Iron Deficiency Anemia In Infants Research Articles

An Approach to Hemequity: Identifying the Barriers and Enablers of Iron Deficiency Reduction Strategies in Low-to-Middle-Income Countries

Background Approximately half a billion women of reproductive age worldwide are anemic, and iron deficiency is the most common cause. Iron deficiency anemia (IDA) is cyclical and compounding with intergenerational transfer of poor iron status, where antenatal and perinatal IDA predisposes to IDA in infancy. While IDA is correctable, it remains under-addressed globally and particularly in low-to-middle-income countries (LMICs), with 85% of cases occurring in LMICs of Africa and Asia. IDA is associated with significant morbidity and mortality. In fact, pre-existing anemia and lack of access to blood components and products are the main drivers of maternal deaths in LMICs. Despite abundant evidence that iron supplementation is an effective and life-saving intervention, there is little understanding of how to deliver it effectively in LMICs and its diverse health systems. Objective The primary objective of this study is to identify the enablers and barriers to effective implementation of IDA reduction strategies in LMICs in the published literature to date. Methods A scoping review was conducted using a comprehensive search of MEDLINE, Embase, Scopus, and grey literature from inception to March 2023. Two reviewers independently screened and performed data extraction. We included studies examining iron supplementation and its implementation amongst women of reproductive age who reside in LMICs, as defined by the World Bank. Behavioral, clinical, patient-oriented and process outcomes were also included. We were guided by the intersectionality-enhanced versions of the Theoretical Domains Framework and Consolidated Framework for Implementation Research in our data synthesis to understand the factors influencing health behaviors. Results Of the 9959 articles screened, 50 studies - primarily randomized control trials (6/50), cohort (19/50), cross-sectional (15/50) and other qualitative study designs (5/50) - were included. 50% of the studies were implemented in Africa, 42% in Asia, 6% in South America and 2% in the Middle East. Barriers and enablers of IDA reduction strategies are summarized in Figure 1. Barriers: Contextual barriers included the gross underestimation and deprioritization of IDA risk in women of reproductive age; gender norms and disparities with women's health ranking as the last priority in family dynamics; and intergenerational influences from mothers-in-law who are unfamiliar with iron supplements. Interestingly, the concept of “pill stigma” emerged as a salient theme where women were fearful that taking iron supplements could be mistaken for taking antiretrovirals, suggesting additive stigma from the HIV/AIDS epidemic. Poverty at the individual, government and stakeholder levels also led to supply chain barriers, further exacerbated by conflict, war and natural disasters undermining food security and community initiatives. Forgetfulness was cited as the most common barrier to individual iron supplement uptake. Enablers: Enablers at the individual level included knowledge of anemia and iron supplements, partner support, early access to care, high socioeconomic status, and maternal literacy. Successful interventions utilized existing infrastructures, such as schools and antenatal clinics, to facilitate delivery of supplements and community initiatives. Moreover, education initiatives that included women and their greater communities increased IDA knowledge and empowered women in community decision making. Community mobilization and the degree of community ownership also determined success and sustainability of IDA reduction strategies. Finally, adherence partners, already part of the woman's social network, helped address social and cultural constraints tailored to her individual context. Conclusion We identified numerous barriers and enablers of IDA reduction strategies at different levels of the socio-ecological model and its interaction with individual-level factors. IDA is not only a medical problem, but one that is rooted in the sociocultural and political context. Both contextual and individual factors contribute to overt and subclinical manifestations of IDA, leading to further iron debt and gender inequity in LMICs. Future interventions must recognize the resilience of LMIC communities and acknowledge the importance of knowledge translation and exchange rooted in local context with community ownership and empowerment.

Evidence-based Egyptian clinical practice guidelines: for the prevention and management of iron deficiency and iron deficiency anemia in infants, children and adolescents

BackgroundIron deficiency (ID) is the most common nutritional disorder affecting all age groups. Infants and young children are vulnerable to anemia especially iron deficiency anemia (IDA), which represents a public health problem with defined impacts on the health of communities. IDA, however, is a preventable and treatable condition; therefore, early diagnosis represents the cornerstone in protection from its adverse consequences and combating its contributing factors. Several international guidelines for the management of ID/IDA are available, however national guidelines that can be implemented and suits our local needs are lacking.ObjectiveTo adapt the pre-existing high-quality practice guidelines for the screening, prevention and management of ID/IDA in different pediatric age groups, to be available for the national use by general practitioners, pediatricians, and other health care professionals.ResultsThe adaptation group for this guideline included key leaders from different Egyptian institutions. The panel used the ADAPTE methodology for adaptation of guidelines. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of detection, identification of infants, children, and adolescents at high risk of developing ID/IDA, proper management, and prevention. The final version of the adapted clinical practice guideline has been made after thorough review of an external review panel and was guided by their official recommendations and modifications. Implementation tools included algorithms, tables, and flow charts to aid decision making in practice, as well as patient-directed information in the Arabic language.ConclusionsThis adapted guideline serves as a tool for the screening, prevention and management of ID/IDA in different pediatric age groups.

Associated factors in pediatric patients admitted with severe iron-deficiency anemia in the last seven years - the experience of a single pediatric unit.

To study the causes of iron deficiency, laboratory findings and clinical manifestation of infants aged 6-12 months and children aged 1-3 years diagnosed with severe iron-deficiency anemia. We conducted an observational, retrospective single tertiary center study between January 2015 and April 2022, which included 142 children. The control group (patients with no diagnosis of severe iron-deficiency anemia) included 71 patients and the study group (patients diagnosed with severe iron-deficiency anemia) included also 71 patients. Clinical data were retrospectively collected from hospital medical records. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) 25.0 software. Seventy-one children had hemoglobin <7 g∕dL and low values of ferritin/serum iron (22 infants aged 6-12 months and 49 children aged 1-3 years). In both the study and control groups, the male gender was slightly more prevalent. Mother's age at birth and living standard is significantly lower in the study group. We note a higher frequency of premature births (14.08%) in children identified with anemia compared to control group (8.45%). We found a statistically significant distribution of cow's milk consumption among the two groups (p<0.001). Pearson's correlation test revealed a significant positive correlation, indicating that anemia is directly proportional to cow's milk consumption. The most frequent cause of iron-deficiency anemia in infants and children 1-3 years old was the consumption of cow's milk following incorrect diversification and incomplete prophylaxis of iron-deficiency anemia.

Effectiveness of weekly and daily iron administration for the prevention of iron deficiency anemia in infants.

Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation (control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.

The Effect of Delayed Cord Clamping (DCC) on Haemoglobin Levels and Oxygen Saturation Levels in Newborns

Background: The case of iron deficiency anaemia in infants is a serious health problem because it interferes with mental and cognitive development. DCC prolongs blood flow from the placenta to the baby through the umbilical cord, increases blood volume, and optimizes oxygen transfusion which might prevent anemia and promote effective self-breathing. Objective: To determine the effect of DCC on Haemoglobin Levels and Oxygen Saturation Levels in Newborns. Method: Experimental research with Post-test Only Control Group design. The total Sampling method was used on 30 newborns as the samples, with 15 intervention groups and 15 control groups. Data collection used the Delayed Cord Clamping procedure, observation sheets, Easy Touch GCHb tool, and Baby SpO2. An Independent T-test was used to process the data. Results: Based on the experiment on 30 infants, it found that the average hemoglobin level of new-borns with the Delayed Cord Clamping treatment was 22.07 gr/dL higher than the hemoglobin level of new-borns without the Delayed Cord Clamping treatment of 17.79 gr/dL. In addition, the average oxygen saturation level of newborns with the Delayed Cord Clamping treatment was 87.4% more than that of newborns without the Delayed Cord Clamping treatment of 77.4%. Conclusion: DCC affects Haemoglobin Levels and Oxygen Saturation Levels in Newborns in the Work Area of the Aikmel Regional Health Centre. There is a need to increase information about the benefits of DCC among health workers.

Iron Deficiency Anemia in Infancy, Childhood, and Adolescence.

Iron deficiency is the most common nutrient deficiency in the world. Epidemiological data indi- cate that iron deficiency is more prevalent in infants, in preschool-children, and in adolescents. Etiologies of iron deficiency in children include inadequate dietary iron intake, which is the most common cause, as well as increased iron requirements, bleeding, and intestinal iron absorption disorders. Iron deficiency can lead to symptoms related to anemia, may interfere with neuro- development and may cause skin, hair, nail, and gastrointestinal problems. This review focuses on the causes, signs, symptoms, diagnosis and management of iron deficiency in infancy, child- hood, and adolescence.

Iron Preparations in the Management of Iron Deficiency Anemia in Infants and Children: A Systematic Review and Meta-Analysis

Iron Preparations in the Management of Iron Deficiency Anemia in Infants and Children: A Systematic Review and Meta-Analysis

Frequency of Iron Deficiency Anaemia in Exclusively Breastfed and Infants Fed on Cow’s Milk

Introduction: Iron is the most prevalent nutrient deficiency in infants and young children around the world despite its importance for healthy brain development. Infants who drink whole cow's milk or other animal milks are at a greater risk of developing iron deficiency anaemia. In our culture, cow's milk consumption is widespread. There were no local studies available on iron deficiency anemia in infants using different types of milk so need for the present study was felt. Objectives: The objectives of this study were to determine the frequency of exclusively breastfed and cow’s milk fed infants at 3 month of age and to compare the frequency of iron deficiency anemia in exclusively breastfed and cow’s milk fed infants. Study Design: It was a cross-sectional study. Setting and Duration: Research was conducted at the Medical Outpatient Department of The Children’s Hospital and The Institute of Child Health Lahore from 08/02/2022 to 07/08/2022. Material and Methods: This study involved 220 infants of both genders at 3 months of age presenting for vaccination. Outcome variables were frequency of exclusive breast feeding and iron deficiency anemia. All patients' guardians signed an informed consent form. Results: There were 115 (52.3%) male and 105 (47.7%) female patients in the study group. The Hb of the patients ranged from 7.6 g/dl to 14.5 g/dl with a mean of 11.00±1.98 g/dl while the serum iron level ranged from 41 µg/dl to 115 µg/dl with a mean of 67.94±22.99 µg/dl. Majority of the parents (56.4%) belonged to poor class and 46.4% mothers were illiterate. The frequency of exclusive breastfed infants was 45 (20.5%). There was no significant difference in the frequency of exclusive breast feeding across gender (p=0.873), socioeconomic (p=0.900) and educational (p=0.858) status. 76 (34.5%) Infants had iron deficiency anemia. The frequency of iron deficiency anemia was higher among infants on cow’s milk (37.7% vs. 22.2%) as compared to those on exclusive breast feeding however the observed difference was statistically insignificant (p=0.051). Similar insignificant difference was observed across gender, socioeconomic and educational status groups. Conclusion: The frequency of exclusive breastfed infants was 45 (20.5%). There was no significant difference in the frequency of exclusive breast feeding across gender (p=0.873), socioeconomic (p=0.900) and educational (p=0.858) status. 76 (34.5%) Infants had iron deficiency anemia. The frequency of iron deficiency anemia was insignificantly higher among infants on cow’s milk (37.7% vs. 22.2%; p=0.051) as compared to those on exclusive breast feeding. Similar insignificant difference was observed across gender, socioeconomic and educational status groups. Keywords: Exclusive Breast Feeding, Cow’s Milk Feeding, Iron Deficiency Anemia

Prevalence of iron deficiency anemia in hospitalized infants

Iron is vital, as it is essential for many metabolic processes, including oxygen transport, electron transport, DNA synthesis and repair. Iron balance in the body is regulated carefully so that iron losses are compensated by sufficient iron absorption. Iron deficiency is a common cause of anemia and is typically due to insufficient intake, poor absorption or overt or occult blood loss. The World Health Organization has recognized iron deficiency anemia as the most common nutritional deficiency in the world with 30% of the population being affected. This study was conducted to estimate the prevalence of iron deficiency anemia in 152 hospitalized infants between 1-12 months old. Iron deficiency anemia resulted highly prevalent in this age group, 45% of infants had Hemoglobin level &lt;10g/dl. Despite nutrition, there are other social-economic factors that play a role in the high prevalence of iron deficiency anemia in infants. Conclusively it is stated that, as iron deficiency impairs neurologic development and growth in infants, an adequate clinical attention and evaluation should be directed towards it. Routine screening starting at 9 to 12 months is recommended to help preventing the development of anemia. It is also important adequate weaning and early introduction of iron-rich foods, 4-6 months of age.

Serum metabolomics of iron deficiency anemia in infants based on ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry

To explore the differential metabolites in the serum of infants with iron deficiency anemia(IDA) and non iron deficiency anemia, and to explore the potential biomarkers. Non-targeted metabolomics of 30 infants with iron deficiency anemia aged 6-11 months and 30 infants with non iron deficiency anemia aged 6-11 months were analyzed by ultra-high performance liquid chromatography with time of flight mass spectrometry using Acquity UPLC BEH C_(18) column(100 mm×2.1 mm, 1.8 μm). The differences of metabolites between the two groups were analyzed by principal component analysis(PCA) and orthogonal partial least squares discriminant analysis(OPLS-DA). Differential metabolites were screened according to OPLS-DA variable importance projection(VIP) &gt;1. The related metabolic pathways involved in the markers were analyzed based on the KEGG database. Differences in serum metabolic profiles between iron deficiency anemia group and non iron deficiency anemia group were observed. The 44 potential biomarkers were mainly lipids. Combined with pathway analysis, the metabolic pathways related to different metabolites included glycerophosphingolipid metabolism and sphingolipid metabolism. There are differences in lipid metabolites between infants with non iron deficiency anemia and iron deficiency anemia, suggesting that the occurrence and progress of iron deficiency anemia are related to lipid metabolism.

Evaluation of the prescription pattern of ferrous sulfate as a therapy for preventing iron deficiency anemia in infants.

Iron deficiency prevalence in infants is high. Therefore, iron supplementation has been recommended and specified as a program. This study aimed to determine the characteristics of the prescription of ferrous sulfate as a preventive therapy for iron deficiency anemia in young infants. We conducted a descriptive cross-sectional study of clinical records of young infants with eight visits per year. We analyzed a total of 287 records. The prescription characteristics included five criteria prescription indication, age at prescription, dosage, periodicity, and time. These characteristics were scored as follows 1 point when it was considered adequate and 0 when it was considered inadequate; the minimum possible score was 0, and the maximum possible score was 5 points. Statistical analysis included percentages and 95% confidence intervals (CI). The prescription pattern of ferrous sulfate as preventive therapy in infants under one year of age was indicated in 100% of the records reviewed. All five criteria were met in 18.1% of the reviewed records (95%CI 13.6-22.6). The lowest compliance corresponded to adequate dosage (29.2%; 95%CI 23.9-34.5). Age at prescription was correct in 75.9% (95%CI 70.9-80.9); duration of prescription was correct in 44.2% (95%CI 38.4-50.0), and periodicity was proper in 31.1% (95%CI 25.9-36.7) of the files reviewed. Compliance with the prescription of ferrous sulfate as a preventive measure for anemia in infants was not as expected; interventions are needed to reverse this behavior.

Prevalence of Iron-Deficiency Anemia in Infants Living in Rural Areas and the Factors that Influence it in the Pandemic COVID-19 Era

BACKGROUND: Iron-deficiency anemia (IDA) is caused by inadequate intake of iron or impaired erythrocyte formation due to chronic blood loss. AIM: This study aimed to obtain data on the prevalence of iron deficiency and IDA in the pandemic COVID-19 era and to investigate the relationship of infant nutritional status, maternal education, maternal occupation, maternal parity, and family income with the prevalence of iron deficiency and IDA in infants 9–12 months at the Cempaka Banjarbaru Community Health Center. METHODS: A cross-sectional analytic descriptive approach was used with a consecutive sampling technique to conduct this study. The sample consisted of 50 infants between 9 and 12 months old that had completed blood count and peripheral blood smear at measles immunization in May–September 2020 at the Cempaka Banjarbaru Community Health Center. RESULTS: The results showed that the prevalence of iron deficiency, IDA, and hemolytic anemia was 16%, 28%, and 22%, respectively. Meanwhile, the data analysis was conducted using Chi-square and Fisher’s exact test. The results showed a significant relationship between family income factors and the prevalence of iron deficiency and IDA (p = 0.023). CONCLUSION: Infants at the age of 9–12 months need to have a complete blood count examination to detect an earlier iron deficiency and IDA.

Iron deficiency anemia in infants in Sousa (PB), Brazil: an association with nutritional status.

The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status. This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression. Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-for-age (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-for-height Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004). About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.

Cognitive control inhibition networks in adulthood are impaired by early iron deficiency in infancy

Iron deficiency, a common form of micronutrient deficiency, primarily affects children and women. The principal cause of iron deficiency is undernutrition in low-income countries and malnutrition in middle to upper income regions. Iron is a key element for myelin production, neuronal metabolism, and dopamine functions. Iron deficiency in early life can alter brain development and exert long-lasting effects. Control inhibition is an executive function that involves several brain regions, including the prefrontal cortex and caudate and sub-thalamic nuclei. Dopamine is the prevalent neurotransmitter underlying cognitive inhibition. We followed cohort study participants who had iron deficiency anemia in infancy as well non-anemic controls. At 22 years of age, the participants were subjected to functional magnetic resonance imaging (fMRI) to evaluate the correlation between functional connectivity and performance on an inhibitory cognitive task (Go/No-Go). We hypothesized that former iron deficient anemic (FIDA) participants demonstrate less strength in functional connectivity compared with controls (C). There were not significant group differences in the behavioral results in terms of accuracy and response time. A continuous covariate interaction analysis of functional connectivity and the Go/No-Go scores demonstrated significant differences between the FIDA and C groups. The FIDA participants demonstrated less strength in connectivity in brain regions related to control inhibition, including the medial temporal lobe, impairment in the integration of the default mode network (indicating decreased attention and alertness), and an increase in connectivity in posterior brain areas, all of which suggest slower circuitry maturation. The results support the hypothesis that FIDA young adults show differences in the connectivity of networks related to executive functions. These differences could increase their vulnerability to develop cognitive dysfunctions or mental disorders in adulthood.

Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews.

Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews.

Study of iron deficiency anemia in infants of 3 to 6 months age group and its risk factors: a cross sectional study

Background: Iron deficiency anemia in 3-6 months-old infants is often neglected. Its presence in healthy infant of less than 6 months of age is largely debated. Neglecting IDA in this critical phase of growth can lead to serious consequences. The aim and objective of the study was to estimate the frequency of IDA in 3-6 months old infants, admitted in rural tertiary care hospital and to study its risk factors.Methods: The cross-sectional study was conducted in the pediatric department of rural tertiary care hospital. 100 infants in the age group 3-6 months were included in the study. Relevant maternal and infant factors were noted. CBC with blood indices, peripheral blood smear and reticulocyte count were studied. Anemia in them was defined as hemoglobin &lt;9.5 g/dl. IDA was diagnosed based in history, examination, indices, and peripheral smear.Results: 22% of infants of 3-6 months had IDA. 40.9% of infants with IDA were low birth weight compared to 11.5% without IDA (p value&lt;0.05). All pre-terms included in the study had IDA. 16% of term, normal birth weight, exclusively breast-fed infants had IDA. Underweight and stunting were seen in 31.8 % and 30.8% of IDA infants compared to 9% and 5.4% of infants without IDA.Conclusions: IDA was quite common in infants less than 6 months and also seen in healthy, term and exclusively breast-fed babies, so universal iron supplementation before 6 months need to be considered in National Iron plus Initiative in India. Preterm, LBW babies and babies with NICU stay are at higher risk of IDA.

Dietary Advice Improves Non-Anemic Iron Deficiency

Source: Parkin PC, Borkhoff CM, Macarthur C, et al. Randomized trial of oral iron and diet advice versus diet advice alone in young children with non-anemic iron deficiency [published online ahead of print February 3, 2021]. J Pediatr. 2021. doi:10.1016/j.jpeds.2021.01.073Investigators from multiple Canadian institutions conducted a randomized trial to compare the effect of oral iron supplementation versus diet advice alone on neurodevelopmental outcomes in children. Parents of children with health supervision visits at 1 of 8 primary care practices in Toronto, Canada, during the study period were eligible. Children were included if they were 12-40 months of age and met criteria for non-anemic iron deficiency (NAID), defined as a hemoglobin ≥110 g/L and serum ferritin <14 μg/L. Children were excluded if they had a developmental condition, were born at a gestational age of <35 weeks or birth-weight of <2,500 grams, had acute illness, had previous anemia or iron deficiency, were receiving iron, or had a c-reactive protein ≥10 mg/L. Child demographics were collected at baseline.Participants were randomized to receive either liquid ferrous sulfate (6 mg elemental iron/kg/day) or liquid placebo in 2 divided doses daily by mouth for 4 months. All parents received diet advice on improving iron status via a written guide. Parents and researchers were blinded to treatment arm. Participants received a developmental assessment of gross motor and cognitive at baseline as well as 4 and 12 months after baseline using the Mullen Scales of Early Learning (MSEL).The primary outcome was MSEL scores 4 and 12 months after baseline. Secondary outcomes included serum ferritin values at 4 and 12 months. The investigators used an intention-to-treat analysis to assess the effect of intervention arm on outcomes, adjusting for baseline score, baseline ferritin, and unbalanced demographic characteristics across treatment arms.There were 60 participants randomized. Participants had a mean age of 24.2 months. Serum ferritin and mean MSEL scores were similar across treatment groups at baseline. The mean between-group difference in MSEL scores at 4 months was 1.1 points (95% CI, -4.2, 6.5) and at 12 months was 4.1 points (95% CI, -1.9, 10.1). The mean between-group difference in serum ferritin at 4 months was 16.9 μg/L (95% CI, 6.5, 27.2) and at 12 months was 3.9 μg/L (95% CI, -7.3, 15.1).The investigators conclude that there is no important between-group difference in neurodevelopmental outcomes in young children NAID treated with ferrous sulfate plus diet advice versus diet advice alone, though serum ferritin values are higher among those who received ferrous sulfate 4 months later.Dr Hogan has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.NAID is found in an estimated 11% of US children ages 6 months to 5 years.1 Approximately 25% to 42% of NAID eventually contributes to anemia in this age group.1 Duration, severity, and age onset of NAID may impact neurocognitive skills, breath-holding spells, restless leg syndrome, attention-deficit, pagophagia (ice craving), and athletic performance.2The definitive diagnostic study for NAID is absent iron staining on bone marrow biopsy, an invasive study.3 Although serum ferritin is specific and usually aligned with total body iron stores, normal thresholds vary with age and assay types. Serum ferritin levels rise during and for days to weeks after acute or chronic infection, injury, exercise, and inflammatory conditions.1-3 Consensus among health organizations as to definitions of NAID based on serum ferritin and other biomarkers vary.1-3Strengths of the current study include randomization and longitudinal data. Limitations include a small, homogeneous, well-educated cohort with self-reported medication compliance, adverse effects, and dietary intake. Even though iron supplementation was prescribed for 4 months, both groups had similarly improved ferritin levels after 12 months and equivalent hemoglobin levels throughout. CRP levels were not obtained at 4 and 12 months’ time points to determine the accuracy of the ferritin levels.1-3 Red blood cell indices, transferrin saturation, reticulocyte hemoglobin content, soluble transferrin receptor, and hepcidin—which are available serum biomarkers to help differentiate low iron stores from NAID—were not assessed.1Non-anemic iron deficiency due to inadequate iron intake in children ages 6 months to 5 years seems resolvable with written nutrition education within 12 months. More research is needed to determine whether low serum ferritin levels are associated with neurodevelopmental outcomes. (See AAP Grand Rounds. 2021;45[3]:27.)4The AAP recommends universal screening for anemia with measurement of hemoglobin concentration at approximately 12 months of age.3 Although the association of iron deficiency anemia in infancy and later cognitive deficits is supported by a number of prior studies, the same cannot be said of NAID.3 Unfortunately, the results of the current study are also inconclusive. Perhaps if low-dose ferrous sulfates (3 mg/kg elemental iron/day) had been used, compliance would have improved, potentially leading to differences in neurodevelopmental outcomes. (See AAP Grand Rounds. 2017;38[4]39.)5

Multiomic Profiling of Iron Deficient Infant Monkeys Detects Biochemical Signatures of Inflammatory and Neural Dysfunction in Blood and CSF Prior to Anemia

Background: Pre-anemic iron deficiency (ID) and ID anemia in infancy is associated with long-term effects on brain development. Iron is an essential micronutrient needed for multiple neurodevelopmental processes, including energy production, myelination and neurotransmission. Serum and cerebrospinal fluid (CSF) metabolomic and proteomic analyses can potentially characterize the metabolic and protein signatures of aberrant iron-dependent brain development pathways. A better understanding of the timing and course of the biochemical signatures of ID-induced dysfunction in the heme and intrathecal compartments may help with early diagnosis and treatment of iron deficiency prior to onset of anemia. Objective: To determine proteomic and metabolomic signatures of ID-induced dysfunction in serum and CSF of infant monkeys prior to the onset of iron deficiency anemia (IDA). Methods: Hematological parameters were determined in rhesus monkey infants (Macaca mulatta) at 4 and 6 months of age as they progressed from preanemic ID to IDA (ID group; n=6) or remained iron-sufficient(IS group; n=12). Blood and CSF were collected at 4 and 6 months and metabolically profiled using HPLC/MS with isobaric standards for identification and quantification. Proteomic quantification utilized a custom TMT-labeled workflow with an Orbitrap Fusion Tribrid mass spectrometer. Serum and CSF metabolomic and proteomic profiles of the ID and IS groups were compared, along with a a third group of infants that became IDA earlier at 4 months of age (IDA group; n=3). Results: Evidence of pre-anemic ID was apparent in some infant at 4 months of age with clinical IDA evident at 6 months A (Hgb &amp;lt;10 g/dL and MCV &amp;lt;60 fL). A total of 1,128 CSF proteins and 251 serum proteins were identified and quantified. Over 4,000 metabolite features were observed in serum and CSF across three modalities including reverse phase positive, reverse phase negative and HILIC mode. Pathway analyses provided evidence of increased inflammatory activity, impacts on neural pathways, and bioindicators of acute phase responses in ID and IDA groups. Signs of these metabolic changes were already present in the preanemic ID? period (4 months). Conclusions: Biomarkers indicating indicative of increased inflammatory activity with downstream effects on pathways involved in normal neural function were detectable in both the CSF and serum of ID monkeys prior to the onset of clinical anemia. Brain-specific proteomic and metabolomic profiling of novel analytes in circulation can facilitate earlier diagnosis and treatment of infantile ID to reduce neurodevelopmental risk. Funded by NIH/NICHD Grant HD089989, this abstract is sponsored by ASH member Zohar Sachs MD, PhD Disclosures No relevant conflicts of interest to declare.

The Prevalence of iron deficiency anemia in infants in a Portuguese population

INTRODUCTION&#x0D; Iron deficiency is the world most prevalent nutritional disorder which is associated with impaired neurocognitive function in infants. The prevalence of iron deficiency anemia (IDA) in Portuguese infants remains unknown. The last study was performed by one of us (HA) in 1994 in a sample of 188 infants revealing a prevalence of IDA of 19%. The main objective of this study is to determine the current prevalence of IDA in a sample of infants nine months of age in Braga, Portugal.&#x0D; METHODS&#x0D; This was a cross-sectional study on a random sample of infants born from September 2016 to February 2017 at Braga Hospital. They were evaluated for anthropometry, socio-economic factors, feeding regime and a blood sample was taken for blood cell counts, serum ferritin and C reactive protein. RESULTS&#x0D; Forty-two infants were included. The prevalence of IDA was 7.1%. Nine infants were anemic (21%); moderate anemia was observed in 2/9 of infants and mild anemia in 7/9 infants. Of the 3 infants with IDA, 2 had been exclusively breastfed until 6 months.&#x0D; CONCLUSIONS&#x0D; Compared to a study from 1994, there may have been a reduction in the prevalence of IDA in this area in Portugal.

The Prevalence and Risk Factors of Iron Deficiency Anemia in Thai Infants by Complete Blood Count at 9-Month-Old

Background: Infants are the most at risk from iron deficiency (ID) and iron deficiency anemia (IDA), but the prevalence of the latter in this group is unclear. Estimation as to the prevalence of IDA using Hb of less than 11 g/dL may have been exaggerated due to thalassemia and hemoglobinopathies. On the other hand, iron studies are costly and not routinely available in low resource settings. In the present research, the authors estimated the prevalence of IDA in 9-month-old infants at the authors’ well-baby clinic by improving the post-iron-treatment criteria of Hb and defined the risk factors of IDA in infants. Objective: To estimate the prevalence of IDA in 9-month-old infants at the well-baby clinic and to define the risk factors of IDA. Materials and Methods: A retrospective cohort study of 391 children who had complete blood count (CBC) screening at 9-month-old at the well-baby clinic. Anemia was defined according to the WHO criteria (hemoglobin of 11 g/dL or less for children aged six months to five years). IDA was defined as an increase of at least Hb 1 g/dL after receiving iron treatment for one to two months. Mean levels of hematological parameters were compared between groups using independent samples t-test. The characteristics with potential risk factors for IDA were compared with iron non-responder and normal group. Multivariable adjusted odd ratios and 95% confidence intervals (CIs) of IDA were calculated using multinomial logistic regression with control for risk factors. Results: One hundred fourteen children (29.1%) were anemic. There was no difference between anemic and non-anemic children in baseline characteristics. Seventy children in the anemic group were diagnosed with IDA. The prevalence of IDA in the present study was 17.9%. The IDA group showed significant improvement in Hb, Hct, MCV, MCH after receiving iron treatment, but there were no significant changes in the iron non-responder group. The risk factor for IDA was exclusive breastfeeding for at least six months (odds ratio 3.14, 95% CI 1.67 to 5.90, p&lt;0.001). Conclusion: The prevalence of IDA and anemia in the present study was 17.9% and 29.1%, respectively. The risk factor for IDA was exclusive breastfeeding for at least six months. Keywords: Anemia, Iron deficiency anemia, Prevalence of anemia in infants, Complete blood count screening, Thai infants