Ferrous Sulfate (Ferro-Liquid)

Check serum ferritin prior to the commencement of medicinal iron following any haemolysis.

Consider delaying/temporarily ceasing medicinal iron with (1) multiple transfusions, particularly >100 mL/kg (2) serum ferritin concentrations >350 microgram/L or (3) have received a transfusion in the last 7 days.

2. Supplementation during erythropoietin therapy

Ferrous sulfate corrects iron deficiency by re-saturating iron storage organs.

IV – Venofer, Ferrosig iron, Ferrum H, Ferinject

Ferrous sulfate (Ferro-Liquid Oral) – 30 mg/mL oral liquid (= 6 mg of elemental iron/mL)

Iron polymaltose (Maltofer) – 37 mg/mL (= 10 mg of elemental iron/mL)

IV

Iron sucrose (Venofer) – 100 mg of elemental iron/5 mL infusion

Iron polymaltose (Ferrosig iron, Ferrum H) – 100 mg of elemental iron/2 mL

Ferric carboxymaltose (Ferinject) 50 mg of elemental iron/mL injection

1. Iron prophylaxis in preterm infants <37 weeks and/or birthweight <2.5 Kg.^5-8

Iron can be from the diet or medicinal iron

2 mg/kg/day – can be started from 2 weeks of age and continue up to 6–12 months of age^8-9

Consider delaying/temporarily ceasing iron with (1) multiple transfusions, particularly >100 mL/kg/day, (2) serum ferritin >350 microgram/L or (3) transfusion in the previous 7 days

2. Supplementation during erythropoietin therapy

Oral: 3–6 mg/kg/day^10-11

IV: 1 mg/kg/day^12-13

IV dose of 20 mg/kg/dose can be given weekly¹³

3. Treatment of iron deficiency anaemia⁸

3–6 mg/kg/day and to continue for 3 months after correction of anaemia⁸

IV

Supplementation on parenteral nutrition >4 weeks

Preterm infants: 200–250 microgram/kg/day¹⁴ or 1400 microgram/kg weekly¹³

Term infants: 50–100 microgram/kg/day¹⁴ or 700 microgram/kg weekly¹³

Supplementation during erythropoietin therapy

1 mg/kg/day¹²

Total iron dose (mg) = (12.5 – observed Hb (g/dL) x body weight (kg) x 3.4 x 1.4¹⁵

Oral iron must be ceased 24 hours before IV iron and should not be given until at least 7 days after last parenteral administration¹⁶

IV iron must be prescribed as mg of elemental iron (e.g. as iron polymaltose) in mL of sodium chloride 0.9% over 4 hours (see Preparation below)

A test dose of 1 mL can be given over 10 minutes prior to the infusion

ECMO: No information.

Renal impairment: No information.

Hepatic impairment: No information.

Treatment: 6 mg/kg/day in iron deficiency anaemia or on erythropoietin.

IV

No preparation.

Draw up required amount of elemental iron from the vial and add to a total volume of sodium chloride 0.9% to a final concentration of no more than 2 mg/mL

Total dose of IV iron required is 60 mg.

Using e.g. Ferrosig ampoules containing 100 mg elemental iron per 2 mL, draw up 1.2 mL (60 mg) of iron.

Add 1.2 mL (60 mg) to 48.8 mL sodium chloride 0.9% to result in a final volume of 50 mL with a concentration of 0.024 mL (1.2 mg) per 1 mL.

Regular serum ferritin if treating iron deficiency anaemia. If the baby has had multiple transfusions, then iron studies would be useful to check for iron overload.

Monitor infusion site and for signs of hypersensitivity during and at least for 30 minutes after administration.

Continuous cardiorespiratory monitoring, oxygen saturations and temperature.

Iron overload conditions: haemochromatosis, haemosiderosis

Hypersensitivity to iron

Uncontrolled hyperparathyroidism

Infectious hepatitis – parenteral iron tends to accumulate in inflamed tissues

Acute renal infections – parenteral iron tends to accumulate in inflamed tissues