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Ferrous Sulphate

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Ferrous sulphate is available in a solution labelled 150mg/5ml, which provides 6mg of elemental iron per ml.

Dose and administration

Prophylaxis

0.5ml/kg/day (3mg/kg/day of elemental iron) in two divided doses:

  • All infants with a birthweight<2500g or a gestation at birth <37 weeks . Infants outside these criteria should be discussed with a specialist first.
  • Commence at 2 weeks of age or on discharge, whichever occurs earliest.

NB. If infant is on ≥100ml/kg/day FM85 fortifier or Preterm formula there is sufficient iron for prophylaxis so additional prophylaxis is not needed.

Treatment

Infants with iron deficiency anaemia:

  • 1ml/kg/day (6mg/kg/day of elemental iron) in two divided doses. 
  • 0.5ml/kg/day (3mg/kg/day) for infants receiving ≥100ml/kg/day FM85 fortification or preterm formula (as these already contain a prophylactic dose of iron)

Indications

  1. Prophylaxis for iron deficiency anaemia in low birthweight infants with reduced body iron stores.
  2. Treatment of documented iron deficiency anaemia.

Contraindications and precautions

  1. Peptic ulcer
  2. Haemolytic anaemias
  3. Haemochromatosis

Clinical pharmacology

Iron is an integral part of haemoglobin. Although the major portion of iron in the body is in the form of haemoglobin, a small amount is also stored in tissues as haemosiderin and ferritin, and in blood it is bound to transferrin, a carrier protein.

The intestine is the primary site for both absorption and excretion of iron. Food and antacid decrease the absorption of iron.

Iron is rigidly conserved in the body. Most of the iron released from breakdown of haemoglobin in the liver is reused.

Possible adverse effects

  1. Gastrointestinal disturbance:
    Nausea, vomiting, constipation.
    Dark stools (green or black).
    Erosion of gastric mucosa.
  2. In preterm infants may cause increased red cell haemolysis and haemolytic anaemia due to low serum vitamin E.
  3. Lethargy.
  4. Hypotension.
  5. Acute toxicity: gastrointestinal disturbances worsened, CNS disorders (lethargy), pallor, cyanosis, shock.

Special considerations

  1. Monitor Hb, PCV, reticulocytes.
  2. Vitamin C may increase iron absorption.

Information for families

Link to Parent information pamphlet - Vitadol C and Iron

Management of Oral Ferrous Sulphate administration

Description

Available in a solution of Ferrous sulphate 150mg/5ml, containing 6mg/ml of elemental iron.

Prescription

Charted on drug prescription chart in ml/dose.

Administration of Oral Ferrous Sulphate

Administer before feeds to maximise absorption. If not tolerated can be administered with a small amount of milk (milk decreases absorption of iron).

Nursing considerations

  • Observe for signs of adverse effects and/or toxicity. Keep in mind gastro-intestinal upset may be dose related.
  • Observe stools. Check for constipation.

Storage

  • Store at room temperature (below 25°C)
  • Protect from light
  • Discard 6 months after opening. Attach a "Do Not Use after" label, and date.

References

  1. Joy R, Krishnamurthy S, Bethou A, Rajappa M, Ananthanarayanan PH, Bhat BV: Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2014, 99(2):F105-109.
  2. Mills RJ, Davies MW. Enteral iron supplementation in preterm and low birth weight infants. Cochrane Database Syst Rev 2012;(3):CD005095.
  3. Anabrees J: Early Enteral Prophylactic iron Supplementation May be Preferred in Preterm Very Low Birth Weight Infants. Journal of clinical neonatology 2014, 3(1):14-15.
  4. Long H, Yi JM, Hu PL, et al. Benefits of iron supplementation for low birth weight infants: A systematic review. BMC Pediatr 2012;12:99.
  5. Franz AR, Mihatsch WA, Sander S, Kron M, Pohlandt F.Prospective randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams. Pediatrics 2000;106(4):700-6.
  6. Taylor TA, Kennedy KA. Randomized trial of iron supplementation versus routine iron intake in VLBW infants.
  7. Pawlak RP and Herfert LA. Drug administration in the NICU. A handbook for Nurses, Neonatal Network 1990, 2nd Edition p100-1.
  8. Royal Children's Hospital, Melbourne. Paediatric Pharmacopoeia 11th Edition, 1994 p74.
  9. Young TE and Mangum OB Neofax. A manual of drugs used in neonatal care. 11th Edition 1998, p176.
  10. Nursing 1997 Drug Handbook, Springhouse. 1997, p857-8.

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Document Control

  • Date last published: 30 March 2018
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years