)

Detailed Description:

Smaller the preterm infants at birth, more susceptible they are to iron deficiency due to low body iron stores. Despite having low iron stores, very low birth weight (VLBW) infants are not usually started on iron supplementation till they reach a postnatal age of 6 to 8 weeks. Such delayed supplementation can lead to rapid depletion of iron stores when erythropoiesis becomes active (by 8 weeks of life).

Depletion of iron stores is the first step in the continuum of changes that occur in iron deficiency. Iron deficiency induces biochemical defects (such as impaired synthesis of DNA and collagen) even before any features of microcytic, hypochromic anemia become evident. The rapidly maturing preterm brain is especially vulnerable to the effects of iron deficiency; poor school-age performance has been reported among children who had low iron stores in their neonatal period.

Early iron supplementation i.e. starting iron once the infant reaches full enteral feeds could potentially improve the iron stores and prevent its depletion. Surprisingly, few studies are available till date to support (or refute!) this view. The current study was designed to test the hypothesis whether early iron supplementation would increase the nutritional iron status (as measured by serum ferritin) at 60 days of life when compared to the existing regime of starting iron at the age 2 months.


Ages Eligible for Study:   up to 60 Days   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Infants who have reached at least 100 ml/kg/day of oral feeds by day 14 of life

Exclusion Criteria:

  • Major congenital anomalies
  • Rh hemolytic disease
  • Twin-to-twin transfusion syndrome
  • Refusal to give consent
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Please refer to this study by its identifier: NCT00683527

All India Institute of Medical Sciences
New Delhi, Delhi (UT), India, 110029
Sponsors and Collaborators
All India Institute of Medical Sciences, New Delhi
Indian Council of Medical Research
Principal Investigator: M Jeeva Sankar, MD DM All India Institute of Medical Sciences, New Delhi
Study Chair: Vinod K Paul, MD PhD All India Institute of Medical Sciences, New Delhi
Study Chair: Ramesh Agarwal, MD DM All India Institute of Medical Sciences, New Delhi
  More Information

Responsible Party: M Jeeva Sankar, Department of Pediatrics, AIIMS, New Delhi Identifier: NCT00683527     History of Changes
Other Study ID Numbers: A-34/2006
Study First Received: May 21, 2008
Last Updated: May 21, 2008

Keywords provided by All India Institute of Medical Sciences, New Delhi:
Iron supplementation
Serum ferritin
Very low birth weight infants

Additional relevant MeSH terms:
Birth Weight
Body Weight
Signs and Symptoms
Trace Elements
Growth Substances
Physiological Effects of Drugs processed this record on April 27, 2017