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Effects of iron supplementation on auditory brainstem response in marginally LBW infants
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Department of Women and Child Health, Karolinska Institute, SE-182 88 Stockholm, Sweden.
Department of Audiology, Karolinska Hospital, SE-171 76 Stockholm, Sweden.
Department of Audiology, Karolinska Hospital, SE-171 76 Stockholm, Sweden.
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2011 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 70, no 6, 601-606 p.Article in journal (Refereed) Published
Abstract [en]

LBW infants are at risk of iron deficiency (ID), which is associated with impaired nervous system development and may lead to prolonged auditory brainstem response (ABR) latencies. We hypothesized that iron supplementation shortens ABR latencies in marginally LBW (MLBW, 2000-2500 g) infants. In a randomized, controlled trial, 285 healthy MLBW infants received 0, 1, or 2 mg iron/kg/d of iron supplements from 6 wk to 6 mo of age. ABR absolute wave V latencies and central conduction time (CCT) were measured at the endpoint. There were no significant differences between groups in ABR wave V latencies (n = 218). Furthermore, there were no significantly prolonged ABR latencies in infants with ID (n = 32). CCT was significantly higher in the 2 mg group than in the placebo group (n = 126). However, there were no significant correlations between CCT and iron intake or any iron status variable, suggesting that differences in CCT were not caused by iron. We conclude that iron supplements did not improve ABR latencies, and iron-deficient MLBW infants did not have impaired ABR latencies at 6 mo, suggesting that ABR is not a sensitive measure of impaired neurological development or that mild/moderate ID causes no such impairment in MLBW infants.

Place, publisher, year, edition, pages
Baltimore: International Pediatrics Research Foundation, Inc , 2011. Vol. 70, no 6, 601-606 p.
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-50927DOI: 10.1203/PDR.0b013e3182320cd0ISI: 000297433900010OAI: oai:DiVA.org:umu-50927DiVA: diva2:479571
Funder
Formas, 222-2005-1894
Note
Supported by grants from the Swedish Research Council Formas 222-2005-1894, Västerbotten County Council (ALF), the Jerring foundation, the Oskar foundation, and the Medical Faculty, Umeå University. The iron drops were provided from Astra Zeneca, Sweden.Available from: 2012-01-18 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically 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)
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Available from: 2012-02-10 Created: 2012-02-09 Last updated: 2012-02-09Bibliographically approved

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