Iron Supplementation In Infants Research Articles

Iron Supplementation in Infancy: Which Preparation and at What age to Begin?

Iron Supplementation in Infancy: Which Preparation and at What age to Begin?

Scientific opinion on the tolerable upper intake level for iron.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the tolerable upper intake level (UL) for iron. Systematic reviews were conducted to identify evidence regarding high iron intakes and risk of chronic diseases, adverse gastrointestinal effects and adverse effects of iron supplementation in infancy, young childhood and pregnancy. It is established that systemic iron overload leads to organ toxicity, but no UL could be established. The only indicator for which a dose-response could be established was black stools, which reflect the presence of large amounts of unabsorbed iron in the gut. This is a conservative endpoint among the chain of events that may lead to systemic iron overload but is not adverse per se. Based on interventions in which black stools did not occur at supplemental iron intakes of 20-25 mg/day (added to a background intake of 15 mg/day), a safe level of intake for iron of 40 mg/day for adults (including pregnant and lactating women) was established. Using allometric scaling (body weight0.75), this value was scaled down to children and adolescents and safe levels of intakes between 10 mg/day (1-3 years) and 35 mg/day (15-17 years) were derived. For infants 7-11 months of age who have a higher iron requirement than young children, allometric scaling was applied to the supplemental iron intakes (i.e. 25 mg/day) and resulted in a safe level of supplemental iron intake of 5 mg/day. This value was extended to 4-6 month-old infants and refers to iron intakes from fortified foods and food supplements, not from infant and follow-on formulae. The application of the safe level of intake is more limited than a UL because the intake level at which the risk of adverse effects starts to increase is not defined.

Role of low dose iron intake on acute respiratory tract infection in infants: A longitudinal study

Background: Anaemia and respiratory tract infections are common problems among infants and a complex relationship exists between iron status and infection. Studies on possible role of iron supplementation to prevent respiratory tract infection in healthy infants are needed so that strategies could be made at the community level to reduce its burden. Objectives: To study the effect of iron intake on the incidence of acute respiratory infection (ARI) in healthy infants. Method: A longitudinal study was done in 106 infants at the paediatric department of a teaching hospital, in which infants coming for routine vaccination with haemoglobin levels ≥10g/dl were divided into two groups after computer generated randomization. Group A received 2mg/kg/day of iron for 3 months and Group B received no supplementation. Episodes of respiratory tract infection were recorded. Follow up was done at 4, 8 and 12 weeks and at 6 months for new episodes of ARI. Growth was monitored. Data were analysed using Mann-Whitney U test, Chi square test and Student ‘t’ test via SPSS version 20.0. Results: After 6 months of follow up, mean haemoglobin in the iron supplemented group (12.76±0.63g/dl) was significantly higher than in the non-supplemental group (11.29±0.98g/dl) (p<0.001), when the baseline haemoglobin levels in both groups were comparable. The incidence of ARI was 66% lower in the iron supplemented group compared with the group with no supplementation (IRR=0.34, 95%CI=0.19-0.59, p=0.0001) Conclusions: Iron supplementation in infants improves their haemoglobin status and decreases episodes of ARI in them.

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

Daily and Weekly Iron Supplementations to Improve Iron Status in Infants: A Randomized Controlled Trial

Background: Iron deficiency anemia screening and iron supplementation in infants aged 6 to12 months are recommended in the Guideline in Child Health Supervision. Objective: To evaluate the effectiveness of weekly iron supplementation compared with daily supplementation in improving the iron status in infants. Materials and Methods: A single-blind randomized controlled trial was conducted in infants aged 6 months visiting the Well Child Clinic between May 2019 and November 2020 at Burapha University Hospital, Chonburi, Thailand. The intervention consisted of either daily or weekly iron supplementation combined with iron-rich complementary food promotion for six months. The outcomes were the differences of serum ferritin and hematological variables before and after being iron supplemented. Results: Sixty-nine of the six-month-old healthy infants were randomized to receive either 10 mg Fe/day as the daily group or 30 mg Fe/week as the weekly group. Forty-five infants with 24 in the daily group and 21 in the weekly group completed the intervention. After the six-month period of iron supplementation, the average differences of serum ferritin in the daily and the weekly group were 10.85 (–13.19, 34.49) and –9.31 (–23.86, –2.30) ng/mL, respectively (p=0.012). The average differences of hemoglobin in the daily and the weekly group were 0.58±0.82 and 0.08±0.59 g/dL, respectively (95% CI 0.06 to 0.93; p=0.026). Conclusion: Daily iron supplementation of 10 mg/day is more effective than 30 mg weekly iron supplementation in improving iron status and hemoglobin level in the Thai infants. Keywords: Anemia; Ferritin; Infants; Iron deficiency; Iron supplementation

Enteral Iron Supplementation in Infants Born Extremely Preterm and its Positive Correlation with Neurodevelopment; Post Hoc Analysis of the Preterm Erythropoietin Neuroprotection Trial Randomized Controlled Trial

To test whether an increased iron dose is associated with improved neurodevelopment as assessed by the Bayley Scales of Infant Development, third edition (BSID-III) among infants enrolled in the Preterm Erythropoietin (Epo) Neuroprotection Trial (PENUT). This is a post hoc analysis of a randomized trial that enrolled infants born at 24-28 completed weeks of gestation. All infants in PENUT who were assessed with BSID-III at 2years were included in this study. The associations between enteral iron dose at 60 and 90days and BSID-III component scores were evaluated using generalized estimating equations models adjusted for potential confounders. In total, 692 infants were analyzed (355 placebo, 337 Epo). Enteral iron supplementation ranged from 0 to 14.7mg/kg/d (IQR 2.1-5.8mg/kg/d) at day 60, with a mean of 3.6mg/kg/d in infants treated with placebo and 4.8mg/kg/d in infants treated with Epo. A significant positive association was seen between BSID-III cognitive scores and iron dose at 60days, with an effect size of 0.77 BSID points per 50mg/kg increase in cumulative iron dose (P=.03). Greater iron doses were associated with greater motor and language scores but did not reach statistical significance. Results at 90days were not significant. The effect size in the infants treated with Epo compared with placebo was consistently greater. A positive association was seen between iron dose at 60days and cognitive outcomes. Our results suggest that increased iron supplementation in infants born preterm, at the doses administered in the PENUT Trial, may have positive neurodevelopmental effects, particularly in infants treated with Epo. Clinicaltrials.gov: NCT01378273.

Early iron supplementation and iron sufficiency at one month of age in NICU patients at-risk for iron deficiency

In order to reduce iron deficiency in neonates at-risk for iron deficiency, we implemented a guideline to increase the consistency of early iron supplementation in infants of diabetic mothers, small for gestational age neonates and very low birthweight premature neonates. Three years following implementation we performed a retrospective analysis in order to assess adherence to the guideline and to compare timing of early iron supplementation and reticulocyte-hemoglobin (RET-He) values at one month of life in at-risk infants. Adherence with early iron supplementation guidelines was 73.4% (399/543) with 51% (275/543) having RET-He values obtained at one month. Despite good adherence, 16% (44/275) had RET-He <25 pg (5th percentile for gestational age). No infants receiving red blood cell transfusion (0/20) had RET-He <25 pg vs. 26.1% (40/153) of those treated with darbepoetin (p < 0.001). There was no evidence of increased feeding intolerance (episodes of emesis/day) with early iron supplementation.

Iron deficiency in healthy 18-month-old Danish children is associated with no oral iron supplementation in infancy and prolonged exclusive breast-feeding.

Fe deficiency (ID) defined as plasma ferritin <12 µg/l is associated with delayed cognitive development in early childhood and increased incidence of infections; however, the longitudinal association between early-life factors and ID in 18-month-old children in Denmark is unknown. The present study aimed to determine the prevalence of ID and to describe risk factors associated with ID in healthy 18-month-old Danish children. Blood samples, anthropometric measurements and self-reported questionnaire data had been obtained in the birth cohort, Odense Child Cohort. The questionnaires were modified from those used in the Danish National Birth Cohort. Plasma ferritin and C-reactive protein in venous, non-fasting samples were analysed in the final sample size of 370 children after exclusion of seventy-nine children due to chronic disease, acute infection, C-reactive protein >10 mg/l, twin birth or prematurity. Associations with ID were analysed by logistic regression, adjusting for sex, maternal education, duration of partial breast-feeding and current intake of milk, fish and meat. Overall, fifty-six children had ID (15·1 %). Factors associated with increased risk were exclusive breast-feeding beyond 4 months (OR 5·97; 95 % CI 1·63, 21·86) and no intake of oral Fe supplements from 6 to 12 months (OR 3·99, 95 % CI 1·33, 11·97. Duration of partial breast-feeding and current diet was not associated with ID. In conclusion, the ID prevalence was 15·1 %, and both exclusive breast-feeding beyond 4 months and no intake of oral Fe supplements from 6 to 12 months were associated with increased risk of ID in 18-month-old children.

Exclusive Cow’s milk intake and asymptomatic Anaemia

It is a strong tradition to introduce cow’s milk (CM) early in infancy. There are reports of various deleterious health effects of CM in infancy. We describe an asymptomatic, well-thriving infant who was exclusively fed with CM and had severe iron deficiency anemia. An eleven-months-old infant during the consultation for fever was found to have severe pallor. Except for systolic murmur, she had a normal systemic examination. Hemoglobin was 2.2 gm/dl, her RBC count, volume and hemoglobin concentration were low. Iron studies done showed a severe iron deficiency state. She was given packed cell transfusions; iron supplements were initiated. Introduction of complementary foods rich in iron is imperative as iron stores begin to deplete at four to six months of age. Initiation of CM early in infant feeding can lead to very severe anemia which can be mitigated by CM fortification, iron supplementation in infants.

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years

To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formula or low-iron formula as part of an iron deficiency anemia prevention trial. Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5days, chronic illness, or iron deficiency anemia at 6months. Six-month-old infants were randomized to iron-fortified (12mg/L) or low-iron (2.3mg/L) formula for 6months. At 16years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group. At the follow-up assessment, the 405 participants averaged 16.2years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high. Adolescents who received iron-fortified formula as infants from 6 to 12months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear. Clinicaltrials.gov: NCT01166451.

Infant Iron Deficiency and Iron Supplementation Predict Adolescent Internalizing, Externalizing, and Social Problems

To evaluate associations between iron supplementation and iron deficiency in infancy and internalizing, externalizing, and social problems in adolescence. The study is a follow-up of infants as adolescents from working-class communities around Santiago, Chile who participated in a preventive trial of iron supplementation at 6 months of age. Inclusionary criteria included birth weight ≥3.0 kg, healthy singleton term birth, vaginal delivery, and a stable caregiver. Iron status was assessed at 12 and 18 months of age. At 11-17 years of age, internalizing, externalizing, and social problems were reported by 1018 adolescents with the Youth Self Report and by parents with the Child Behavior Checklist. Adolescents who received iron supplementation in infancy had greater self-reported attention-deficit/hyperactivity disorder but lower parent-reported conduct disorder symptoms than those who did not (Ps < .05). Iron deficiency with or without anemia at 12 or 18 months of age predicted greater adolescent behavior problems compared with iron sufficiency: more adolescent-reported anxiety and social problems, and parent-reported social, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, oppositional defiant, conduct, aggression, and rule breaking problems (Ps < .05). The threshold was iron deficiency with or without anemia for each of these outcomes. Iron deficiency with or without anemia in infancy was associated with increased internalizing, externalizing, and social problems in adolescence.

Neurological effects of iron supplementation in infancy: finding the balance between health and harm in iron-replete infants

Iron mediates many biochemical processes in neural networks that proliferate during brain development. Insufficient iron causes irreversible neurodevelopmental deficits, and most high-income countries recommend that infants older than 4-6 months receive additional iron via food fortification or supplementation to prevent iron-deficiency anaemia. Now that the prevalence of iron-deficiency anaemia in children has decreased to less than 10% in most developed countries, concerns that the recommended intakes far exceed those required to prevent iron-deficiency anaemia have been raised, and emerging evidence suggests that iron overexposure could be linked to adverse outcomes later in life. In this Viewpoint, we discuss the importance of iron for neurodevelopment, investigate the biochemical markers used to assess iron stores, summarise the disparity in public health policies among high-income countries, and discuss the potential association between iron overexposure and adverse neurological outcomes later in life. We present a case for new studies to establish the optimal amount of iron that both prevents deficiency and reduces the potential risk of long-term negative health outcomes.

Lower systolic blood pressure at age 7 y in low-birth-weight children who received iron supplements in infancy: results from a randomized controlled trial

Background: Low birth weight (LBW) (≤2500 g) is associated with iron deficiency in infancy and high blood pressure (BP) later in life.Objective: We investigated the effect of iron supplementation that was given to LBW infants on midchildhood BP.Design: The study was a randomized, double-blind, controlled trial that included 285 marginally LBW (2000-2500-g) infants at 2 Swedish centers between May 2004 and November 2007. The infants were randomly assigned to receive a placebo or 1 or 2 mg Fe · kg-1 · d-1 from 6 wk to 6 mo of age. In secondary analyses at the age of 7 y, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the prevalence of children with BP within the hypertensive range (>90th percentile) were compared between the groups.Results: BP was analyzed via intention to treat in 189 children (66%). The mean ± SD SBP was 103 ± 8.1, 101 ± 7.5, and 101 ± 7.8 mm Hg in children who had received the placebo (n = 70), 1 mg Fe · kg-1 · d-1 (n = 54), or 2 mg Fe · kg-1 · d-1 (n = 65), respectively. When the iron-supplemented groups were combined in covariate-adjusted analyses, the mean SBP in LBW children who had received iron supplementation in infancy was 2.2 mm Hg (95% CI: 0.3, 4.2 mm Hg) lower than in those who were unsupplemented (P = 0.026). Multivariate logistic regression showed that iron supplementation in infancy reduced the odds of having an SBP within the hypertensive range at 7 y of age (OR: 0.32; 95% CI: 0.11, 0.96). For DBP, there were no significant differences between the intervention groups.Conclusions: LBW children who receive iron supplementation (1 or 2 mg Fe · kg-1 · d-1) in infancy have lower SBP at 7 y. This (to our knowledge) novel observation suggests that the increased risk of hypertension that is observed in children and adults who are born small might be reduced with early micronutrient interventions. This trial was registered at clinicaltrials.gov as NCT00558454.

Iron Supplements for Infants at Risk for Iron Deficiency.

Professional societies have published recommendations for iron dosing of preterm neonates, but differences exist between guidelines. To help develop standardized guidelines, we performed a 10-year analysis of iron dosing in groups at risk for iron deficiency: IDM (infants of diabetic mothers), SGA (small for gestational age), and VLBW premature neonates (very low birth weight, <1500 g). We analyzed iron dosing after red cell transfusions and erythropoiesis-stimulating agents (ESA). Of IDM, 11.8% received iron in the hospital; 9.8% of SGA and 27.1% of VLBW neonates received iron. Twenty percent of those who received iron had it started by day 14; 63% by 1 month. Supplemental iron was stopped after red cell transfusions in 73% of neonates receiving iron. An ESA was administered to 1677, of which 33% received iron within 3 days. This marked variation indicates that a consistent approach is needed, and using this report and a literature review, we standardized our iron-dosing guidelines.

Iron deficiency among apparently healthy children aged 6 to 24 months in Ibadan, Nigeria

ABSTRACTIron deficiency remains a global public health challenge, with a higher burden in children in the tropics. When it occurs early in life, it may have long-term effects on neurodevelopment. The aims of this study were to assess the iron status of children aged 6–24 months, to determine the prevalence of iron deficiency and its associated factors in Ibadan, Nigeria. The authors conducted a cross-sectional study between March and June 2014. A total of 202 apparently healthy children aged between 6 and 24 months attending 2 major immunization clinics in Ibadan were included. A questionnaire was used to collect information on sociodemographic characteristics, pregnancy and birth history, and nutritional history. Physical examination was carried out on all the subjects, and serum ferritin level was determined using an enzyme-linked immunosorbent assay (ELISA) technique. Iron deficiency was defined using a cutoff value of <30 µg/L. Fifty-nine children (29.2%) had iron deficiency. No clinical features were found to be significantly associated with iron deficiency. Iron deficiency was associated with breastfeeding (P = .020) and younger age (P = .015) in the study population. One hundred and forty-three (70.8%) of the study participants had anemia, and 39 (19.3%) had iron deficiency anemia. The prevalence of iron deficiency among apparently healthy children aged 6–24 months in Ibadan, Nigeria, is high. There is the need for a national policy on routine screening for iron deficiency and iron supplementation for infants and young children as recommended by the World Health Organization.

Iron Supplementation in Pregnancy or Infancy and Motor Development: A Randomized Controlled Trial.

Insufficient iron levels for optimal fetal and infant development is a concern during pregnancy and infancy. The goal of this study was to assess the effects of iron supplementation in pregnancy and/or infancy on motor development at 9 months. The study was a randomized controlled trial (RCT) of infancy iron supplementation linked to an RCT of pregnancy iron supplementation, conducted in Hebei, China. A total of 1482 infants were randomly assigned to receive placebo (n = 730) or supplemental iron (n = 752) from 6 weeks to 9 months. Gross motor development (assessed by using the Peabody Developmental Motor Scale, Second Edition, instrument) was the primary outcome. Neurologic integrity and motor quality were secondary outcomes. Motor outcome was available for 1196 infants, divided into 4 supplementation period groups: (1) placebo in pregnancy/placebo in infancy (n = 288); (2) placebo in pregnancy/iron in infancy (n = 305); (3) iron in pregnancy/placebo in infancy (n = 298); and (4) iron in pregnancy/iron in infancy (n = 305). Using the Peabody Developmental Motor Scale, instrument, iron supplementation in infancy but not pregnancy improved gross motor scores: overall, P < .001; reflexes, P = .03; stationary, P < .001; and locomotion, P < .001. Iron supplementation in infancy improved motor scores by 0.3 SD compared with no supplementation or supplementation during pregnancy alone. Effects of iron supplementation in infancy alone were similar to effects with iron in both pregnancy and infancy. The RCT design supports the causal inference that iron supplementation in infancy, with or without iron supplementation in pregnancy, improved gross motor test scores at 9 months.

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

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

Effects of prenatal and/or postnatal supplementation with iron, PUFA or folic acid on neurodevelopment: update.

Neurodevelopment has been linked, among other factors, to maternal and early infant diets. The objective of this review, which is part of the NUTRIMENTHE research project 'The effect of diet on the mental performance of children' (www.nutrimenthe.com), was to update current evidence on the effects of nutritional interventions such as iron, folic acid or n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation during pregnancy and/or in early life on the mental performance and psychomotor development of children. In May 2014, we searched MEDLINE and The Cochrane Database of Systematic Reviews for relevant studies published since 2009. The limited updated evidence suggests that iron supplementation of infants may positively influence the psychomotor development of children, although it does not seem to alter their mental development or behaviour. The use of multivitamin-containing folic acid supplements during pregnancy did not benefit the mental performance of the offspring. Evidence from randomised controlled trials (RCT) did not show a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on childhood cognitive and visual development. Caution is needed when interpreting current evidence, as many of the included trials had methodological limitations such as small sample sizes, high attrition rates, and no intention-to-treat analyses. Taken together, the evidence is still inconclusive. Large, high-quality RCT to assess the effects of supplementation with iron, LCPUFA or folic acid are still needed to further clarify the effects of these, and other nutrients, on neurodevelopment. Recent recommendations from scientific societies are briefly presented.

Effect of Iron Supplementation in the Prevention of Anemia Associated with Malaria in Children Aged 6 to 59 Months in Bakperou (Benin) in 2013

Introduction: Anemia is a largely widespread public health issue, with major consequences on human health and the economic and social development. Objective: To determine the effect of iron supplementation in the prevention of anemia in children aged 6 to 59 months having malaria in the village of Bakperou (Benin) in 2013. Setting and methods: It was an interventional study carried out in two phases in a village of Parakou (Bakperou) from 15 may to 30 September, 2013. A descriptive phase including 236 children among whom 70, divided into two groups of 35 each, were selected for the experimental phase. One group had received an iron supplementation of 2mg/ kg/day during a period of two months. The second group had not received any supplementation. Results: The mean age of the included children was 33.2 ± 13.5 months. In the supplemented children, the mean age was 32.0 ± 13.1 months for 34.5 ± 13.9 in the non- supplemented ones. The most represented sex was the female (63.3%). Sex ratio was 0.6. In the supplemented ones, female percentage was 56.7% and 66.7% 9 in the non- supplemented. The incidence of malaria was 63.3% IC95% [49.9% - 75.4%]. In the supplemented children, incidence of anemia in children having malaria was 43.3% IC95% [25.5% - 62.6%] and 73.3% IC95% [25.5% - 62.6%] in the non- supplemented. The non-supplemented children ran twice more risk of having anemia with malaria than supplemented ones (p < 0.05). Conclusion: Iron supplementation of infants and children in the village of Bakperou (Parakou) proved to be efficient and enable to implement a supplementation program in order to reduce anemia associated with malaria in children.

PROPHYLAXIS OF IRON DEFICIENCY ANEMIA IN INFANTS AND TODLLERS: A MULTIDISCIPLINARY APPROACH (LITERATURE REVIEW)

Iron deficiency is one of the most common micronutrient deficiency in infancy and childhood. The main long lasting effect of iron deficiency anemia in infancy is poor neurocognitive development. Despite early treatment with iron supplements, lower cognitive performance remains even after reaching adulthood. Therefore iron deficiency anemia should be regarded not only as a haematological problem, but as a result of imperfections in the social system. Preventive strategies occupie most important place ensuring the normal development of the child. The main recommendations regarding iron deficiency prophylaxis are as follows: delayed umbilical cord clamping, exclusive breastfeeding until 6 months of age, iron fortified formula for non-breastfed infants, iron supplements for infants with risk factors, complementary feeding starting at 6 months of age, avoiding cow‘s milk until 12 months of age and restriction of intake to less than 500 ml per day for toddlers. The article analyzes iron deficiency impact on the development of central nervous system, the characteristics of iron homeostasis in children, iron deficiency anemia causes and pathophysiological mechanisms. Based on the latest scientific literature iron deficiency prevention strategies and practical recommendations are provided.