Abstract
Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem. Identification of anemia is crucial to public health interventions. It is estimated globally that 273 million children under 5 years of age were anemic in 2011, and about ~50% of those cases were attributable to iron deficiency (Lancet Global Health 1:e16-e25, 2013). Iron-deficiency anemia (IDA) in infants adversely impacts short-term hematological indices and long-term neuro-cognitive functions of learning and memory that result in both fatigue and low economic productivity. IDA contributes to death and disability and is an important risk factor for maternal and perinatal mortality, including the risks for stillbirths, prematurity, and low birth weight (Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Ch. 3 (World Health Organization, Geneva, 2004)). Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as delayed cord clamping (DCC). DCC until 1-3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn. DCC, an effective anemia prevention strategy, requires cooperation among health providers involved in childbirth, and a participatory culture change in public health. Public intervention strategies must consider multiple factors associated with anemia listed in this review before designing intervention studies that aim to reduce anemia prevalence in infants and toddlers. IMPACT: Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem and identification of anemia is crucial to public health interventions. Delayed cord clamping (DCC) until 1-3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn. Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as DCC.
Highlights
Anemia is a condition in which hemoglobin (Hb) concentration is lower than the normal expected ranges for age and sex [3, 4]
Higher ferritin levels were observed at 6 months of age in the umbilical cord milking (UCM) group, regardless of maternal anemia status, compared to the immediate cord clamping group [83]
Control of inflammation through prevention and treatment of HIV, malaria and helminthic infections in children aged under 3 years; 4
Summary
Anemia is a condition in which hemoglobin (Hb) concentration is lower than the normal expected ranges for age and sex [3, 4]. Higher ferritin levels were observed at 6 months of age in the UCM group, regardless of maternal anemia status, compared to the immediate cord clamping group [83] Thereafter, both DCC and UCM interventions are relevant for infants living in low-resource settings or in settings with less access to iron-rich foods and greater risk of anemia. Despite the observed protection against early infantile iron deficiency from placental transfusion of maternal iron stores, prevalence of anemia continues to remain high among infants aged 7-12 months. The WHO recommends daily iron supplementation as a public health intervention in infants and young children aged 6-23 months, living in settings where the prevalence of anemia is 40% or higher in order to prevent iron deficiency and anemia [53]. Newer innovative oral iron formulation such as sucrosomial iron with its protective phospholipid bilayer that offers higher iron bioavailability and improved gastrointestinal tolerance are emerging [114]
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