Iron requirements in the first year of life depend on birth weight, gestational age, initial hemoglobin content, rate of growth and magnitude of loss in the neonatal period. One third of the mineral content of the fetus is deposited in the last trimester. The infant born prematurely has less iron at birth than the infant born at term and is at increased risk for developing iron deficiency anemia.
When the infant doubles his or her birth weight, or by approximately 2 months of age, he or she will have depleted iron stores. For some infants this may occur sooner.
The American Academy of Pediatrics recommends 2-4 mg iron/kg/d up to a maximum of 15 mg iron/d by the time the infant is 2 months old. This may be offered as an iron supplement or as an iron fortified formula for the formula fed infant. Iron fortified formula will provide approximately 2 mg/kg/d if the infant's energy intake from formula is adequate.
Most infants, including VLBW infants should be offered formulas with iron at the time formula is introduced.
The AAP states the following, "Preterm infants receiving human milk should receive supplementation with ferrous sulfate."
Iron from fortified formula and/or supplements should be continued for at least the first year of life.