Daily iron supplementation is more effective than weekly supplementation for preventing anemia in infants under 7 years old. Three studies found daily supplementation significantly improved hemoglobin levels and reduced anemia prevalence compared to controls or weekly supplementation. Additionally, early iron supplementation starting at 2 weeks of age may improve iron status for very low birth weight infants, as indicated by higher serum ferritin levels, compared to later supplementation starting at 6 weeks of age. However, one study found early supplementation did not improve ferritin or hematological parameters in very low birth weight infants. Overall, the studies suggest daily iron supplementation, and potentially early supplementation, may help prevent anemia in young children, especially those with low birth weights, but the optimal timing requires more research

1. P = Children under 7 years old
I = Iron supplementation
C = None
O = Risk of anemia
Sub Theme 2: Prophylactic iron supplementation to prevent iron deficiency in infants
Article Title and Reference Author and
Year
Design Sample size (n)
and type
Purpose of study Key findings
Article 1 Effectiveness of daily and weekly
iron supplementation in the
prevention of anemia in infants
Rev Saude Publica: 42 (5), pp
Engstrom, E.M.
et al (2008)
Randomized, controlled,
non-blinded clinical field
trial
Randomized to:
1)daily iron supplementation
group (n=150; 12.5mg
Fe/day);
2) weekly iron
supplementation group
(n=147; 25mg Fe/week)
3)control group.
N=391
Children aged 6
months at start
of study
To evaluate the
effectiveness of
universal prophylactic
targeting with iron
sulfate on daily or
weekly basis in the
prevention of anemia in
infants
Mean Hb levels were
significantly different between
the daily supplementation
group and control group.
Analysis by adherence to
protocol showed a clear dose-
response effect in DG
when compared to CG for both
mean Hb (p for linear
trend=0.006) and prevalence
ratio of anemia (p for
linear trend=0.018).
No effect was observed for the
weekly regimen

2. Interventions consisted of
universal supplementation
with iron sulfate for 24
weeks, combined with
educational adherence-
promoting measures
In summary, study shows that
only daily supplementation
with iron was effective in
preventing anemia among
studied infants
Article 2 Prophylaxis for iron deficiency
anemia using ferrous sulfate
among
infants followed up at a primary
healthcare unit in the municipality
of Embu-SP (2003/2004)
Sao Paulo Medical Journal: 126
(2), pp 96-101
Shibukawa,
A.F. et al
(2008)
Cross sectional study
Sample was randomly
selected from a
population who had
received prophylactic iron
supplementation since
weaning.
Children's Hb was taken
and parental interviews
completed
N=118 children
with a mean age
of 15.8 months
to investigate
the prevalence of
anemia among children
aged 12 to 18 months
who were being
followed up by the
hospital healthcare
program and had
received guidance for
prophylactic use of
ferrous sulfate, and to
study the factors
associated with anemia
in this group of
children.
41.6% (49/116) of children
were receiving iron
supplements at the time of
the study. However, 41.6%
of the sample were anemic.
There was no statistical
association observed
between use of iron
supplements and presence
of anemia.
Only per capita income had
a significant negative
association with presence
of anemia (p=0.03)
Article 3 Greater effectiveness of daily
iron supplementation scheme
in infants
Rev Saude Publica: 44 (2),
Prospective study
Children were divided
into two supplementary
groups:
1) Daily iron doasge
(n=34)
N=103 non-
anemic children
aged between 6
and 18 months
To assess the
effectiveness of weekly
and daily schemes of
preventive
supplementation with
supplementary iron to
prevent iron deficiency
anemia in non-anemic
After six months of
supplementation, higher means
of hemoglobin were found in
daily dosage group than in the
weekly dosage group
(p=0.015);
Lower prevalence of anemia
was also observed in the daily

3. 2)Weekly iron dosage
(n=69)
Assessments were made
at baseline and after 6
months
infants. dosage group ( p=0.04).
The daily dosage
recommended by the
Sociedade Brasileira
de Pediatria was found to be
more effective to prevent
anemia in infants, when
compared to the dosage used
by the Ministry of Health
Sub Theme 3: Iron supplementation in low birth weight infants
Article Title and Reference Author and
Year
Design Sample size (n)
and type
Purpose of study Key findings
Article 1 Benefits of Iron supplementation
for low birth weight infants: A
systematic review
BMC Pediatrics: 12 (99)
Long, H. et al
(2012)
Systematic Review
15 studies included
(10/15 were randomized
studies,
Studies published
Low birth
weight infants
from birth to 80
days;
Treatment
groups ranged
To examine the
effects of iron
supplementation on
hematologic iron
status, growth,
neuro-development,
Iron supplementation
significantly increased
hematologic measures of
iron status relative to
placebo or over time in
most studies

4. between 1960-2010
Studies of generally
acceptable quality
from n=16-90 and adverse effects
in low birth
weight/premature
infants.
All controlled studies that
examined iron-deficiency
anemia (IDA)/ID reported
a decreased prevalence of
IDA/ID with iron
supplementation
Article 2 Early iron supplementation in
very low birth weight infants – a
randomized controlled trial
Acta Paediatrica: 98, pp 953-8
Sankar, M.J. et
al (2009)
Randomized controlled
trial, blinded to lab
personnel
Infants were randomly
assigned to
1) Early iron
Supplementation group
(n=22) (oral iron in a dose
of either 3 mg/kg/day
(birth weights of 1000–
1500 g) or 4mg/kg/day
(for those weighing
<1000 g at birth) for 6
weeks
2) Control n-24 (no iron
supplementation)
N=46 infants
Preterm VLBW
infants who
received at least
100 mL/kg/day
of oral feeds by
day 14 of life
To evaluate if
supplementing iron
at 2 weeks of age
improves serum
ferritin and/or
haematological
parameters at 2
months of life in
very low birth
weight (VLBW)
infants.
Serum ferritin at 60 days
was not different between
the
two groups
A significant fall in serum
ferritin iwas observed in
the control group (mean
difference: 15.8; 95% CI:
8.5, 23.0; p = 0.002) but
not in the intervention
group (mean difference:
5.4; 95% CI: –1.8,
12.7; p = 0.13).
Supplementing iron at 2
weeks of life did not

5. improve either
serum ferritin or
haematological
parameters at 2 months of
age in preterm VLBW
infants
Article 3 Early versus Late Prophylactic
Iron Supplementation in VLBW
Infants: A Randomized
Controlled Trial
Arch Dis Child Fetal Neonatal
Ed: 99, pp F105-9
Joy, R. et al
(2014)
Single blinded parallel-
group randomized
controlled trial
Infants were randomized
to:
1)Early iron group (2
mg/kg/day elemental
iron) at 2 weeks
postnatal age
2) Late Iron Group (2
mg/kg/day elemental
iron) at 6 weeks
postnatal age
Evaluations were
completed at 2,6 and 12
weeks
N=93 infants;
n=46 (early iron
group); n=47
(late iron group)
To evaluate whether
preterm very low
birth weight infants
receiving early iron
supplementation (2
mg/kg/day elemental
iron) at 2 weeks
postnatal age have
improved serum
ferritin levels
compared with late
iron supplementation
at 6 weeks postnatal
age.
Serum ferritin level was
significantly higher
(P<0.001) at 12 weeks in
the Early Iron group
There was a significant
decrease of ferritin in the
Late Iron group and
significant increase in
ferritin in the Early Iron
group at 6 weeks
compared with 2 weeks