Dear Rob, my understanding would be that as a premie he didn't get his fair
share on iron in utero (cut off- out too soon) and then he proceeded to
grow well (dbling birth wt in 4 mo) and used up whatever iron he had on
board for this growth.  Once you give iron from an exogenous source, it
isn't well absorbed from breast milk so the exogenous source (drops or
cereal) becomes the primary source for the iron.  I don't believe it
matters if iron food is given at a different time than br milk.  It just
means if iron food is given at all.

Cereal idea sounds OK if he is ready to try it.  Strained apricots are also
a fair source.  PDA and VSD might have been getting symptomatic because of
the anemia.  I tend to test premies sooner than 6 mo because I believe this
is a known problem - for them not to have adequate iron stores.  So I'd go
with iron, lasix and dig and breast compression and see how he progresses.
If not so anemic he may not need dig and lasix, or maybe less.  Less anemia
will probably lead to better appetite.  I think he had several  things all
converge at once because of the anemia.

My info also says iron given with a Vit C source is absorbed more
efficiently. We use Vitafol.  Lactoferrin only works with breast milk, I
think................  Sincerely, Pat in SNJ

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