SUMMARY In this single blinded parallel-group randomized controlled trial (RCT), preterm very-low-birth-weight (VLBW) infants received early iron (EI) supplementation (starting at 2 weeks postnatal age), or late iron (LI) supplementation (starting at 6 weeks postnatal age) [1]. The primary outcome was serum ferritin level at 12 weeks, and the secondary outcomes were the incidence of neonatal morbidities, hemoglobin level, anthropometric parameters and blood transfusion requirements. Outcomes were analyzed in 46 and 47 babies in EI and LI groups, respectively. Serum ferritin level was significantly higher (P<0.001) at 12 weeks in the EI group. Hemoglobin and mean corpuscular hemoglobin concentration (MCHC) were also significantly (P<0.001) higher at 12 weeks in the EI group. There were no significant differences in the incidences of neonatal morbidities [necrotizing enterocolitis (NEC), periventricular leukomalacia, retinopathy of prematurity (ROP)], anthropometric parameters and blood transfusion requirements between the two groups. The authors concluded that EI supplementation in preterm VLBW infants improves serum ferritin and hemoglobin levels. COMMENTARIES Evidence - based - medicine Viewpoint This RCT on early versus late enteral iron supplementation in preterm VLBW babies is timely, generalizable and well conceived. The authors concluded that EI supplementation in preterm VLBW infants improves serum ferritin, hemoglobin and MCHC at 12 weeks of postnatal age without any concomitant difference in inflammation to account for the difference in ferritin levels. The study is justified because there is still substantial uncertainty about the optimal age at which enteral iron supplementation should commence in such infants. The method of randomization and allocation concealment in the study is appropriate. Measurement bias was restricted by masking the outcome analyzers. One of the potential dangers of EI supplementation is increase in free radical mediated diseases, such as NEC and ROP. The authors rightly concluded that although their trial was not able to detect a significant difference in these diseases, the study was underpowered to do so. The study confirms the efficacy of early iron supplementation but it is inconclusive regarding the safety of the intervention. Only a large study or a metaanalysis of existing trials may be able to shed light on the equally important issue of safety.