Iron Supplementation Strategies to Prevent Deficiency in Infants

Abstract

Introduction: Iron deficiency (ID) affects 15-30% of infants and impairs neurodevelopment. Optimal timing, dose, and duration of prophylactic iron remain unclear. Methods: Systematic review of 14 RCTs (n=3,802) comparing universal iron supplementation (1-2 mg/kg/day from 4-6 months) versus selective supplementation (only if hemoglobin <11 g/dL or ferritin <12 μg/L). Primary outcome: ID at 12 months. Secondary: neurodevelopment (Bayley-III). Results: Universal supplementation reduced ID at 12 months (7.2% vs 18.4%, RR 0.39, p<0.001) and iron deficiency anemia (2.1% vs 7.8%, RR 0.27). No difference in Bayley-III scores at 12 or 24 months. However, universal supplementation increased constipation (14% vs 5%, p=0.01). Discussion: Preventing biochemical ID does not translate into measurable neurodevelopmental benefit in well-nourished populations. Selective screening may be cost-effective. Conclusion: Universal iron supplementation is not recommended for all infants. Targeted screening at 9-12 months is a reasonable alternative.