What is the recommended dosing for Ranferron (Intravenous Iron) in pediatric patients?

Ranferron (Intravenous Iron) Dosing in Pediatric Patients

For pediatric patients requiring intravenous iron supplementation, Ranferron should be dosed at 50-100 mcg/kg/day up to a maximum of 5 mg/day for routine supplementation in infants and children, with higher doses of 200-250 mcg/kg/day recommended for preterm infants. 1

Age-Based Dosing Recommendations

The ESPGHAN/ESPEN/ESPR/CSPEN guidelines provide specific dosing recommendations for parenteral iron in pediatric patients:

• Preterm infants: 200-250 mcg/kg/day
• Term infants to 3 months: 250 mcg/kg/day
• Infants 3-12 months: 100 mcg/kg/day
• Children >12 months: 50 mcg/kg/day (up to maximum 5 mg/day) 1

Administration Considerations

Route and Method

• Parenteral iron can be administered either:

  • Added to parenteral nutrition solutions daily, or
  • As intermittent, separate infusions 1

• If giving as separate infusions, iron sucrose is the most studied iron preparation in children and is recommended for intermittent administration 1

• For administration:

  • Slow IV administration is essential
  • Iron dextran should not exceed 1.0 mL (50 mg) per minute if given undiluted 2
  • Other formulations have specific administration requirements that generally do not include IV push 2

Safety Precautions

• Monitor for adverse reactions during administration
• Iron sucrose has shown fewer severe adverse events in children compared to older iron formulations 1
• A test dose is recommended before initiating iron dextran therapy, but newer formulations may not require this precaution 2

Monitoring

Iron status should be regularly monitored in patients on long-term parenteral iron supplementation to prevent both iron deficiency and iron overload:

• Monitor at minimum:
  • Hemoglobin
  • Serum ferritin 1
• Frequency of monitoring should be increased in patients with high gastrointestinal fluid losses (e.g., ileostomy) 1

Special Considerations

Short-term vs. Long-term Therapy

• Routine provision of iron in parenteral nutrition is not recommended for short-term PN (<3 weeks) 1
• For long-term PN, parenteral iron should be given if enteral iron supplementation is insufficient to maintain adequate iron status 1

Compatibility with PN Solutions

• Iron dextran at 10 mg/L is stable for 48 hours when added to fat-free PN solutions
• Iron dextran cannot be added to lipid emulsions or all-in-one admixtures as it destabilizes the emulsion
• Iron sucrose has been shown to be stable in fat-free PN solutions at concentrations up to 2.5 mg/L 1

Contraindications

• IV iron should not be administered to patients with active infection 2
• Caution should be used during periods of neutropenia due to potential increased infection risk 2

By following these evidence-based dosing recommendations and administration guidelines, clinicians can effectively and safely treat iron deficiency in pediatric patients requiring intravenous iron supplementation.