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Iron supplements reduce the risk of iron deficiency anemia in marginally low birth weight infants
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Department of Women and Child Health, Division of Neonatology, Karolinska Institute, Stockholm, Sweden.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
2010 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 126, no 4, e874-e883 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Low birth weight infants are at risk for iron deficiency (ID). Most LBW infants have marginally low birth weight (MLBW, 2000–2500 g) and it is not known whether they benefit from iron supplements. The objective of this trial was to study the effects of iron supplementation in MLBW infants.

METHOD: In a randomized controlled trial, we assigned 285 healthy, MLBW infants to receive iron supplements at a dose of 0 (placebo), 1, or 2 mg/kg per day between 6 weeks and 6 months of age. Hemoglobin levels, ferritin levels, transferrin saturation, mean cell volume, and transferrin receptor levels were analyzed at 6 months. Growth and morbidity were monitored.

RESULTS: Iron supplementation resulted in significant dose-dependent effects on hemoglobin and all iron status indicators at 6 months. The prevalence of ID at 6 months was 36% in the placebo group, 8.2% in the 1 mg/kg per day group, and 3.8% in the 2 mg/kg per day group (P < .001). The prevalence rates of ID anemia (IDA) were 9.9%, 2.7%, and 0%, respectively (P = .004). Among infants who were exclusively breastfed at 6 weeks, the prevalence of IDA was 18% in the placebo group. There were no significant differences between groups in growth or morbidity.

CONCLUSIONS: MLBW infants have relatively high risks of ID and IDA, especially if they are breastfed. Iron supplementation at 2 mg/kg per day from 6 weeks to 6 months reduces this risk effectively, with no short-term adverse effects on morbidity or growth.

Place, publisher, year, edition, pages
American Academy of Pediatrics , 2010. Vol. 126, no 4, e874-e883 p.
Keyword [en]
low birth weight, iron deficiency, iron deficiency anemia, preterm, small for gestational age, randomized controlled trial, morbidity, growth, adverse effect
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-38499DOI: 10.1542/peds.2009-3624ISI: 000282526100015PubMedID: 20819898OAI: oai:DiVA.org:umu-38499DiVA: diva2:378373
Available from: 2010-12-15 Created: 2010-12-15 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Effects of iron supplementation on iron status, health and neurological development in marginally low birth weight infants.
Open this publication in new window or tab >>Effects of iron supplementation on iron status, health and neurological development in marginally low birth weight infants.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Due to small iron stores and rapid growth during the first months of life, infants with low birth weight (LBW) are at risk of iron deficiency (ID). ID in infancy is associated with irreversible impaired neurodevelopment. Preventive iron supplementation may reduce the risk of ID and benefit neurodevelopment, but there is also a possible risk of adverse effects. More than 50% of all LBW infants are born with marginally LBW (MLBW, 2000-2500g), and it is not known if they benefit from iron supplementation.

Methods We randomized 285 healthy, Swedish, MLBW infants to receive 3 different doses of oral iron supplements; 0 (Placebo), 1, and 2 mg/kg/day from six weeks to six months of age. Iron status, during and after the intervention was assessed and so was the prevalence of ID and ID anemia (IDA), growth, morbidity and the interplay with iron and the erythropoetic hormones hepcidin and erythropoietin (EPO). As a proxy for conduction speed in the developing brain, auditory brainstem response (ABR) was analyzed at six months. In a follow up at 3.5 years of age, the children were assessed with a cognitive test (WPPSI-III) and a validated parental checklist of behavioral problems (CBCL), and compared to a matched reference group of 95 children born with normal birth weight.

Results At six months of age, the prevalence of ID and IDA was significantly higher in the placebo group compared to the iron supplemented infants. 36% had ID in the placebo group, compared to 8% and 4 % in the 1 and 2mg/kg/day-groups, respectively. The prevalence of IDA was 10%, 3% and 0%, respectively. ABR-latencies did not correlate with the iron intake and was not increased in infants with ID or IDA. ABR wave V latencies were similar in all three groups. Hepcidin correlated to ferritin and increased in supplemented infants while EPO, which was negatively correlated to iron status indicators, decreased. At follow up there were no differences in cognitive scores between the groups but the prevalence of behavioral problems was significantly higher in the placebo group compared to those supplemented and to controls. The relative risk increase of CBCL-scores above a validated cutoff was 4.5 (1.4 – 14.2) in the placebo-group compared to supplemented children. There was no detected difference in growth or morbidity at any age.

Conclusion MLBW infants are at risk of ID in infancy and behavioral problems at 3 years of age. Iron supplementation at a dose of 1-2 mg/kg/day from six weeks to six months of age reduces the risks with no adverse effects, suggesting both short and long term benefit. MLBW infants should be included in general iron supplementation programs during their first six months of life.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2012. 75 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1481
Keyword
Auditory brainstem response, behavior, breast feeding, cognition, erythropoietin, ferritin, growth, hemoglobin, hepcidin, human infant, iron, iron deficiency, iron deficiency anemia, iron status, iron supplementation, low birth weight, morbidity, neurodevelopment, nutritional requirements, randomized controlled trial
National Category
Clinical Medicine Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-52079 (URN)978-91-7459-371-6 (ISBN)
Public defence
NUS 6A–L - Biomedicinhuset, Sal E04 (byggnad R1), Umeå Universitetssjukhus, Umeå (English)
Opponent
Supervisors
Available from: 2012-02-10 Created: 2012-02-09 Last updated: 2012-02-09Bibliographically approved

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Berglund, StaffanDomellöf, Magnus

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