Background: Eternal Iron supplementation is providing of prophylaxisâ€™s iron for pre-terms andrnlow birth weight infants to supply sufficient iron for growth and development without increasingrnthe risk of iron overload .Preterm infants are deprived of the significant iron accretion that occursrnin the third trimester of pregnancy and have reduced iron stores at birth compared with termrninfants .Iron deficiency in infancy is associated with a range of clinical andrndevelopmentallyimportant issues including neurodevelopmental deficits, delayed maturation ofrnthe auditory brainstem response, risk for poor cognitive, motor, socialâ€“emotional andrnneurophysiological development. rnObjective:The primary objective of this study is to evaluate thecurrent iron supplementationrnpractice and anemia for pre-terms and low birth weight infantsat Tikur Anbessa spatializedrnhospital and Gandhi memorial hospital fromJanuary 1,2019 to December 31, 2020 rnMethod:A cross sectional study was done by using patient charts review that wereevaluated atrnnewborn intensive care unit,wards and high-risk infant clinicof Tikur Anbessa spatializedrnhospitaland gandy memorial hospital.Datawas collected through retrospective chart reviewrnwhich meet the inclusion criteria by using structured check list which is prepared from previousrnliterature with few amendments. The data was coded, cleaned and entered in to Epi data versionrn4.6 and then transferred to SPSS version 26 software program for further analysis. Descriptivernsummary measures were presented using Tables and Figures. The data was categorized andrnsummarized with descriptive statistics rnResult:There were 245 pre-terms and low birth weight infants included in this study. Ironrnprophylaxis supplementation practice was 53.1%, where 54.6% of supplemented infant wasrnfemales. Mean iron prophylaxis starting time was 7.4 weeks and average dose ofrnsupplementation was1.94mg/k/day.Mean duration of iron supplementation was 5.4 months. Onernhundred thirteen (86.9%) of supplemented infants were below 34 weeks GA. Ninety-fourrn(72.3%) of iron supplemented infants birth weight were below 1500 grams. Around 65.4 % ofrninfantes were started iron prophylaxes in the rage of (3 -8) weeks of post-natal age and 65.4rnpercent of infants supplemented 2 to 4mg/kg/day of elementary iron. According to this studyrnprevalence of anemia was 39.6% and 4.1 % severe anemia,20.6% moderate and 75.3% had mildrnanemia where all of severe anemia was non-supplemented infants. rnConclusion:Iron prophylaxis practice was low in TASH and GMH and a great variability in therntiming of beginning, dose, and ending of iron prophylaxis which needs standardization.rnprophylaxis iron supplementation practice is imperative to protect anemia in preterm and lowrnbirth weight infants. Anemia was high for those non supplemented infants whereas preventiverniron prophylaxis prevents severe anemia significant.