Iron Deficiency Anemia In Children Research Articles

ASSOCIATION OF FEBRILE SEIZURES WITH IRON DEFICIENCY ANEMIA: A PROSPECTIVE STUDY.

Introduction: Febrile seizures are common in pediatric age group. These seizures are benign and self limiting and usually do not recur after 5 years of age. In pediatric patients viral illnesses are commonly associated with incidence of febrile seizures. Family history of febrile seizures may be present in many cases. Many studies have concluded that febrile seizures are more common in children having iron deficiency some other studies have even reported that iron deficiency is less frequent in children with febrile seizures. We conducted this study of iron deficiency anemia in children presenting with febrile seizures.
 Materials and Methods: 50 pediatric patients presenting with febrile seizures were included in this study on the basis of a predefined inclusion and exclusion criteria. Demographic details such as age and gender was noted. Previous history of febrile seizure was asked for and noted. Family and past history was noted. Serum Ferritin levels were determined in all the cases. Hemoglobin levels less than 11 gm/dl was taken as cutoff for the diagnosis of anemia. For statistical analysis SSPS 21.0 software was used and p value less than 0.05 was taken as statistically significant.
 Results: Out of 50 studied cases 36 (72.00%) were males and 14 (28.00%) were females with a M: F ratio of 1:0.38. The mean age of patients was found to be 18.18 +/- 11.32 months. Majority of the cases (74%) were having first onset of febrile seizures. Second and third episode of febrile seizures was seen in 8 (16%) and 5 (10%) cases respectively. 42 (84%) patients were found to have simple febrile seizures whereas remaining 8 (16%) patients had complex febrile seizures. criteria 36 (72%) patients were found to have iron deficiency anemia defined as serum Ferritin level below 12 microgram/lit.
 Conclusion: Iron deficiency anemia is associated with an increased risk of febrile seizures in pediatric age group.
 Keywords: Febrile Seizures, Iron deficiency anemia, Serum Ferritin, Hemoglobin.

A Novel Nano-Iron Supplement Versus Standard Treatment for Iron Deficiency Anaemia in Children 6-35 Months (IHAT-GUT Trial): A Double-Blind, Randomised, Placebo-Controlled Non-Inferiority Trial in the Gambia

Background: Iron deficiency anaemia (IDA) is the leading cause of years lost to disability in most sub-Saharan African countries and is especially common in young children. The IHAT-GUT trial assessed the efficacy and safety of a novel nano iron supplement, which is a dietary ferritin analogue termed iron hydroxide adipate tartrate (IHAT), for the treatment of IDA in children under 3 years of age. Methods: In this single-centre, randomised, double-blind, parallel, placebo-controlled, non-inferiority study in The Gambia, children 6-35 months with IDA (7£Hb<11g/dL and ferritin<30mg/L) were randomly assigned (1:1:1) to receive either IHAT, ferrous sulphate (FeSO4) or placebo daily for 3 months (85 days). The daily iron dose was 12.5mg Fe equivalent for FeSO4 and the estimated bioequivalent dose for IHAT (20mg Fe). The primary efficacy endpoint was the composite of haemoglobin response at day 85 and correction of iron deficiency. The non-inferiority margin was 10%. The primary safety endpoint was moderate-severe diarrhoea analysed as incidence density and prevalence over the 3 months intervention. Secondary endpoints reported herein include hospitalisation, acute respiratory infection, malaria, treatment failures, iron handling markers, inflammatory markers, longitudinal prevalence of diarrhoea and incidence density of bloody diarrhoea. Main analyses were per-protocol (PP) and intention-to-treat (ITT) analyses. Findings: Between Nov 2017 and Nov 2018, 642 children were randomised into the study (214 per study group). A total of 50 children (26.5%) in the IHAT group achieved the primary efficacy endpoint, as compared with 42 (21.2%) in the FeSO4 group (OR 1.39, 80% CI 1.01-1.91, P=0.0002 for non-inferiority) and with 2 (1%) in the placebo group. Diarrhoea prevalence was similar between groups, with 40 children (21.2%) in the IHAT group developing at least one episode of moderate-severe diarrhoea over the 85 days intervention, compared with 47 (23.7%) in the FeSO4 group (OR 1.18, 80% CI 0.86-1.62,P=0.25 for superiority) and 40 (20.5%) in the placebo group (OR 0.96, 80% CI 0.7-1.33, P=0.001 for noninferiority). Incidence density of moderate-severe diarrhoea was 2.74 in the IHAT group, 3.51 in the FeSO4 group and 2.96 in the placebo group (RR 0.77, 80% CI 0.59-1.01, P=0.11 for superiority). There were 143 children with adverse events (AEs) in the IHAT group, 146 in the FeSO4 group and 143 in the placebo group. There were overall 35 cases of diarrhoea reported as AEs in the IHAT group compared with 51 cases in the FeSO4 group and 37 cases in the placebo group. Interpretation: In young children with IDA, IHAT was non-inferior to standard-of-care FeSO4 in terms of ID correction and haemoglobin response and was not associated with increased adverse events or cases of diarrhoea in comparison with placebo. Clinical Trial Registration Details: This trial is registered with clinicaltrials.gov (NCT02941081). Funding Information: Bill & Melinda Gates Foundation (OPP1140952). Declaration of Interests: D.I.A.P., N.F. and J.J.P. are inventors of the IHAT iron supplementation technology, for which they could receive future awards to inventors through the MRC Awards to Inventor scheme. They are also scientific advisors to Nemysis Ltd, who now hold the license for IHAT. They have received honoraria or consultancy fees from some or all of: Vifor Pharma UK, Shield Therapeutics, Entia Ltd, Danone Nutricia, UN Food and Agriculture Organisation (FAO) and Nemysis Ltd, for work concerning iron in health. D.I.A.P. has since moved to full employment in the iron and health industry with Vifor Pharma UK but all work pertaining to this publication was conducted whilst at the University of Cambridge and MRC Unit The Gambia at LSHTM. Notwithstanding, the authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: The trial was conducted in accordance with the ethical principles of the Declaration of Helsinki, and that are consistent with the International Conference on Harmonisation (ICH) requirements for Good Clinical Practice (GCP), and the applicable regulatory requirements. The study sponsor was the London School of Hygiene and Tropical Medicine (LSHTM) and the study was conducted at the Medical Research Council (MRC) Unit The Gambia at LSHTM (MRCG). Scientific advice on the study protocol was given by the UK Medicines and Healthcare products Regulatory Agency (MHRA 1400, 21/12/2016). The study protocol and any subsequent amendments were reviewed and approved by The Gambia Government/MRC Joint Ethics Committee(reference SCC1489). Clinical Trials Authorisation was granted by the Medicines Control Agency, The Gambia (HP373/347/16/MJK(80)). Informed consent given by parent or guardian.

Nutrition Intervention among Children under 24 months suffering from Iron Deficiency Anemia in rural Cameroon

Almost 63% of young children living in Cameroon are anemic. However, young children in rural area are most affected. Current policy recommends the need to combine several strategies to reduce the burden of anemia in rural areas. A 20-week nutrition intervention program consisting of 4 weeks of nutrition education and 16 weeks of iron supplementation was carried out in 50 Cameroonian children aged 6-23 months in rural area, with mild iron deficiency anemia (IDA). Participants were distributed randomly by drawing lots into intervention and control groups with 25 participants in each group. A nutrition knowledge questionnaire, anthropometric measurements, hemoglobin (Hb) level, serum ferritin (SF), serum iron and iron status biomarkers were obtained in both groups before and after nutrition intervention. At the end of the study, the mothers of intervention group had greater knowledge on iron, IDA and dietary strategies to reduce IDA in children. Concerning anthropometric parameters, there were no significant differences in the weight/age, height/age and weight/height (p>0.05) before and after the intervention in both groups. At the end of nutrition intervention, a significant gain in Hb level was found in the both groups but significant difference was observed in the intervention group (10.63±0.18 and 11.46±0.19g/L; p=0.0001). However, the SF and serum iron were significantly lower in the control group compared to the intervention group (18.89±7.54 µg/L vs 28.93±5.81 µg/L; p=0.03) and (11.46±1.02 µg/L vs 19.65±0.78 µg/L; p=0.01) respectively. Iron status has improved in the both group. The incidence of anemia (28% and 76%; p=0.0007), iron deficiency (56% and 68%; p>0.05) and iron deficiency anemia (32% and 64%; p=0.02) was significantly lower in the intervention group compared to the control group. The study findings showed that, nutrition education combined with iron supplementation impact positively on the iron status of young children. It is therefore important to educate mothers or caregivers about good nutrition in addition to with others strategies.

Iron Deficiency Anemia in Children with Febrile Seizures

Aim: To determine the frequency of iron deficiency anemia in children presenting with febrile seizures. Materials and Methods: This descriptive cross sectional study was conducted on 90 patients at department of Pediatrics, Ayub Teaching Hospital, Abbottabad. Children with febrile seizures of both genders and with age range from 6 months to 5 years were included. Children with intracranial infection, metabolic disorders, and thalassemia were excluded. The recorded data from the children were age, gender, hemoglobin level, red cells distribution width, serum ferritin and iron deficiency anemia. Descriptive statistics were calculated. Iron deficiency anemia was stratified by age and gender to see effect modification by using Chi-square test at P ≤ 0.05 to be level of significance. Results: The mean age and hemoglobin were 1.44 ± 0.988 years and 10.33 ± 2.44 g/dl respectively. The males were 53(58.9%) and females were 37 (41.1%). Most of the children hemoglobin level was less than 10 g/dl (n=51, 56.7%). Fifty children have red cells distribution width of greater or equal to 16% (56.7%). The serum ferritin was less than or equal to 7 ng/ml in 50(55.6%) and greater than 7 ng/ml in 40(44.4%) cases. Iron deficiency anemia was present in 53(58.9%). The association of iron deficiency anemia in febrile seizure with age (P=0.359) and gender (P=0.598) was not statistically significant. Conclusion: More than half of the children affected by febrile seizure have iron deficiency anemia

Lymphocyte subset alterations in childhood iron deficiency anemia: A case–control study from Northern India

Background: The impact of iron deficiency anemia (IDA) on innate immunity is well documented, but the data on its effect on cells of the adaptive immune system are scant. The aim of this study was to assess peripheral blood lymphocyte subsets in children with IDA using flow cytometry. Materials and Methods: The total and differential lymphocyte populations of 80 iron-deficient children and 40 controls were assessed using a single-tube flow cytometry panel. Results: Children in the IDA group showed a significant decrease in total leukocyte count as compared to controls (P = 0.03). The study also found a significant increase in total lymphocytes and CD19 + B cells (P = 0.042 and 0.040, respectively). CD3, CD4, CD8, and NK cells were unaltered. Conclusion: The study concluded that iron deficiency in children is associated with relative lymphocytosis contributed mainly by the B lymphocytes. There is no quantitative defect in cells of the adaptive limb of the immune system in IDA. In view of the increased incidence of infections in these children, functional assays for identifying qualitative defects may prove useful.

Interleukin-2 gene expression and its relation to red blood cell indices and T lymphocytes in anemic Egyptian children

Context Iron-deficiency anemia (IDA) is a health problem affecting children, females, and the aged. Increased knowledge about the etiology and cytokines of IDA can aid early detection and management. Aims The objectives of this research to assess interleukin-2 (IL-2) gene expression by real-time PCR and examine its relation to red blood cell indices and T lymphocytes in IDA in children. Settings and design This was a case–control study. A total of 60 children was included, and two groups were identified: group 1 (latent iron-deficiency anemia) and group 2 (IDA). Moreover, 30 healthy children were included as a control group. Patients and methods Complete blood count, serum ferritin, and immunophenotyping of the T lymphocyte subtypes were performed. Statistical analysis used Statistical Package for Social Science (SPSS) for Windows (version 16.0) software program was used for statistical analysis. Results A total of 21 (70%) patients of IDA group showed a low IL-2 gene expression. There is a significant positive correlation between IL-2 gene expression and T lymphocyte cell count (CD3+), cytotoxic T lymphocyte cells count (CD3+CD8+), and mean fluorescence intensity of CD3+CD8+ cells. Conclusions There was a significant positive correlation between IL-2 gene expression and red blood cell count, mean corpuscular hemoglobin concentration, serum ferritin level, serum iron level, T lymphocyte cells count (CD3+), cytotoxic T lymphocyte cells count (CD3+CD8+), and mean fluorescence intensity of CD3+CD8+ cells.

Meta-analysis on prevalence of iron deficiency anemia in Chinese children aged 0-14 years from 2000 to 2020

Objective To systematically review the prevalence of iron-deficiency anemia among children aged 0- 14 years in China from 2000 to 2020, and to provide a reference for prevention and controlling of IDA among Chinese children. Methods CNKI, CBM, WanFang Data, VIP databases, PubMed, Embase and Web of Science were electronically searched to collect crosssectional studies on the prevalence of iron deficiency anemia in children aged 0-14 years of China from 2000 to April 2020. Two reviewers independently conducted literature screening, methodological evaluation and data extraction, and used Stata 13.0 software to combine the data to estimate the prevalence. The Q test and I 2 statistics were used to evaluate the heterogeneity of studies. Begg and Egger test were used to evaluater. Results A total of 60 articles were included, including 122 771 children, among whom 28 693 were sick. Meta-analysis results showed that the total prevalence rate of children aged 0-14 years in China from 2000 to 2020 was 19.9%. The prevalence rate of girls (18.7%) was higher than that of boys (16.9%), and the difference was statistically significant ( P <0.05). The prevalence rate was highest in infancy (30.3%), followed by in early childhood (16.7%). From 2006 to 2010, the prevalence rate of children was the highest (22.6%). In recent years, the prevalence rate of children with iron deficiency anemia was lower than before. Mild anemia was found in 88.7% of the children, and moderate or severe anemia was found in 11.3% of the children. The prevalence rate of children in western China was the highest, 31.9% and 28.3% respectively, and the incidence rate in east China (13.1%), south China (14.0%) and northeast China (16.6%) was relatively low. The prevalence rate of rural children (25.6%) was much higher than that of urban children (9.1%), especially in western rural areas. Conclusion The prevalence of i- ron-deficiency anemia among children aged 0-14 years in China from 2000 to 2020 is still high and the differences between different regions are significant, so more attention should be paid to the prevention and treatment of iron-deficiency anemia among infants and children in poor areas. 【摘要】 目的 系统评价 2000—2020 年中国 0~14 岁儿童缺铁性贫血 (kon deficieng anemia, IDA)的流行现状, 为中国 儿童IDA的防治提供依据。 方法 通过计算机检索中国知网、中国生物医学文献数据库、维普、万方、PubMed、Embase、 Web of Science数据库, 收集 2000 年 1 月 1 日至 2020 年 4 月 29 日公开发表的关于中国0~14岁儿童缺铁性贫血的横断面 研究。中文检索词包括缺铁性贫血、儿童、小儿、患病率、现况, 英文检索词包括 Anemia、iron-deficiency、child、children、epidemiology、cross-sectional studies、China、Chinese等, 并追溯参考文献以补充相关文献。由 2 位研究者独立进行文献筛选、方 法学评价和资料提取, 应用 Stata 13.0 软件对结果进行数据合并估算患病率, 利用C检验和 I 2 值评价研究异质性, Begg 及 Egger检验评价发表偏倚。 结果 共纳人 60 篇文献 122 771 例儿童, 其中患病儿童 28 693 例。Meta分析结果显示, 2000—2020 年中国 0~14 岁儿童总患病率为 19.9%, 女童患病率 (18.7%) 高于男童 (16.9%), 差异有统计学意义 ( P <0.05); 婴儿 期患病率最高 (30.3%), 其次为幼儿期 (16.7%); 2006—2010 年儿童患病率最高 (22.6%), 但近年来儿童缺铁性贫血患病 率较前下降, 2011—2015 年为 21.9%, 2016—2020 年降至 16.8%; 88.7% 的患病儿童表现为轻度贫血, 仅 11.3% 表现为中重 度;西北、西南地区儿童患病率最高, 分别为 31.9%, 28.3%, 华东、华南及东北发病率相对较低, 分别为 13.1%, 14.0%, 16.6%; 农村儿童患病率 (25.6%)远高于城市儿童 (9.1%), 尤以西部农村地区表现明显。 结论 2000—2020 年中国 0~14 岁儿童缺铁性贫血患病率仍较高且地区间差异显著, 应继续重视婴幼儿及贫困地区儿童缺铁性贫血防治工作。

Clinical usefulness of the reticulocyte hemoglobin equivalent in children on hemodialysis.

Iron-deficiency anemia is common in hemodialysis patients. Serum ferritin and transferrin saturation (TS) are used for its detection. The reticulocyte hemoglobin equivalent (RET-He) is a marker that is not altered by inflammatory conditions and directly reflects iron availability in the bone marrow. To explore the diagnostic capability of RET-He to detect absolute iron deficiency and assess its correlation with traditional markers of iron deficiency. Retrospective study comparing RET-He with ferritin and TS in children on hemodialysis seen at Hospital Garrahan between July 2016 and July 2019. In 164 observations carried out in 40 children, a weak positive correlation was found between hemoglobin and RETHe (r = 0.35, p < 0.001), a significant positive correlation between TS and RET-He (r = 0.52, p < 0.001), a low negative correlation between hemoglobin and ferritin (r = -0.19, p = 0.02), and a lack of correlation between hemoglobin and TS (r = 0.05, p = 0.5). Anemia was observed in 50 %; iron-deficiency anemia was detected by traditional markers in 13 % and by RET-He in 44 %. RET-He showed a sensitivity of 90.9 % (95 % CI: 57.1-99.5 %), a specificity of 74.5 % (95 % CI: 66.7-81 %), a negative predictive value of 99.1 % (95 % CI: 94.5-99.9 %), and a positive predictive value of 20.4 % (95 % CI: 10.7-34.7 %) to detect iron-deficiency anemia with a cut-off value of 29 pg. Despite its limited capability, the use of RET-He as a biomarker of iron deficiency increases the detection of iron-deficiency anemia in children on hemodialysis.

A 12 Year-Old Girl with Severe Iron Deficiency Anemia Secondary to Chronic Pediculosis Infestation

A 12 year-old female presented to an outside emergency department with her grandmother due to worsening fatigue over the preceding six months. She also reported intermittent right-sided abdominal discomfort for two months. The patient's past medical history was only remarkable for chronic infestation withPediculus humanus capitis(head louse), reportedly treated multiple times with topical medications without resolution. The infection had been persistent for six years. She did not consume excessive amounts of cow's milk. Physical exam was remarkable for pallor, tachycardia, systolic ejection murmur and visible nits. Laboratory studies showed hemoglobin 4.7 g/dL, mean corpuscular volume (MCV) 53.4 fL, reticulocytes 3.9%, white blood cell count 14.2 x 103 /µL, platelet count 449 x 103 /µL, total iron binding capacity (TIBC) 472 µg/dL, serum iron 8 µg/dL, iron saturation 2%, and ferritin 2 ng/mL. Peripheral blood smear showed a severe microcytic hypochromic anemia with anisopoikilocytosis, without schistocytes or blasts. She was premenarchal. Stool was negative for occult blood, ova and parasites, and celiac studies were negative. A diagnosis of iron deficiency of anemia (IDA) was made by the classic presentation of microcytic, hypochromic anemia with hypoferritinemia and elevated TIBC, along with an inappropriately low reticulocyte count. The most common etiologies of iron deficiency anemia in children were ruled out by history and laboratory evaluation, making chronic pediculosis the most likely cause in this patient. She received aggressive treatment for pediculosis, packed red blood cell transfusions, and oral ferrous sulfate. By day 65 after presentation, her laboratory values had normalized (hemoglobin of 13.6 g/dL, MCV of 80.3 fL, ferritin of 28 ng/mL). Pediculosis infestation remained resolved. Iron deficiency is the leading etiology of anemia worldwide and the most common hematologic disorder. Parasitic and vector-borne infections are a common cause of IDA internationally, but uncommon in developed countries. Severe iron deficiency secondary to pediculosis in children is an exceedingly rare entity despite high infestation rates, with nearly 40% of North American children affected.Pediculus humanusis an Arthropod species of sucking lice belonging to the familyPediculidae. The two subspecies arePediculus humanus capitis(head louse) andPediculus humanus humanus(body louse). The average child with pediculosis infestation will average 0.008 mL of blood loss per day due to louse consumption; however, heavily infested children can lose up to 0.7 mL per day. Thus, the patient may have had greater than 1.5 liters of blood consumed during her period of infestation. To our knowledge, this is the only reported case of a child in the United States with severe IDA secondary to chronic severe lice infestation. Iron deficiency is likely an under-recognized complication of severe and/or chronic pediculosis. In patients with history of mental health conditions, homelessness, or children who are in neglectful social situations, an evaluation of hemoglobin and iron status by the pediatrician may be a useful adjunct in severe cases. Disclosures No relevant conflicts of interest to declare.

The Impact of Lactoferrin Fortification on the Health Benefits and Sensory Properties of Yogurt

The aim of this work was to study the effect of milk supplementation with lactoferrin on the rheological and sensory properties of yogurt and to evaluate the efficiency of lactoferrin-fortified yogurt in the treatment of iron deficiency anemia (IDA), microcytic hypochromic anemia, in children. For this purpose, yogurt was manufactured from milk fortified with commercial lactoferrin and the yogurt sensory characteristics, pH and concentration of lactic acid of supplemented yogurts, were determined throughout the shelf-life period storage (7 days) at 4°C and compared with a control yogurt. Furthermore, the use of lactoferrin-fortified yogurt in treatment of IDA in comparison to commercial lactoferrin alone (lactoferrin dissolved in water) were assessed with 20 children (2–5 years old) suffering from IDA. Children were divided into two groups (A and B), 10 children each. Group A received lactoferrin-fortified yogurt while, group B received commercial lactoferrin dissolved in water. The blood cells indices, Hb, HCT, MCV, TLC, Platelets, Serum iron, Serum ferritin, TIBC and Transferrin were analyzed before and after treatment for each group. The results showed that manufactured fortified yogurt was firm, with acceptable sensory properties and the Hb and red blood cell indices significantly improved in patients received lactoferrin-fortified yogurt even than patients received lactoferrin only. This study concluded that lactoferrin addition had no significant effect on yogurt manufacture and the yogurt produced from milk fortified with lactoferrin had a vital supportive treatment for the management of IDA in children.

Diagnostic Patterns of Iron Deficiency and Iron Deficiency Anaemia in Children of 6 to 59 Months in Cameroon

A Cross sectional multicentre study was carried out to determine the prevalence of Iron deficiency (ID) and Iron deficiency anaemia (IDA) in children using Ferritin and full blood count. Full blood count was done with Mindray Bc-2800 and Ferritin test with Enzyme Linked Immuno-Sorbent Assay. Authorization was granted by Cameroonian national Ethical Committee. Data were analysed using Statistical Package of Social Sciences 21.0 significant results were considered for P&lt; 0.05. ID varied from 4.2% to 9.6% for cut-offs of 30 and 50μg/L. IDA ranged from 4.2 to 8.5% at these 2 cut-offs. Considering red cells indices, Mean Corpuscular Volume and Mean Corpuscular Haemoglobin blood count currently used should be interpreted cautiously as only Mean Corpuscular Volume and Mean Corpuscular Haemoglobin corroborate with a Ferritin level lower than 30 μg/L.

Association between Consumption of Cow’s Milk and Iron Deficiency Anemia in Children: Are There Roles for Hepcidin-25/Ferroportin? A Case-Control Study

Systemic iron homeostasis is regulated by the interaction of the peptide hormone, hepcidin and the iron exporter, ferroportin. The objective was to investigate the relationship between the consumption of cow’s milk and iron deficiency anemia in children 2–10 years old and its association with the hepcidin-25 and ferroportin concentrations. The study population consisted of 187 prepubescent children of similar ideal body weight (IBW:90–120%); 82 children with iron deficiency anemia (37girls and 45boys; 4.27 ± 0.28 years) and 105 (47girls and 58boys; 4.25 ± 0.34 years) healthy age-sex-matched controls. Serum fasting hepcidin-25/ferroportin concentrations were measured by enzyme immunoassay in all subjects. Mean cow’s milk consumption in the anemic group (373 ± 248 mL/d) tended to be higher than that in the control group (320 ± 226 mL/d), but the result was not statistically significant (p = 0.063).The mean hepcidin-25 level was significantly higher in the anemic group (19.5 ± 18.4 ng/mL) than in the healthy controls (11.0 ± 10.7, p < 0.001). The mean ferroportin level was lower in the anemic group (21.04 ± 5.74 ng/mL) than in the healthy controls (22.68 ± 4.77 ng/ml, p = 0.037). Consuming cow’s milk was not associated with IDA in prepubertal children, provided that it was adequately supplemented with iron-enriched foods. We observed a significant increase in hepcidin-25 levels and a decrease in ferroportin levels in children with iron deficiency anemia compared with healthy controls. Children who consumed more cow’s milk had higher levels of hepcidin-25. Iron deficiency anemia is not a concern when cow’s milk is given to children if the complementary foods are rich in iron.

Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diagnosis and Therapy.

Iron deficiency and iron-deficiency anemia (IDA) affects approximately two billion people worldwide, and most of them reside in low- and middle-income countries. In these nations, additional causes of anemia include parasitic infections like malaria, other nutritional deficiencies, chronic diseases, hemoglobinopathies, and lead poisoning. Maternal anemia in resource-poor nations is associated with low birth weight, increased perinatal mortality, and decreased work productivity. Maintaining a normal iron balance in these settings is challenging, as iron-rich foods with good bioavailability are of animal origin and either expensive and/or available in short supply. Apart from infrequent consumption of meat, inadequate vitamin C intake, and diets rich in inhibitors of iron absorption are additional important risk factors for IDA in low-income countries. In-home iron fortification of complementary foods with micronutrient powders has been shown to effectively reduce the risk of iron deficiency and IDA in infants and young children in developing countries but is associated with unfavorable changes in gut flora and induction of intestinal inflammation that may lead to diarrhea and hospitalization. In developed countries, iron deficiency is the only frequent micronutrient deficiency. In the industrialized world, IDA is more common in infants beyond the sixth month of life, in adolescent females with heavy menstrual bleeding, in women of childbearing age and older people. Other special at-risk populations for IDA in developed countries are regular blood donors, endurance athletes, and vegetarians. Several medicinal ferrous or ferric oral iron products exist, and their use is not associated with harmful effects on the overall incidence of infectious illnesses in sideropenic and/or anemic subjects. However, further research is needed to clarify the risks and benefits of supplemental iron for children exposed to parasitic infections in low-income countries, and for children genetically predisposed to iron overload.

Comparison of Conventional and Newer Iron Preparations for the Treatment of Iron Deficiency Anaemia in Children

Introduction: Commonly used iron salt, ferrous sulphate for the treatment of iron deficiency anemia, has several gastrointestinal side effects. Nowadays new iron salts such as ferrous bisglycinate are marketed with claims of raising hemoglobin faster with fewer gastrointestinal side effects.&#x0D; Objective: To compare the efficacy of ferrous sulphate with ferrous bisglycinate for the treatment of iron deficiency anemia in children.&#x0D; Methods: This randomized controlled trial was carried out at Children Hospital, PIMS, Islamabad from July 2015 to June 2016. A total of 136 children were selected through systematic sampling and randomized into 2 groups using a computer-generated table of random numbers; ferrous sulphate as group 1 and ferrous bisglycinate as group 2. Clinical outcome was assessed on the basis of a mean increase in hemoglobin after 12 weeks of therapy in both groups. The data was entered and analyzed using SPSS version 20. &#x0D; Results: The baseline characteristics i.e. mean age, mean hemoglobin levels were similar in both study groups. After 12 weeks of treatment, the mean increase in hemoglobin was 1.8 ±1.59 g/dl in ferrous sulphate group as compare to 2.5 ±1.31g/dl in ferrous bisglycinate group showing the higher level of rising with ferrous bisglycinate than ferrous sulphate, P =0.0033.&#x0D; Conclusion: Newer iron preparation, ferrous bisglycinate is a better treatment option than conventional preparation of ferrous sulphate for increasing hemoglobin in iron deficiency anemia in children.

Efficacy of an iron-fortified infant cereal to reduce the risk of iron deficiency anemia in young children in East Cameroon.

Complementary foods in Africa are often poor sources of bioavailable iron. We assessed the efficacy of iron‐fortified wheat‐based infant cereal (IC) to reduce the risk of iron deficiency anemia in children aged 18–59 months in Cameroon. A 6‐month double‐blind, cluster‐randomized controlled trial was conducted in 2017 among anemic (hemoglobin 7–11 g/dl) but otherwise healthy children. In conjunction with usual diet, children received two 50 g servings/day of a standard, micronutrient‐fortified IC (providing 3.75 mg iron/serving; n = 106) or the same IC without iron fortification (n = 99). Anthropometric measurements, blood sampling, and systematic deworming were performed in all children at baseline (pre‐intervention), 3, and 6 months. Mean hemoglobin, ferritin adjusted for C‐reactive protein (CRP), serum iron, transferrin saturation, prevalence of anemia, iron deficiency, and iron deficiency anemia as well as anthropometrics were compared between the groups at baseline, 3, and 6 months. Compared to the control group, children consuming the iron‐fortified IC had significantly higher baseline‐adjusted mean hemoglobin (10.0 ± 1.8 vs. 9.7 ± 1.4 g/dl, respectively; p = .023), ferritin adjusted for CRP (16.1 ± 8.3 vs. 9.5 ± 7.5 μg/L, p < .001), serum iron (14.5 ± 3.9 vs. 11.2 ± 4.4 μg/dl; p < .001), and transferrin saturation (19.0 ± 17.4 vs. 10.7 ± 12.5%; p ˂ .001) at 6 months. The prevalence of anemia, iron deficiency, and iron deficiency anemia at 6 months decreased by a larger extent in the iron‐fortified group versus controls (all p < .01). In addition, at 6 months, children in the iron‐fortified group demonstrated higher weight‐for‐age z‐scores (p = .016) compared to the control group. Wheat‐based IC fortified with 7.5 mg ferrous fumarate administered daily for 6 months improved iron and nutritional status and decreased the prevalence of iron deficiency anemia in children aged 18–59 months in Salapoumbé, Cameroon.

PREVALENCE OF IRON DEFICIENCY ANEMIA AMONG CHILDREN WITH SCHOOL FAILURE AND ITS RELATION TO INTELLIGENCE QUOTIENT

Introduction: An estimated 25% of school-aged children a worldwide is anemic. Iron deficiency is thought to account for about half of the global cases of anemia and is associated with inadequate dietary Recent years have shown a growing interest and concern in many countries about the problem of school failure and the determination of its main contributing factors. This problem is known as the “one hundred factors problem” and a great deal of research has been done on identifying the factors that affect the low performance of students (school failure and dropout) at different educational levels (primary, secondary and higher). Aim of the study: This study will be designed to evaluate the prevalence of iron deficiency anemia among children with school failure, the relationship between the degree of iron deficiency anemia (IDA) and changes in the level of intelligence quotient (IQ). Patients and Methods: This study is a prospective study on 100 children aged from 5 to 12 years old during the period from August 2018 – October 2019 and are divided in to two groups group A with IDA and group B without IDA. The patients who will be included in our study as anemic group who have: CBC: Hgb less than 11.5gm% Low MCV, Serum Ferritin: Less than 12ng/ml, and Free Erythrocyte Protoporphyrin: Increase than 23.8mg/dl. Then after confirmation that our patients are iron deficiency anemia the following was done for anemic and non-anemic group. Intelligence quotient: IQ was assessed by Stanford _Binet Intelligence scales. Before and after treatment, after correction of clinical and lab manifestations. Statistical analysis: Data were analyzed using Statistical Program for Social Science (SPSS) version 15.0. Quantitative data were expressed as mean ± standard deviation (SD). Qualitative data were expressed as frequency and percentage. Results: Prevalence of IDA was significantly higher among children with school failure. 68% of the studied group had IDA while the other 32% had no IDA (Mean hematological values of Hb, MCV and serum ferritn; respectively were low and FEP was elevated in anemic children, our results confirmed Free erythrocyte protoporphyrin (FEP) to be the most significant factor for the diagnosis of iron deficiency anemia in children, Our result revealed that there was a significant difference in the level of IQ between anemic and non-anemic group and in our study there was improvement of IQ after treatment with iron). Conclusion: The study found a positive correlation between IDA and poor school performance, although iron deficiency anemia (IDA) is a high risk factor for school failure but not the only cause in primary school children, free erythrocyte protoporphyrin (FEP) is the most sensitive and specific predictor for diagnosis of iron deficiency anemia in comparison to the other predictors although it is expensive. Recommendations: Pediatricians and mass media should raise awareness about iron deficiency and its sequelae, also the importance of the presence of the pediatric clinics for those apparently normal children. Screening of iron deficiency anemia in pale children and in poor school performance children to decrease its prevalence and impact on children. Proper complementary early feeding with iron rich foods to decrease iron deficiency anemia between infants and children. Treatment of IDA should occur early as possible by dietary improvement or by oral iron supplementation by giving 6mg elemental iron/kg/day divided into 2-3 doses continued for 2-3 month after correction of anemia to replenish body stores. Adding iron to widespread food as bread may be beneficial for prophylaxis of IDA.

Effectiveness of iron supplementation for children with iron deficiency anemia: Study in Purbalingga, Central Java

Background: Iron Deficiency Anaemia (IDA) is one of major factors for human health, especially young children. Iron supplementation can indicate a good response in haemoglobin concentration. Objective: This study is to observe prevalence of anaemia and effectiveness of iron supplementation for children in Purbalingga district, Central Java. Methods: This study was a quasi-experimental study by measuring haemoglobin concentration before (pre) and after (post) treatment. Its participants were determined by a purposive sampling method. 64 children (less than 5 years old) were included in criteria of anaemia. Their blood samples were collected before the treatment to measure SI (Serum Iron) and TIBC (Total Iron Binding Capacity). Administering 4 mg of iron per kg of body weight per day was conducted for a month. Data of participants such as age, nutritional status, socio-demographic, and medical history were also collected. A paired t-test was used to analyse mean differences of haemoglobin levels before and after treatment. Results: Among the 64 children with anaemia, 98.4% indicated Iron Deficiency (ID) with 59.4% of them indicating IDA based on level of SI and TIBC. Anaemia has more prevalence in group of 6 - <12 months of age. There was a statistically significant increase of haemoglobin level with a mean difference of 1.52 g/dL between the pre and post treatment (p=0.000). Conclusion: The prevalence of IDA in children (less than 5 years old) in Purbalingga District Hospital was 59.4%. Adequately oral iron supplementation for a month indicated a statistically significant increase of haemoglobin levels

ASSOCIAÇÃO DO ESTADO NUTRICIONAL COM MARCADORES DE ANEMIA FERROPRIVA EM PRÉ-ESCOLARES ATENDIDOS EM UMAESF DE PRESIDENTE PRUDENTE-SP

Iron deficiency is the cause of 50% of anemia cases, being related to an unbalanced diet and nutrient malabsorption, affecting mainly children. The aim of the present study was to relate anthropometric measurements and markers of iron deficiency anemia in children attending a Family Health Strategy (FHS). Information was collected from medical records about breastfeeding, biochemical indicators of anemia and recent anthropometric measurements. Correlation analyzes were established between anthropometric measurements and blood count values, considering a level of statistical significance of p&lt;0.05. The results show that 27.27% are in anemia, and only 19.69% of the 66 children had iron and ferritin tests. There was no correlation between body mass indexand hemoglobin and hematocrit results. It was concluded that the prevalence of iron deficiency anemia, identified by hemoglobin values, was low. However, there is a high occurrence of prophylactic supplementation without indication with ferrous sulfate, increasing the risk of excessive iron supplementation.

Iron-deficiency anaemia in children with congenital heart diseases at a teaching hospital in Ghana

BackgroundUncorrected congenital heart lesions in children keep them in a state of constant hypoxia with compromised quality of life and reduced life expectancy. This requires early diagnosis and interventions including prevention and treatment of the resultant anaemia. Unfortunately, congenital heart disease (CHD) often goes unrecognized and thus untreated. ObjectivesWe determined the occurrence of CHD in children below 15 years at the Komfo Anokye Teaching Hospital (KATH), assessed the prevalence of relative iron deficiency anaemia in that cohort and the use of iron supplementation in these patients. MethodsWe conducted a cross-sectional study, using a structured data collection tool, by retrospectively reviewing patient records from December 2015 to January 2010. Data was also obtained prospectively from January 2016 to March 2016. ResultsEighty cases (44 females and 36 males) of CHD were encountered. Tetralogy of Fallot was the most common (48.8%) CHD. Cases of cyanotic congenital heart disease were reported at autopsy. Of the 80 cases, 48 (72.7%) had signs of relative iron deficiency. Thirty (62.5%) of the 48 patients did not receive iron supplementation. In 14 cases, full blood count was not determined and yet 10 patients received iron at sub-optimal doses (<3 mg/kg/day) and one was given iron at 6 mg/kg/day. ConclusionCHD is a common phenomenon among newborns at KATH. Use of iron supplementation was suboptimal. Compliance with guidelines on the use of iron as well as structures for early detection of CHD for definitive interventions are advocated.

Efficacy of Pandughni Vati &amp; Punarnavadi Mandura Vati in the managment of Pandu w.s.r. iron deficiency anemia in children- An open labelled comparative clinical trial

Background:Anemia is a public health problem worldwide, and its prevalence in India is higher than any other south asian countries. Iron deficiency anemia (IDA) is having larger share out of all types of anaemia’s. Symptomatology of IDA resembles with Kapha dominant variety of Pandu. Pandughni Vati (PV) and Punarnavadi Mandura (PM) Vati mentioned in Ayurveda are being used in clinical practice since long.Aim:To assess the efficacy of Pandughni Vati and compare its clinical efficacy with Punarnavadi Mandura Vati in the management of Pandu ws.r. iron deficiency anemia in children.Materials and methods:Present clinical study was a randomized trial for management of iron deficiency anemia aged 2–16 years. Out of total 91 patients enrolled, 60 completed the study and divided into two groups. In group A, Pandughni Vati (trial drug) and in group B, Punarnavadi Mandura Vati in the management of Pandu ws.r. iron deficiency anemia in children. (standard drug) were given to 30-30 patients respectively for a duration of 90 days in age specific doses. Patients were assessed by clinical signs and symptoms of Pandu and investigation parameters like complete blood count, serum iron, serum ferritin and total iron binding capacity (TIBC) on baseline and after 90 days of treatment. Statistical analysis was carried out by Sigma Stat software.Results:On comparison, highly significant difference was found between two groups in subjective parameters such as Panduta (pallor), Daurbalya (weakness), Hriddrava (palpitation), Akshikuta Shotha (periorbital oedema), Pindikodweshtana (leg cramps) and Shwasa (breathlessness) whereas objective and saturation percentage except serum ferritin.Conclusion:The study revealed that, both the drugs; Pandughni Vati and Punarnavadi Mandura Vati were equally effective in the management of IDA so, it could be concluded that Pandughni Vati, can be used as mineral-free, safe, easily obtainable, palatable, cost-effective alternative drug of choice in alternative of Punarnavadi Mandura in iron deficiency anemia in children.