Iron Status In Infants Research Articles

An Elevation of Serum Ferritin Level Might Increase Clinical Risk for the Persistence of Patent Ductus Arteriosus, Sepsis and Bronchopulmonary Dysplasia in Erythropoietin-Treated Very-Low-Birth-Weight Infants

Background: The substantial risk of iron overload is not routinely monitored in most of the neonatal intensive care units (NICUs) in Japan; however, blood transfusion is an essential strategy for successfully treating preterm low-birth-weight infants. Objective: The aim of this study was to investigate the iron status and clinical features of infants with a birth weight of <1,500 g, i.e. very-low-birth-weight infants (VLBWIs). Methods: This prospective observational study enrolled 176 (82.6%) patients from a total of 213 VLBWIs admitted to our NICU from 2009 to 2014. Clinical information was collected including maternal records and infant morbidity and treatment. Management strategies including enteral iron supplementation, erythropoietin administration and blood transfusion were allowed according to the consensus in Japan. The hematological status was surveyed from birth to 12 postnatal weeks of age. The iron status was determined according to serum iron, unbound iron-binding capacity and serum ferritin. The definition of hyperferritinemia was set as a value of ≥500 ng/ml. Results: Twenty-four (13.6%) infants displayed hyperferritinemia. A multiple logistic analysis selected 3 associated factors of hyperferritinemia: surgical ligation for patent ductus arteriosus, sepsis and moderate or severe states of bronchopulmonary dysplasia. We also verified that the value of ferritin was significantly correlated with those of aspartate transaminase, creatine kinase and C-reactive protein according to a multilinear regression analysis. After excluding the ferritin data of these outliers, we did not observe any factors associated with hyperferritinemia. Conclusions: Hyperferritinemia might be associated with oxygen radical diseases and susceptibility to infection.

A Prospective Study of Iron Status of Exclusively Breastfed Infants Weighing 1800-2499g At Birth and Correlation With Breast Milk Lactoferrin

Background: Iron status of exclusively breastfed low birth weight (LBW) infants has not been evaluated sufficiently. We determined the iron status of infants weighing 1800-2499g at birth and correlated it with breast milk lactoferrin levels of their mothers. Methods: Sixty five exclusively breastfed LBW infants were recruited at 6 weeks and followed-up until 6 months of age. Iron parameters (serum iron, serum ferritin, iron binding capacity, percent transferring saturation) and breastmilk lactoferrin were measured and compared at 6 weeks and 6 months of age. Hemoglobin (Hb) was measured at 6, 10, 14, 18 weeks and 6 months of age. If at any time, Hb of the infant was &lt;10.5g/dl then iron supplementation was started at 3mg/kg/day for a minimum of 2 months or till Hb rose to&gt;10.5g/dl. Results: Fifty (76.9%) out of 65 infants developed anemia between 10 weeks and 6 months of age. At 6 months of age 32.2% babies showed iron deficiency (serum ferritin level &lt;10ng/mL). There was no correlation between breast milk lactoferrin and infants’ serum iron profile either at 6 weeks or at 6 months of age. Conclusion: About 1/3rd infants developed iron deficiency state at 6 months of age. Three-fourth infants required iron supplementation by 6 months of age. There was no relationship between maternal breast milk lactoferrin with infants’ iron profile either at 6 weeks or at 6 months of age.

Validation of a Novel Method for Use in Studies of Iron Status, Brain Function (EEG), and Recognition Memory Performance in Infancy

BackgroundEarly infancy is a time of peak cortical development when young infants are more susceptible to cognitive deficits from nutritional deficiencies. Previous studies link EEG measures of brain function to behavioral measures during recognition memory tasks in early infancy, but few in the context of nutrition deficiencies. Animal studies have shown that specific nutritional deficiencies affect the brain in targeted areas rather than as a broad cognitive change, but many current studies of nutrition and cognition in human infants only use general measures of cognition.ObjectiveOur study is unique in looking at early infant recognition memory, brain function, and iron status. This analysis examines the relationship between behavioral and brain (EEG) measures of memory as a validation of methods that could be applied in subsequent studies of the relationship between infant iron status and cognitive function.MethodsEEG data were collected from infants (4–6 mo, N=30) during a memory task (Oddball) in which the infants observed novel and familiar stimuli of emotionally neutral female faces. During a related memory behavior task (Paired Comparison), infants viewed two faces simultaneously and the length of infant gaze at each stimulus by stimulus type was measured. Hemoglobin and serum ferritin were measured to assess anemia and iron stores, respectively. The main EEG outcomes were the difference in amplitude and slope of the late slow wave (ΔLSW) between novel and familiar stimuli, a known measure of memory. The percent of time spent looking at the novel versus familiar stimuli (%Nov), as well as the total time spent in attention were the main memory behavior outcomes. Student's t‐tests and regression modeling were used to analyze the association between ΔLSW and %Nov. Age, sex, race, birth weight, and maternal education were assessed as potential confounders in regression models.Results and ConclusionsPreliminary results show that ΔLSW was significantly associated with %Nov (β = 0.52 ± 0.27; p=.04). These results show that our novel combination of methods successfully measures recognition memory and improves on previous work by using specific behavioral tasks and measures of brain function in the context of infant iron deficiency. This study will inform future work in the fields of nutrition and cognition.Support or Funding InformationFunded by USDA/CUAES (Hatch #NYC399413) and Cornell Human Ecology Alumni Association; JEHN supported by NSF GRFP

The Relationship Between Infant Iron Status, Maternal‐Infant Interactions, and Cultural Ideology

BackgroundAlthough there is no clinical definition of iron deficiency (ID) in infants younger than 12 months, studies have shown that low levels of serum ferritin in early infancy is linked to deficits in behavior, cognition, and motor activity. These deficits can negatively affect the infant's social interactions with the mother and other caretakers, and thus social and cognitive development.ObjectiveTo describe the relationship between iron status in early infancy, the quality of maternal‐infant interactions, and maternal cultural ideology.MethodsIn this study, 4–6 month old infants (n= 64) and their mothers were evaluated with PROCESS, the Pediatric Review of Children's Environmental Support and Stimulation. The PROCESS, derived from the Home Observation for Measurement of the Environment‐Inventory for Infants (HOME), was designed to assess maternal caregiving and infant response in a clinical setting, and provides scores in four categories: maternal warmth, caring, responsiveness, and sensitivity in a clinical setting. As the PROCESS is a culturally sensitive measure, some questions were removed from the total score to form a new scale named “Cultural Context.” Infant anemia and iron stores were assessed with hemoglobin (Hb) &lt;11.0 g/dL and serum ferritin, respectively. Associations between infant iron levels and the overall quality of the mother‐infant interactions, as well as each separate category, were estimated using linear regression models in SPSS. Potential confounders that were tested include maternal education and age, infant age, birth weight, number of previous children and the Cultural Context scale of the PROCESS.ResultsInfant Hb alone did not significantly predict the quality of maternal‐infant interactions (b=1.6 ± 1.067 (SE), p=.137). When the confounder Cultural Context was included in the model infant Hb became positively associated with the quality of maternal‐infant interactions (b=1.7 ± 0.8, p&lt;.05). Infant anemia status was not significantly associated with the quality of maternal‐infant interactions Infant serum ferritin was also not significantly associated with any category of the maternal‐infant interaction nor the total PROCESS score.ConclusionThese results could be important in predicting the quality of maternal‐infant interactions based on infant Hb and highlight the importance of including cultural biases in socio‐behavioral analyses.Support or Funding InformationFunded by USDA/CUAES (#NYC‐399413) &amp; Cornell Human Ecology Alumni Association; JN supported by NSF GRFP

Effect of timing of umbilical cord clamping on anaemia at 8 and 12 months and later neurodevelopment in late pre-term and term infants; a facility-based, randomized-controlled trial in Nepal.

BackgroundDelayed cord clamping at birth has shown to benefit neonates with increased placental transfusion leading to higher haemoglobin concentrations, additional iron stores and less anaemia later in infancy, higher red blood cell flow to vital organs and better cardiopulmonary adaptation. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants also in regions with a relatively low prevalence of iron deficiency anaemia. In Nepal, there is a high anaemia prevalence among children between 6 and 17 months (72–78 %). The objective of the proposed study is to evaluate the effects of delayed and early cord clamping on anaemia (and haemoglobin level) at 8 and 12 months, ferritin at 8 and 12 months, bilirubin at 2–3 days, admission to Neonatal Intensive Care Unit (NICU) or special care nursery, and development at 12 and 18–24 months of age.Methods/designA randomized, controlled trial comparing delayed and early cord clamping will be implemented at Paropakar Maternity and Women’s Hospital in Kathmandu, Nepal. Pregnant woman of gestational age 34–41 weeks who deliver vaginally will be included in the study. The interventions will consist of delayed clamping of the umbilical cord (≥180 s after delivery) or early clamping of the umbilical cord (≤60 s). At 8 and 12 months of age, infant’s iron status and developmental milestones will be measured.DiscussionThis trial is important to perform because, although strong indications for the beneficial effect of delayed cord clamping on anaemia at 8 to 12 months of age exist, it has not yet been evaluated by a randomized trial in this setting. The proposed study will analyse both outcome as well as safety effects. Additionally, the results may not only contribute to practice in Nepal, but also to the global community, in particular to other low-income countries with a high prevalence of iron deficiency anaemia.Trial registrationClinical trial.gov NCT02222805. Registered August 19 2014.

Low-Dose Iron Supplementation in Infancy Modestly Increases Infant Iron Status at 9 Mo without Decreasing Growth or Increasing Illness in a Randomized Clinical Trial in Rural China

Background: Previous trials of iron supplementation in infancy did not consider maternal iron supplementation.Objective: This study assessed effects of iron supplementation in infancy and/or pregnancy on infant iron status, illnesses, and growth at 9 mo.Methods: Enrollment occurred from December 2009 to June 2012 in Hebei, China. Infants born to women in a pregnancy iron supplementation trial were randomly assigned 1:1 to iron [∼1 mg Fe/(kg · d) as oral iron proteinsuccynilate] or placebo from 6 wk to 9 mo, excluding infants with cord ferritin <35 μg/L. Study groups were pregnancy placebo/infancy placebo (placebo/placebo), pregnancy placebo/infancy iron (placebo/iron), pregnancy iron/infancy placebo (iron/placebo), and pregnancy iron/infancy iron (iron/iron). The primary outcome was 9-mo iron status: iron deficiency (ID) by cutoff (≥2 abnormal iron measures) or body iron <0 mg/kg and ID + anemia (hemoglobin <110 g/L). Secondary outcomes were doctor visits or hospitalizations and weight or length gain from birth to 9 mo. Statistical analysis by intention to treat and dose-response (between number of iron bottles received and outcome) used logistic regression with concomitant RRs and general linear models, with covariate control as applicable.Results: Of 1482 infants randomly allocated, 1276 had 9-mo data (n = 312–327/group). Iron supplementation in infancy, but not pregnancy, reduced ID risk: RRs (95% CIs) were 0.89 (0.79, 0.998) for placebo/iron compared to placebo/placebo, 0.79 (0.63, 0.98) for placebo/iron compared to iron/placebo, 0.87 (0.77, 0.98) for iron/iron compared to placebo/placebo, and 0.86 (0.77, 0.97) for iron/iron compared to iron/placebo. However, >60% of infants still had ID at 9 mo. Receiving more bottles of iron in infancy was associated with better infant iron status at 9 mo but only among iron-supplemented infants whose mothers were also iron supplemented (i.e., the iron/iron group). There were no group differences in hospitalizations or illnesses and no adverse effects on growth overall or among infants who were iron sufficient at birth.Conclusions: Iron supplementation in Chinese infants reduced ID at 9 mo without adverse effects on growth or illness. Effects of iron supplementation in pregnancy were observed only when higher amounts of iron were distributed in infancy. This trial was registered at clinicaltrials.gov as NCT00613717.

Hepcidin and iron status in pregnant women and full-term newborns in first days of life

The amount of iron is regulated by hepcidin. The aim of the study was to assess hepcidin concentrations in healthy pregnant women before delivery, in cord blood, and in 3-day-old newborns in relation to maternal and neonatal iron status. The study group consisted of 44 mother-newborn pairs. Serum concentrations of hepcidin, ferritin, and transferrin receptor (sTfR) were assessed. Maternal hepcidin was significantly lower than cord blood (p < 0.001), and full-term newborn values (p < 0.001). Mothers also had the lowest ferritin and sTfR concentrations. The highest concentration of hepcidin was observed in the newborns. They had lower sTfR and higher ferritin concentrations than in cord blood (p < 0.001). Maternal ferritin correlated negatively with sTfR (R = -0.50 p = 0.005), and positively with hepcidin (R = 0.41; p = 0.005). There were no correlations between hepcidin and ferritin or sTfR concentrations in cord blood, nor between hepcidin and ferritin or sTfR concentrations in the newborns. Moreover, there were no correlations between maternal and cord blood or neonatal blood hepcidin, nor between maternal hepcidin and infant iron status. There were also no correlations between hepcidin in cord blood and hepcidin or parameters of the iron status in the children. It may be assumed that a relatively low concentration of hepcidin in women in late pregnancy facilitates their iron accumulation. Higher levels of hepcidin in full-term newborns than in their mothers may be the result of a relatively high level of iron from the stored supplies. Neonatal iron status was independently associated with either maternal or cord blood hepcidin.

The Role of Breastfeeding in the Prevention of Childhood Malnutrition.

Breastfeeding has an important role in the prevention of different forms of childhood malnutrition, including wasting, stunting, over- and underweight and micronutrient deficiencies. This chapter reviews research that demonstrates how improved breastfeeding rates have the potential to improve childhood nutrition, with associated impacts on infectious and noninfectious disease prevention. The unique composition of breastmilk, the importance of breastfeeding in infectious disease prevention, the iron status of breastfed infants, and breastfeeding's protective effect on overweight and obesity are discussed based on currently available research. Early and tailored dietary counseling is needed to improve maternal diets, which can affect the nutritional status of breastmilk. Promotion and support of breastfeeding are important to prevent childhood morbidity and mortality. A review of the literature reveals key factors shown to be effective in improving breastfeeding rates, especially including legislation to control the marketing of breastmilk substitutes. In conclusion, breastfeeding is shown to be the best natural resource to improve childhood nutrition throughout the world.

The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal

Background/Objectives:Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal.Subjects/Methods:In a cross-sectional survey, we randomly selected 500 mother–infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein.Results:The altitude-adjusted prevalence of anemia was 49% among infants 2–6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7–12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 μg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations.Conclusions:Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.

In-home fortification with 2.5 mg iron as NaFeEDTA does not reduce anaemia but increases weight gain: a randomised controlled trial in Kenyan infants.

In-home fortification of infants with micronutrient powders (MNPs) containing 12.5 mg iron may increase morbidity from infections; therefore, an efficacious low-dose iron-containing MNP might be advantageous. Effects of iron-containing MNPs on infant growth are unclear. We assessed the efficacy of a low-iron MNP on iron status and growth and monitored safety in a randomised, controlled, double-blind 1-year trial in 6-month-old infants (n = 287) consuming daily a maize porridge fortified with either a MNP including 2.5 mg iron as NaFeEDTA (MNP + Fe) or the same MNP without iron (MNP - Fe). At baseline, after 6 and 12 months, we determined haemoglobin (Hb), iron status [serum ferritin (SF), soluble transferrin receptor (sTfR) and zinc protoporphyrin (ZPP)], inflammation [C-reactive protein (CRP)] and anthropometrics. We investigated safety using weekly morbidity questionnaires asking for diarrhoea, cough, flu, bloody or mucus-containing stool and dyspnoea, and recorded any other illness. Furthermore, feeding history and compliance were assessed weekly. At baseline, 71% of the infants were anaemic and 22% iron deficient; prevalence of inflammation was high (31% had an elevated CRP). Over the 1 year, Hb increased and SF decreased in both groups, without significant treatment effects of the iron fortification. At end point, the weight of infants consuming MNP + Fe was greater than in the MNP - Fe group (9.9 vs. 9.5 kg, P = 0.038). Mothers of infants in the MNP + Fe group reported more infant days spent with cough (P = 0.003) and dyspnoea (P = 0.0002); there were no significant differences on any other of the weekly morbidity measures. In this study, low-dose iron-containing MNP did not improve infant's iron status or reduce anaemia prevalence, likely because absorption was inadequate due to the high prevalence of infections and the low-iron dose.

Effect of Daily Antenatal Iron Supplementation on Plasmodium Infection in Kenyan Women: A Randomized Clinical Trial.

Anemia affects most pregnant African women and is predominantly due to iron deficiency, but antenatal iron supplementation has uncertain health benefits and can increase the malaria burden. To measure the effect of antenatal iron supplementation on maternal Plasmodium infection risk, maternal iron status, and neonatal outcomes. Randomized placebo-controlled trial conducted October 2011 through April 2013 in a malaria endemic area among 470 rural Kenyan women aged 15 to 45 years with singleton pregnancies, gestational age of 13 to 23 weeks, and hemoglobin concentration of 9 g/dL or greater. All women received 5.7 mg iron/day through flour fortification during intervention, and usual intermittent preventive treatment against malaria was given. Supervised daily supplementation with 60 mg of elemental iron (as ferrous fumarate, n = 237 women) or placebo (n = 233) from randomization until 1 month postpartum. Primary outcome was maternal Plasmodium infection at birth. Predefined secondary outcomes were birth weight and gestational age at delivery, intrauterine growth, and maternal and infant iron status at 1 month after birth. Among the 470 participating women, 40 women (22 iron, 18 placebo) were lost to follow-up or excluded at birth; 12 mothers were lost to follow-up postpartum (5 iron, 7 placebo). At baseline, 190 of 318 women (59.7%) were iron-deficient. In intention-to-treat analysis, comparison of women who received iron vs placebo, respectively, yielded the following results at birth: Plasmodium infection risk: 50.9% vs 52.1% (crude difference, -1.2%, 95% CI, -11.8% to 9.5%; P = .83); birth weight: 3202 g vs 3053 g (crude difference, 150 g, 95% CI, 56 to 244; P = .002); birth-weight-for-gestational-age z score: 0.52 vs 0.31 (crude difference, 0.21, 95% CI, -0.11 to 0.52; P = .20); and at 1 month after birth: maternal hemoglobin concentration: 12.89 g/dL vs 11.99 g/dL (crude difference, 0.90 g/dL, 95% CI, 0.61 to 1.19; P < .001); geometric mean maternal plasma ferritin concentration: 32.1 µg/L vs 14.4 µg/L (crude difference, 123.4%, 95% CI, 85.5% to 169.1%; P < .001); geometric mean neonatal plasma ferritin concentration: 163.0 µg/L vs 138.7 µg/L (crude difference, 17.5%, 95% CI, 2.4% to 34.8%; P = .02). Serious adverse events were reported for 9 and 12 women who received iron and placebo, respectively. There was no evidence that intervention effects on Plasmodium infection risk were modified by intermittent preventive treatment use. Among rural Kenyan women with singleton pregnancies, administration of daily iron supplementation, compared with administration of placebo, resulted in no significant differences in overall maternal Plasmodium infection risk. Iron supplementation led to increased birth weight. clinicaltrials.gov Identifier: NCT01308112.

Antiretroviral Treatment Is Associated With Iron Deficiency in HIV-Infected Malawian Women That Is Mitigated With Supplementation, but Is Not Associated With Infant Iron Deficiency During 24 Weeks of Exclusive Breastfeeding.

In resource-limited settings without safe alternatives to breastfeeding, the WHO recommends exclusive breastfeeding and antiretroviral (ARV) prophylaxis. Given the high prevalence of anemia among HIV-infected women, mothers and their infants (through fetal iron accretion) may be at risk of iron deficiency. We assessed the effects of maternal micronutrient-fortified lipid-based nutrient supplements (LNS) and maternal ARV treatment or infant ARV prophylaxis on maternal and infant iron status during exclusive breastfeeding from birth to 24 weeks. The Breastfeeding, Antiretrovirals, and Nutrition study was a randomized controlled trial conducted in Lilongwe, Malawi, from 2004 to 2010. HIV-infected mothers (CD4 >200 cells/μL) and their infants were randomly assigned to 28-week interventions: maternal LNS/maternal ARV (n = 424), maternal LNS/infant ARV (n = 426), maternal LNS (n = 334), maternal ARV (n = 425), infant ARV (n = 426), or control (n = 334). Longitudinal models tested intervention effects on hemoglobin (Hb). In a subsample (n = 537) with multiple iron indicators, intervention effects on Hb, transferrin receptors (TfR), and ferritin were tested with linear and Poisson regression. In longitudinal models, LNS effects on maternal and infant Hb were minimal. In subsample mothers, maternal ARVs were associated with tissue iron depletion (TfR >8.3 mg/L) (risk ratio: 3.1, P < 0.01), but not in ARV-treated mothers receiving LNS (P = 0.17). LNS without ARVs was not associated with iron deficiency or anemia (P > 0.1). In subsample infants, interventions were not associated with impaired iron status (all P > 0.1). Maternal ARV treatment with protease inhibitors is associated with maternal tissue iron depletion; but LNS mitigates adverse effects. ARVs do not seem to influence infant iron status; however, extended use needs to be evaluated.

Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnancy: A Systematic Review for the U.S. Preventive Services Task Force

Routine screening and supplementation for iron deficiency anemia (IDA) in asymptomatic, nonanemic pregnant women could improve maternal and infant health outcomes. Update of a 2006 systematic review by the U.S. Preventive Services Task Force on screening and supplementation for IDA in pregnancy. MEDLINE and the Cochrane Library (1996 to August 2014) and reference lists of relevant systematic reviews to identify studies published since 1996. English-language trials and controlled observational studies about effectiveness of screening and routine supplementation for IDA in developed countries. Data extraction and quality assessment confirmed and dual-rated by a second investigator using prespecified criteria. No study directly compared clinical outcomes or harms of screening or not screening pregnant women for IDA. Twelve supplementation trials were included, and no controlled observational studies met inclusion criteria. On the basis of 11 trials, routine maternal iron supplementation had inconsistent effects on rates of cesarean delivery, small size for gestational age, and low birthweight and no effect on maternal quality of life, gestational age, Apgar scores, preterm birth, or infant mortality. Twelve trials reported improvements in maternal hematologic indices, although not all were statistically significant. Pooled analysis of 4 trials resulted in a statistically significant difference in IDA incidence at term, favoring supplementation (risk ratio, 0.29 [95% CI, 0.17 to 0.49]; I2= 0%). Maternal iron supplementation did not affect infant iron status at 6 months. Harms, none of which were serious or had long-term consequences, were inconsistently reported in 10 of the trials, with most finding no difference between groups. Data from trials in countries with limited generalizability to U.S. populations were included. Studies were methodologically heterogeneous, and some were small and underpowered. There is inconclusive evidence that routine prenatal supplementation for IDA improves maternal or infant clinical health outcomes, but supplementation may improve maternal hematologic indices. Agency for Healthcare Research and Quality.

Infant nutritional outcomes in an integrated agriculture, health and nutrition program in Western Kenya

The Mama SASHA project integrated an orange‐fleshed sweetpotato (OFSP)‐focused, agricultural‐nutrition education intervention into delivery of routine health services and pregnant women's clubs. It aimed to improve diets, nutrition and health of pregnant /lactating women and their infants. We enrolled 505 women from intervention and control facilities during first antenatal care visit in early pregnancy. Infant anthropometry, vitamin A and iron status were assessed at 4 and 9 mos of age and anemia at 9 mos. There were no significant socioeconomic differences at enrollment. OFSP consumption was significantly higher and maternal MUAC significantly lower in intervention mothers at enrollment and throughout the follow up period. Mean birth weight was 3.27±0.5 kg and did not differ between groups. At 9 mos household food security and coverage with VA supplementation were significantly higher in controls; consumption of OFSP was significantly higher in intervention infants. From 4 to 9 mos postpartum, stunting increased significantly in controls (6.9% to 10.6%, p&lt;0.05); stunting decreased nonsignificantly in the intervention group (11.5% to 10.3%, p&gt;0.05). There was no change in either underweight from 4 to 9 mos (intervention: 3.1% to 3.3%; controls: 3.9% to 4.3%) or wasting (intervention: 2.1% to 1.6%; controls: 2.9% to 2.7%). There were no significant group differences in infant micronutrient status or anemia at 4 or 9 months. Further analysis will evaluate impact using mixed models that control for clustering, repeated measures and confounding.

Massage therapy improves the development of HIV-exposed infants living in a low socio-economic, peri-urban community of South Africa

The aim of this study was to assess the effect of massage therapy on the growth and development of infants of HIV-infected mothers in a low socio-economic community in Cape Town. It was a prospective, randomised, controlled intervention trial that included massage therapy and control groups of HIV-infected mothers and their normal birth weight infants who were enrolled in the prevention of mother-to-child transmission (PMTCT) programme. Participants were recruited at the 6-week clinic visit and followed up every 2 weeks until their infants were 9 months of age. Mother–infant pairs in the massage therapy and control groups included 73 and 88 at 6 weeks and 55 and 58 at 9 months, respectively. Mothers in the intervention group were trained to massage their infants for 15min daily. The socioeconomic status, immunity, relationship with the partner and mental pain of mothers; the infants’ dietary intake, anthropometry and development (Griffiths Mental Development Scales); and haematological and iron status of mothers and infants were assessed at baseline and follow-up. Nine infants (5.3%) were HIV-infected on the HIV DNA PCR test at 6 weeks. Despite significantly higher levels of maternal mental pain, infants in the massage therapy compared to control group scored higher in all five of the Griffiths Scales of Mental Development and significantly higher in the mean quotient (p=0.002) and mean percentile (p=0.004) for the hearing and speech scale at 9 months. Based on the mean difference in scores, the massage therapy group showed greater improvement for all five scales compared to the control group. The mean difference in scores was significantly greater for the hearing and speech quotient (21.9 vs. 11.2) (p<0.03) and the general quotient percentile (19.3 vs. 7.7) (p=0.03) in the massage therapy compared to the control group. These scales remained significant when adjusting for the relationship with the partner and maternal mental pain. Both groups had lower scores in the performance scale at 9 months although this was significantly worse in the control compared to the massage therapy group when adjusting for maternal CD4 count, anaemia, relationship with the partner and mental pain. There were no significant differences in the anthropometric measurements between the two groups. In conclusion, based on the Griffiths Scales, massage therapy improved the overall development and had a significant effect on the hearing and speech and general quotient of HIV-exposed infants in this study.

The Iron Status of Very Low Birth Weight Infants Receiving Multiple Erythrocyte Transfusions during Hospitalization in the Neonatal Intensive Care Unit.

PurposeWe investigated the iron status of very low birth weight infants receiving multiple erythrocyte transfusions during hospitalization in the neonatal intensive care unit (NICU).MethodsWe enrolled 46 very low birth weight infants who were admitted to the Kyungpook National University Hospital between January 2012 and December 2013. Serum ferritin was measured on their first day of life and weekly thereafter. We collected individual data of the frequency and volume of erythrocyte transfusion and the amount of iron intake.ResultsA total of 38 (82.6%) of very low birth weight infants received a mean volume of 99.3±93.5 mL of erythrocyte transfusions in NICU. The minimum and maximum serum ferritin levels during hospitalization were 146.2±114.9 ng/mL and 456.7±361.9 ng/mL, respectively. The total volume of erythrocyte transfusion was not correlated to maximum serum ferritin concentrations after controlling for the amount of iron intake (r=0.012, p=0.945). Non-transfused infants took significantly higher iron intake compared to infants receiving ≥100 mL/kg erythrocyte transfusion (p<0.001). Minimum and maximum serum ferritin levels of non-transfused infants were higher than those of infants receiving <100 mL/kg erythrocyte transfusions (p=0.026 and p=0.022, respectively). Infants with morbidity including bronchopulmonary dysplasia or retinopathy of prematurity received a significantly higher volume of erythrocyte transfusions compared to infants without morbidity (p<0.001).ConclusionVery low birth weight infants undergoing multiply erythrocyte transfusions had excessive iron stores and non-transfused infants also might had a risk of iron overload during hospitalization in the NICU.

Household Food Insecurity, Mother's Feeding Practices, and the Early Childhood's Iron Status.

Background:Health consequences of food insecurity among infants and toddlers have not been fully examined. The purpose of this study was to assess the relationship between household food insecurity, mother's infant feeding practices and iron status of 6–24 months children.Methods:In this cross-sectional study, 423 mother-child pairs were randomly selected by multistage sampling method. Children blood samples were analyzed for hemoglobin and serum ferritin concentrations. Household food security was evaluated using a validated Household Food Insecurity Access Scale. The mother's feeding practices were evaluated using Infant and Young Child Feeding practice variables including: The duration of breastfeeding and the time of introducing of complementary feeding.Results:Based on the results, of the studied households only 47.7% were food secure. Mild and moderate-severe household food insecurity was 39.5% and 12.8%, respectively. Anemia, iron deficiency (ID), and iron deficiency anemia were seen in 29.1%, 12.2%, and 4.8% of children, respectively. There was no significant association between household food insecurity; mother's feeding practices and child ID with or without anemia.Conclusions:We found no association between household food insecurity and the occurrence of anemia in the 6–24 months children. However, these findings do not rule out the possibility of other micronutrient deficiencies among the food-insecure household children.

PO-0579 Risk Factors For Iron Deficiency And Iron Deficiency Anaemia In Late Preterm Infants At The Age Of 6 Weeks: Abstract PO-0579 Table 1

Background and aims Iron deficiency (ID) has long-term detrimental effects on neurodevelopment. Preterm infants are at risk for developing ID or iron deficiency anaemia (IDA) during the first weeks of life. The aim of this study was to identify early risk factors during hospitalisation for a deprived iron status in late preterm infants at the age of 6 weeks. Methods We analysed the iron status of 99 infants born between 32 and 35 weeks of gestational age from March 2011 to May 2013 in three non-tertiary hospitals in the Netherlands. ID and IDA at the age of 6 weeks were defined as a ferritin concentration Results ID and IDA at 6 weeks were present in 34% and 28% of the infants, respectively. Until now risk factors for ID were collected in 63 infants (shown in table 1). Multivariate regression analysis showed that ID at the age of 6 weeks was associated with a lower birth weight, a lower serum ferritin at the age of 1 week (p = 0.013) and a higher number of blood draws during hospitalisation (p = 0.018). IDA was also associated with the number of blood draws (p = 0.023). ID and IDA were not associated with mean iron intake. Conclusion ID and IDA are quite common among late preterm infants at the age of 6 weeks. Risk factors include a low birth weight, a lower serum ferritin at 1 week and a higher number of blood draws during hospital stay.

Hepcidin and iron homeostasis during pregnancy.

Hepcidin is the master regulator of systemic iron bioavailability in humans. This review examines primary research articles that assessed hepcidin during pregnancy and postpartum and report its relationship to maternal and infant iron status and birth outcomes; areas for future research are also discussed. A systematic search of the databases Medline and Cumulative Index to Nursing and Allied Health returned 16 primary research articles including 10 human and six animal studies. Collectively, the results indicate that hepcidin is lower during pregnancy than in a non-pregnant state, presumably to ensure greater iron bioavailability to the mother and fetus. Pregnant women with undetectable serum hepcidin transferred a greater quantity of maternally ingested iron to their fetus compared to women with detectable hepcidin, indicating that maternal hepcidin in part determines the iron bioavailability to the fetus. However, inflammatory states, including preeclampsia, malaria infection, and obesity were associated with higher hepcidin during pregnancy compared to healthy controls, suggesting that maternal and fetal iron bioavailability could be compromised in such conditions. Future studies should examine the relative contribution of maternal versus fetal hepcidin to the control of placental iron transfer as well as optimizing maternal and fetal iron bioavailability in pregnancies complicated by inflammation.

Iron metabolism in infants: influence of bovine lactoferrin from iron-fortified formula

ObjectiveThe aim of this study was to evaluate whether an iron-fortified formula with a concentration of lactoferrin would significantly improve the hematologic indexes and iron status in term infants compared with those same values in infants fed an iron-fortified formula without lactoferrin. MethodIn this prospective, multicenter, controlled intervention study, 260 infants ages 4 to 6 mo were selected from six maternal and children's health care hospitals in the area. All infants were divided into two groups with the sequence of outpatient: lactoferrin-fortified formula milk group (fortified group, FG, containing lactoferrin 38 mg/100 g milk and iron element 4 mg/100 g milk) and no lactoferrin fortified milk (control group, CG, containing lactoferrin 0 mg/100 g milk and iron element 4 mg/100 g milk) for 3 mo. The levels of weight, height, and head circumference and the concentration of hemoglobin (Hb), serum ferritin (SF), and serum transferring receptor (sTfR) were measured and sTfR-SF index (TFR-F index), total body iron content (TBIC) and low height for age (HAZ), low weight for age (WAZ), and low weight for height (WHZ) were computed before and after the intervention, respectively. ResultsIn all, 213 (115 in FG and 98 in CG) infants completed the intervention trial and all measurements of biochemical indicators. There were no significant differences in the average amount of daily intake of formula milk (94.3 ± 9.8 g versus 88.2 ± 8.7 g for FG and CG; P > 0.05) and iron element (3.8 ± 0.4 mg versus 3.7 ± 0.6 mg for FG and CG; P > 0.05). The average amount of daily intake of lactoferrin for infants in FG group was 35.8 ± 3.7 mg. The levels of weight, WAZ, WHZ, Hb, SF, TFR-F index, and TBIC after intervention of infants in FG were all significantly higher than those of infants in CG weight, 8723 ± 245 g versus 8558 ± 214g; WAZ, 1.02 ± 0.31 versus 0.44 ± 0.18; WHZ, 0.98 ± 0.31 versus 0.41 ± 0.12; Hb, 125.5 ± 15.4 g/L versus 116.9 ± 13.1 g/L; SF, 44.7 ± 17.2 μg/L versus 31.6 ± 18.4 μg/L; TFR-F index, 1.88 ± 0.41 versus 1.26 ± 0.39; TBIC, 6.12 ± 0.78 mg/kg versus 5.26 ± 0.55 mg/kg for FG and CG; P < 0.05), but significantly lower (P < 0.05) for the prevalence of anemia (4.1% versus 7.5%), iron deficiency (13.9% versus 24.4%), and iron-deficient anemia (1.7% versus 6.1%). ConclusionWhen infants who were exclusively breastfed were supplemented with lactoferrin-fortified milk, significant increases in TBIC and iron absorption in the intestine were seen.