Background: Preterm babies with anaemia (also known as anaemia of prematurity) experience a bigger and quicker haemoglobin decline. As a result, blood transfusions and the administration of human synthetic erythropoietin are required. The purpose of this research was to assess ferritin and zinc protoporphyrin to heme ratio (ZnPP/H) as biomarkers of iron status in preterm neonates and to ascertain the influence of particular clinical events on these parameters. Methods: 170 preterm babies with gestational ages of less than 34 weeks who were chosen from the Neonatal Intensive Care Unit at Benha University Hospital participated in this prospective cross-sectional research. Results: 81 infants (49.1%) of the cases in our research that were examined had anaemia. Patients with sepsis had substantially lower platelet counts than individuals without the condition. The septic group had substantially higher CRP levels. Ferritin levels were noticeably lower in the anaemic group than in the non-anemic group. After 4 weeks, there was a substantial rise in ZPP/H ratio. ZPP/H ratio substantially fell after blood infusions compared to baseline. Conclusion: ZnPP/H may be a better predictor of iron status in this group than ferritin since sepsis and transfusion have a higher effect on it than on ferritin. In terms of the effects of clinical events, serum ferritin levels were substantially reduced in the anaemic group compared to the non-anemic group, whereas ZPP and ZPP/H ratio levels were markedly higher. The septic group had noticeably greater serum ferritin values.