Iron Deficiency In Infants Research Articles

Prevalence of iron deficiency in extreme preterm infants at 4 or 6 months corrected age despite receiving prophylactic iron supplements.

Prevalence of iron deficiency in extreme preterm infants at 4 or 6 months corrected age despite receiving prophylactic iron supplements.

The effect of iron supplementation in preterm infants at different gestational ages

BackgroundIron deficiency (ID) is the most prevalent nutritional deficiency disease in preterm infants, significantly affecting their growth and development. For preterm infants to flourish physically and neurologically, timely iron supplementation is essential. The main goals of this study were to determine whether the present iron supplementation regimen results in iron overload in late preterm infants and whether it can meet the growth requirements of early preterm infants for catch-up.MethodsWe conducted a prospective follow-up study on preterm infants at the Department of Child Health, West China Second University Hospital, Sichuan University, from January 1, 2020, to August 31, 2020. In this study, 177 preterm infants were divided into two groups based on gestational age—early preterm infants (gestational age < 34 weeks) and late preterm infants (gestational age ≥ 34 weeks and < 37 weeks)—to compare the incidence of iron deficiency, iron status, and physical growth of preterm infants receiving iron supplements (2–4 mg/kg/d).ResultsIron supplementation considerably reduced the incidence of iron deficiency in preterm infants. The prevalence of iron deficiency in early preterm infants and late preterm infants was 11.3% and 5.1%, respectively, at the corrected gestational age of 3 months; at the corrected gestational age of 6 months, the prevalence was 5.3% and 6.3%, respectively. No preterm infants with iron deficiency were detected in either group at the corrected gestational age of 12 months. Ferritin was substantially lower in early preterm infants (36.87 ± 31.57 ng/ml) than in late preterm infants (65.78 ± 75.76 ng/ml) at the corrected gestational age of 3 months (p < 0.05). A multifactorial regression analysis of factors influencing iron metabolism levels in preterm infants revealed a positive relationship between log10hepcidin, birth weight, and ferritin, with higher birth weights resulting in higher ferritin levels.ConclusionsPostnatal iron supplementation at 2–4 mg/kg/d in preterm infants significantly decreases the incidence of ID. There were substantial differences in iron levels across preterm infants of varying gestational ages. A tailored iron supplementation plan based on growth, birth weight, and gestational age may be a more suitable route for iron supplementation. Although the current study found that the postnatal iron status of early preterm infants differed from that of late preterm infants, the actual mechanism of action remains unknown, and large-sample, multicenter clinical studies are required to investigate this further.

Long-term Effects of Iron Deficiency in Early Infancy on Neurodevelopment

Introduction and Purpose: Iron deficiency alongside anaemia is one of the most significant global health concerns with potentially long-lasting implications on child development and health outcomes. The period of infancy represents a crucial phase of central nervous system maturation, rendering infants particularly susceptible to the adverse effects of iron deficiency. It is therefore crucial to pay close attention to this issue. The aim of this review is to elucidate the neurological implications of iron deficiency in infancy and emphasize the necessity of implementing preventive strategies to safeguard child development. State of Knowledge: Iron deficiency in infancy can result in impairments of brain development. Extensive research highlights the influence of this micronutrient on various physiological processes, including the synthesis of neurotransmitters, neuronal metabolism, myelination, synaptogenesis and gene expression. Furthermore, iron deficiency during infancy is associated with adverse developmental outcomes, including cognitive, motor, and socioemotional deficits. Long-term follow-up studies have elucidated the enduring neurological consequences of iron deficiency in infancy, with effects extending into childhood and beyond. Summary: Given that the changes that occur during the infantile period are often irreversible and have long-lasting implications for future development, it is of the utmost importance to prioritize prevention strategies.

Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study.

Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.

Optimization of Blending Ratio of Emmer Wheat Flour, White Sesame Powder and Sweet Potato Leaves Powder to Produce Nutrient-Dense and Sensory Acceptable Gruel

ABSTRACT This study focuses on optimizing the blending ratio of Emmer Wheat Flour (EWF), White Sesame Powder (WSP), and Sweet Potato Leaf Powder (SPLP) to improve the nutritional and sensory properties of gruel for children up to 2 years of age. Thirteen formulations were created with the help of D-optimal mixture design (Minitab Ver. 19.2), considering EWF (70–80%), WSP (10–20%), and SPLP (5–10%). The resulting gruel underwent analysis for proximate, mineral, functional, anti-nutritional, and sensory properties. Graphical optimization revealed that a blend of 71.30% EWF, 20% WSP, and 8.70% SPLP yielded nutrient-enriched gruel with high sensory acceptability (Desirability: 0.85). This optimized gruel contains essential nutrients, including fat (8.35%), protein (15.058%), fiber (8.27%), carbohydrates (62.073%), energy (425.91 kcal/100 g), and minerals (Fe: 9.17, Zn: 3.79, Ca: 393.027 mg/100 g). Overall, the study concludes that EWF, WSP, and SPLP-based gruel can effectively address protein-energy malnutrition and iron deficiency in infants. Novelty Impact Statement Preparation of gruel from the locally available and cost-effective materials are considered in this study. Preparation of the gruel from the emmer wheat, sesame powder and sweet potato leaves powder is not reported yet. The SPLP is rich in different nutrients, and they are the waste produced in the production system. So, using these locally available ingredients to alleviate malnutrition is very important.

Prevalence and predictors of anemia among six-week-old infants in Kwale County, Kenya: A cross-sectional study.

Anemia is a significant public health problem among children worldwide. The etiology of anemia is multifactorial but iron deficiency (ID) is the most common cause of anemia in low- and middle-income countries. ID and anemia in infancy can impair growth and cognitive development. The aim of this study was to determine the prevalence and predictors of anemia among six-week-old infants in Kwale County, Kenya. This cross-sectional study included 424 mother-infant pairs. Structured questionnaires were administered to the mothers to obtain information on socio-demographic variables, maternal characteristics and birth information. Anthropometric data was collected for each child. A heel prick was done to measure hemoglobin and zinc protoporphyrin concentration levels. Chi-square test, bivariate and multivariate regression analyses were done to determine factors associated with anemia. The prevalence of ID, anemia and IDA was 60.4% (95%CI: 55.9-65.2), 21.0% (95%CI: 17.5-25.2) and 15.8% (95%CI: 12.7-19.7) respectively. Bivariate analysis showed that the risk of anemia was significantly higher among male infants (odds ratio (OR) = 2.20 (95%CI: 1.33-3.63), p = 0.002), iron deficient infants (OR = 2.35 (95%CI: 1.39-3.99), p = 0.001) and infants from Msambweni Sub-County (OR = 2.80 (95%CI: 1.40-4.62), p<0.001). Multivariate analysis revealed that odds of anemia were significantly higher in infants born to mothers who did not use iron supplements during pregnancy (adjusted odds ratio (aOR) = 74.01 (95%CI: 2.45-2238.21), p = 0.013 and significantly lower in infants born to mothers with parity ≥ 4 (aOR = 0.05 ((95%CI: 0.00-0.77), p = 0.024). In six-week-old infants in rural Kenya, anemia prevalence was 21.0% with ID accounting for 75.3% of anemia cases. Given the physical and cognitive impairments associated with ID and anemia in early infancy, it may be prudent to re-evaluate the current Kenyan pediatric protocols to include anemia screening and potential treatment of infants less than 6-months of age.

Iron deficiency in healthy, term infants aged five months, in a pediatric outpatient clinic: a prospective study

BackgroundIron deficiency (ID) is prevalent in Malaysian children. The incidence of ID in infants under 6 months of age is unknown. Our aim was to determine the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in healthy, term infants aged below 6 months in our hospital population.MethodsA prospective longitudinal pilot study of mother-infant pairs was conducted on infants receiving routine immunizations in a mother and child clinic at a university hospital, in Kuala Lumpur, Malaysia. Mothers completed standardized questionnaires at 3- and 5-month postnatal visits. Maternal and infant full blood count, ferritin, and C-reactive protein (CRP) levels were measured at 3 months and for the infants repeated at 5 months. Infant anthropometric measurements were obtained at both visits. We conducted a univariate analysis to identify factors associated with ID and IDA.ResultsAltogether, 91 mother-infant pairs were enrolled, with 88 completing the study. No infant had ID or IDA at 3 months; the lowest ferritin level was 16.6 µg/L. At 5 months, 5.9% (5/85) of infants had ID, and 2.4% (2/85) had IDA. Median (interquartile range) infant ferritin levels significantly declined from 113.4 (65.0–183.6) µg/L at 3 months to 50.9 (29.2–70.4) µg/L at 5 months, p < 0.001. Exclusive breastfeeding until 3 or 5 months was significantly associated with ID at 5 months (p = 0.020, and p = 0.008, respectively) on univariate analysis. The drop in ferritin between 3–5 months was significantly associated with weight and length gains between 0–3 months (p = 0.018, p = 0.009, respectively). Altogether, 14.3% of infants exclusively breastfed until 5 months developed ID. At 5 months, 3.4% of infants were underweight, 1.1% stunted, and 10.2% wasted.ConclusionsIn exclusively breastfed term infants, ID occurred by 5 months. Early introduction of iron-rich foods should be considered in exclusively breastfed babies. A high prevalence of wasting suggests a calorie deficit in this population and will lead to stunting if not addressed.

Prevalence of iron deficiency in infants aged 6–12 months and its relationship with socioeconomic level and iron prophylaxis use

Prevalence of iron deficiency in infants aged 6–12 months and its relationship with socioeconomic level and iron prophylaxis use

Iron Deficiency in Young Children Beyond Anemia: Clinical Features, Maternal Factors, and the Predictor for Neuropsychomotor Development Delay

Introduction: Iron deficiency (ID) is the most common micronutrient deficiency in children and is prevalent in young children, especially in those with long-term exclusive breastfeeding (BF). Iron deficiency anemia (IDA), the most common type of pediatric anemia, while it is not the only clinical manifestation of ID. In Taiwan, prevalence of IDA was up to 23% in child-bearing women. It was reported that the iron levels in the breast milk of IDA mothers were markedly lower than that of non-IDA mothers. ID alone in young children can cause neurocognitive development symptoms, including inattention, psychomotor delay, cognition impairment, pica, etc, in children. However, clinical reports on ID, not IDA, are relatively few. We aimed to investigate the clinical features and influencing factors of ID in young children. Methods and Materials: There were 33 young children diagnosed as ID at outpatient department at Taipei Medical University Hospital from 2017 to 2019. The charts were retrospectively reviewed and clinical data were collected, including diagnostic age, initial symptoms, periods of breast-feeding (BF), hemoglobin (Hb), mean corpuscular volume (MCV), serum ferritin (SF), serum iron, total iron binding capacity (TIBC), zinc levels, thalassemia survey, duration of iron supplement, and laboratory improvement after iron supplement. Whether there were neuropsychomotor (NPMD) delay depended on the chart record of doctors of pediatric rehabilitation. Results: The median age of ID diagnosis was 2.5 years (range: 5 month－7.17 years). There were 31 (94%) of ID children initially presented with either koilonychias, picky eating, or poor appetite. 24 (72.7%) were found to have koilonychias, and among them, 18 (54.5%) had flat nails and 6 (18.2%) had spoon nails. 17 (51.5%) were picky eaters, 16 (48.5%) had poor appetite, 7 (21.2%) had pale nails, and 3 (9.1%) had pica. 11 (33.3%) had NPMD delay. The median duration of BF was 10.8 months (range: 0 to 36). There were 12 (36.4%) children whose mother had IDA. The median Hb was 11.2 g/dL (IQR: 10－12.65), median MCV was 76.45 fL, median SF level was 25 ng/mL (IQR: 13.25－45.5), and median transferrin saturation was 9.25% (IQR: 7－12.88). The median serum zinc level at diagnosis of ID was 66.4 μg/dL. In addition, 21 (63.6%) has concurrent zinc deficiency, 10 (30.3%) had pediatric IDA, and 2 (6.3%) had combined thalassemia trait. The median (IQR) duration of iron supplement is 3 (3-6) months. After treatment, patients' data revealed a significant increase in median Hb of 12.6 mg/dL, median MCV of 78.7 fL, median SF of 47 ng/mL, and median transferrin saturation of 15.35%. By correlation analysis, breastfeeding duration was also moderately correlated to SF level (Pearson rank=-0.5224). Maternal IDA history also had a negative correlation to SF level in ID children (Pearson rank=-0.4053). By multivariate linear regression (MVLR) analysis, breastfeeding duration and maternal IDA history were identified as significantly inverse predictors for SF levels in ID children. ID children with NPMD delay had significantly higher rate of concurrent zinc deficiency. By MVLR analysis, serum zinc level was identified as a significant inverse predictor for NPMD delay among ID children (Odd's ratio: 0.89, 95%CI: 0.799-0.991, p-value=0.0336*). Conclusion: Our results highlighted the clinical features of ID in infants and children. A high proportion of ID children had maternal IDA history (36.4%) and NPMD delay (33.3%). Iron supplementary was effective to improve ID. Breastfeeding duration and maternal IDA history can negatively impact SF level in ID children. Good levels of serum zinc in ID children can predict lower risk of NPMD delay. Disclosures : No relevant conflicts of interest to declare.

Accuracy of Reticulocyte Hemoglobin for Diagnosing Iron Deficiency in Very Preterm Infants: A Population-Based Cohort Study

Background: Preterm born infants are at an increased risk of developing iron deficiency (ID) despite preventative iron supplementation, which can lead to long-term negative neurodevelopmental and behavioral outcomes. Serum ferritin (SF) is the commonly used test for diagnosing ID. However, SF is influenced by infection and inflammation, making it an unreliable marker in such situations. An alternative, reticulocyte hemoglobin equivalent (Ret-He), measures the iron content in newly produced red blood cells, providing an immediate assessment of iron availability. Unlike SF, Ret-He tests are automated, can be performed on the same blood sample as a complete blood count, and is not influenced by infection or inflammation like SF. However, there is limited literature on the reliability of Ret-He as an ID marker in very preterm infants (VPI) during their first year of life. This study aims to evaluate the diagnostic accuracy of Ret-He as an ID indicator in VPI at 4-6 months of corrected age (CA) compared to SF levels. Objective: To investigate the accuracy of Ret-He in detecting ID in VPI at 4-6 months CA Methods: A retrospective population-based cohort study was conducted using a population-based Provincial Perinatal Follow-Up (PFUP) database on all live VPIs born in Nova Scotia between 2012 and 2018. Infants with hematological disorders, chromosomal abnormalities, or major congenital anomalies were excluded. Prophylactic iron supplementation (2-3 mg/kg/day) starting at 2-4 weeks of chronological age was a standard of care for all included infants. Iron supplementation was recommended until 9-12 months CA. All infants underwent SF and CBC testing at either 4- or 6-months CA to assess iron stores and guide supplementation. In 2012, Ret-He was added as an additional marker of ID for clinical decision-making. Two definitions of ID were used. Definition one defined ID as SF level &amp;lt;20 mcg/L. Definition two defined ID as SF level &amp;lt;20 mcg/L at 4 months and &amp;lt;12 mcg/L at 6 months CA. Receiver operating characteristic curves were performed and the areas under the curves (AUC) were calculated to assess the accuracy of Ret-He in classifying patients with ID. The optimal cut-off point for Ret-He was determined using Youden's index, from which sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The Spearman correlation coefficient was calculated between SF and Ret-He. Statistical significance was set at a two-sided P value of &amp;lt; 0.05. Results: A total of 156 patients were included. Under definition one, 62 (39.7%) met the criteria for ID. Under definition two, 39 (25.0%) patients had ID. Baseline characteristics are provided in Table 1. The Spearman correlation coefficient between SF and Ret-He was 0.23 (p=0.004). Under definition one, the AUC of Ret-He for diagnosing ID was 0.64 (p=0.002) and 0.69 (p&amp;lt;0.001) under definition two (Figure 1). The optimal cut-off value for Ret-He in ID diagnosis was 29.4 pg irrespective of the definition. Sensitivity, specificity, PPV, and NPV for both definitions are reported in Table 1. Conclusion: Regardless of the ID definition used, the AUCs indicated a weak discriminatory ability of Ret-He for ID diagnosis. The study indicated a weak positive relationship between SF and Ret-He. Ret-He's low diagnostic accuracy in this study is comparable to other studies involving healthy pediatric populations but lower than studies involving children with chronic health conditions. Clinicians should use caution when relying on Ret-He alone to diagnose ID in VPI. Further research is needed to determine the optimal diagnostic approach for identifying ID in VPI as well as explore the clinical utility of Ret-He in combination with other ID biomarkers such as SF and transferrin saturation.

31 Iron Deficiency in Formula-fed Very Preterm Infants: Do We Need to Revise Recommendations for Iron Supplementation?

Abstract Background Preterm infants are at risk for iron deficiency (ID). The Canadian Paediatric Society (CPS) recommends iron supplementation of 2 to 3mg/kg/day for breastfed (BF) preterm infants born &amp;lt;2 kg. Additional iron supplementation is not recommended if these infants are primarily formula-fed (FF) with iron-rich formula, since formula is thought to provide enough iron. However, these recommendations are not universally accepted. Objectives To investigate how feeding type influences the iron status of very preterm infants (VPI) at 4 to 6 months corrected age. Design/Methods A retrospective population-based cohort study was conducted using a provincial database of all VPI (&amp;lt;31 weeks gestational age) born in Nova Scotia from 2005-2018. Information about feeding type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. Two groups were compared using chi-square and unpaired t-tests. Results 392 infants were studied (gestational age: 23-30 weeks). Of these, 285 were exclusively FF with iron-rich formula, and 107 were exclusively or partially BF. Neonatal variables were comparable between the two groups. An elemental iron intake of &amp;gt;2 mg/kg/day was obtained from formula alone in only 20.4% of FF infants. FF infants were less likely to receive additional iron supplements. However, total iron intake (from formula and supplements) was higher in FF infants. Despite this, 36.8% of infants in FF group developed ID, versus 20.6% in the BF group (Table 1). Conclusion Most VPI fail to receive elemental iron of &amp;gt;2 mg/kg/day from formula alone. ID is significantly more prevalent in FF infants than in BF infants, despite higher iron intake. Our findings do not support the current CPS guidelines.

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.

Comparison of two dosage regimens of iron in preterm infants for the prevention of iron deficiency: A prospective interventional study

Abstract BACKGROUND: The majority of infants born &lt;32 weeks of gestation develop anemia. The cause depends on multiple factors, most common being iron deficiency. Iron being a major nutrient, its deficiency may lead to irreversible neurodevelopment and cognitive impairment and overdose lead to neurodegeneration and gastrointestinal intolerance. Although the need for iron and outcome of iron deficiencies has been studied much, valid studies pertaining dosage for prevention of iron deficiency in preterm infants are insufficient. OBJECTIVE: To compare two dosage regimens of iron for the prevention of iron deficiency among preterm infants born &lt;32 weeks at 6 weeks of chronological age. MATERIALS AND METHODS: A prospective interventional study performed in a level III neonatal intensive care unit. A total of 64 infants with &lt;32 weeks of gestation were studied, were classified into two grouped, and initiated with iron at two different doses (2 and 4 mg/kg/day). The preintervention and postintervention hemoglobin and serum ferritin were compared at 6 weeks of chronological age. RESULTS: Of the 32 babies with iron initiated at 2 mg/kg/day, 21 babies had low hemoglobin level and 11 babies had normal hemoglobin level, and 10 babies had low ferritin level and 22 babies had normal ferritin level. Of the 32 babies with iron at 4 mg/kg/day, all babies had normal hemoglobin and ferritin levels. Conclusion: The incidence of anemia is lower in the infants receiving iron at 4 mg/kg/day compared with infants receiving iron at 2 mg/kg/day.

IRON DEFICIENCY in INFANCY and CHILDHOOD

IRON DEFICIENCY in INFANCY and CHILDHOOD

Mild form of iron deficiency anemia and a latent iron deficiency as a border – line state in infants aged under 2 years

The mentioned forms of iron deficiency in infants aged 6 mos - 2 yrs were found to be wide – spread, almost blurred clinically, and of high spontaneous reversity. Therefore, failing to affect the children’s growth, physical development and the morbidity rate these disorders could be considered as a border–line stete.

Periodic leg movements during sleep and iron status in infants with prematurity, Down syndrome and Prader-Willi syndrome.

Sleep disturbances including bedtime problems and night awakenings are common during infancy. Polysomnography during the first years of life is performed mainly to rule out sleep-disordered breathing; however, sleep-related movement disorders can constitute a significant contributor to sleep disruption in this age group. Almost no studies have investigated the presence of periodic limb movements during sleep and underlying iron deficiency in infants, especially in those born preterm or with an underlying genetic syndrome. In this retrospective study we included infants 3-24 months referred for polysomnography for snoring or frequent nocturnal awakenings. All children had bloodwork (ferritin and haemoglobin) conducted within 3months of the overnight sleep study. We studied 79 infants, including 31 (39.2%) full-term without diagnosis, 10 (12.7%) born premature, 16 (20.3%) with Down syndrome, 15 (19.0%) with Prader-Willi syndrome, and the remaining seven (8.9%) had various disorders. Compared with those with Down syndrome, Prader-Willi syndrome and full-term infants, those with prematurity showed a statistically significant elevated periodic limb movement index and lower ferritin levels than the other groups. Both ferritin (r= -0.18) and haemoglobin (r= -0.30) were negatively correlated with periodic limb movement index; however, this correlation reached statistical significance only for haemoglobin. Iron deficiency is associated with increased periodic leg movements during sleep in infants. Infants with prematurity had higher periodic limb movement index and lower ferritin levels than infants with Down syndrome, Prader-Willi syndrome or without diagnosis.

Formula Feeding Significantly Increases Risk of Iron Deficiency in Very Preterm Infants during the First 4-6 Months of Life

Introduction: Iron deficiency (ID) early in life is associated with adverse neurodevelopmental and behavioural outcomes later in life. Preterm infants are considered at increased risk of developing ID due to their relative lack of iron stores, accelerated growth during the first few weeks of life and multiple phlebotomies received while in hospital. Breast fed (BF) preterm infants are considered at particularly increased risk of ID due to the lower iron content of breast milk. Therefore, iron supplementation is routinely recommended for these infants. However, the supplemental iron requirements of formula fed (FF) preterm infants are generally deemed to be lower due to the presence of iron in formulas. The Canadian Pediatric Society recommends no additional iron supplementation for preterm infants with a birth weight <2kg if they are primarily FF with iron-rich formula. The American Academy of Pediatrics makes no general recommendation for iron supplementation in infants fed primarily with iron-rich formula. The primary objective of this study was to investigate how feeding type influences the iron status of very preterm infants at 4-6-months corrected age (CA). A secondary objective was to further explore the risk factors associated with ID in the FF group. Methods: A retrospective population-based cohort study was conducted at IWK Health using the Perinatal Follow-Up Program database, a provincial database containing relevant clinical information for all very preterm infants (<31 weeks gestational age) born in the province of Nova Scotia, Canada. All very preterm infants born in Nova Scotia from 2005-2018 were included. Infants with severe congenital malformations, chromosomal anomalies and/or hemolytic anemias were excluded. Information about presence of ID, feeding type, iron intake from formula, and supplemental iron therapy at 4-6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin <20 and <12 mcg/L at 4-and 6-months CA, respectively. Variables were compared between the FF and BF groups using chi square and unpaired t-tests. The FF group was further divided into ID and non-ID groups, which were compared using similar analysis techniques. Results: A total of 392 infants were studied (gestational age: 23-30 weeks; 55.75% male). Of these, 285 were exclusively FF with iron-rich formula and 107 were exclusively or partially BF. Mean birth weight, gestational age and neonatal variables were comparable between the two groups. Mean iron intake from formula in the FF group was 1.66 mg/kg/day. An elemental iron intake of ≥ 2mg/kg/day was obtained from formula alone in only 20.4% of FF infants. FF infants were also less likely to receive additional iron supplements (Table 1). However, mean total daily iron intake (from formula and supplements) was higher in the FF group. Despite this, 36.8% of infants in FF group developed ID versus 20.6% in BF group (p=0.002). Table 2 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were both lower in the ID group. The ID group also had a higher percentage of infants born <1100g (p=0.01). More babies in the ID group received at least one blood transfusion (Odds:1.1-3.0). Other neonatal variables were comparable between the two groups. ID infants had a higher daily formula intake, daily iron intake from formula and total daily iron intake combined from formula and supplements. Conclusion: Most very preterm infants fail to receive elemental iron of 2mg/kg/day from formula alone. ID is significantly more prevalent in FF infants than BF infants despite higher iron intake overall. A possible explanation for this finding could be that the bioavailability of iron from formula is lower than from breast milk. Breast milk contains lactoferrin, which aids iron absorption. Thus, iron from breast milk may be better absorbed than iron from formula. Our observations suggest the need to revisit the international recommendations for iron supplementation in FF very preterm infants. Lower gestational age, lower birth weight and need for blood transfusions were associated with ID in FF infants. Plausibly, blood transfusions may lead clinicians to withhold necessary iron supplementation for fear of iron overload in these infants, leading to unintentional ID. We suggest that optimal iron supplementation in this population should be guided by a risk adapted strategy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol

BackgroundAn intact umbilical cord allows the physiological transfusion of blood from the placenta to the neonate, which reduces infant iron deficiency and is associated with improved development during early childhood. The implementation of delayed cord clamping practice varies depending on mode of delivery, as well as gestational age and neonatal compromise. Emerging evidence shows that infants requiring resuscitation would benefit if respiratory support were provided with the umbilical cord intact. Common barriers to providing intact cord resuscitation is the availability of neonatal resuscitation equipment close to the mother, organizational readiness for change as well as attitudes and beliefs about placental transfusion within the multidisciplinary team. Hence, clinical evaluations of cord clamping practice should include implementation outcomes in order to develop strategies for optimal cord management practice.MethodsThe Sustained cord circulation And Ventilation (SAVE) study is a hybrid type I randomized controlled study combining the evaluation of clinical outcomes with implementation and health service outcomes. In phase I of the study, a method for providing in-bed intact cord resuscitation was developed, in phase II of the study the intervention was adapted to be used in multiple settings. In phase III of the study, a full-scale multicenter study will be initiated with concurrent evaluation of clinical, implementation and health service outcomes. Clinical data on neonatal outcomes will be recorded at the labor and neonatal units. Implementation outcomes will be collected from electronic surveys sent to parents as well as staff and managers within the birth and neonatal units. Descriptive and comparative statistics and regression modelling will be used for analysis. Quantitative data will be supplemented by qualitative methods using a thematic analysis with an inductive approach.DiscussionThe SAVE study enables the safe development and evaluation of a method for intact cord resuscitation in a multicenter trial. The study identifies barriers and facilitators for intact cord resuscitation. The knowledge provided from the study will be of benefit for the development of cord clamping practice in different challenging clinical settings and provide evidence for development of clinical guidelines regarding optimal cord clamping.Trial registrationClinicaltrials.gov, NCT04070560. Registered 28 August 2019.

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.

Early-life adversity is associated with poor iron status in infancy.

Exposure to early-life adversity (ELA) and iron deficiency early in life are known risk factors for suboptimal brain and socioemotional development. Iron deficiency may arise from and co-occur with ELA, which could negatively affect development. In the present study, we investigated whether ELA is associated with iron deficiency in infants receiving no iron supplementation. This study is a secondary analysis of extant data collected in the 1990s; participants were healthy infants from working-class communities in Santiago, Chile (N = 534, 45.5% female). We measured stressful life events, maternal depression, and low home support for child development during infancy and assessed iron status when the infant was 12 months old. Slightly more than half of the infants were iron-deficient (51%), and 25.8% were iron-deficient anemic at 12 months. Results indicated that ELA was associated with lower iron levels and iron deficiency at 12 months. The findings are consistent with animal and human prenatal models of stress and iron status and provide evidence of the association between postnatal ELA and iron status in humans. The findings also highlight a nutritional pathway by which ELA may impact development and present a nutritionally-focused avenue for future research on ELA and psychopathology.