Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status

Iron deficiency anemia (IDA) is still a major nutritional and public health problem in developing countries. The prevalence among young children and pregnant women is particularly high. Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy. We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren. Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi, Pakistan and were divided into two equal groups, i.e., daily and weekly supplementation groups. Hemoglobin (Hb), hematocrit (Hct), serum iron, total iron binding capacity (TIBC), and serum ferritin were determined before the start of the study. Ferrous sulfate (200 mg) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months. When post-supplementation values of the above-mentioned parameters were determined, a significant improvement was observed in all parameters in both groups. It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia. Moreover, weekly iron supplementation is cost effective and has no or fewer side-effects.     

Iron status in exclusively breast-fed infants.

The aim of this study is to evaluate the iron nutritional status of infants breast-fed exclusively and for a prolonged period in relation to their growth rate and dietary changes. Forty subjects (25 breast-fed; 15 formula-fed) were studied from 0 to 9 months of age. Milk (human or formula) was the only source of food during the first 6 months. From the sixth month onward mothers were instructed to use iron- and ascorbic acid-rich foods to supplement breast-feeding. At the ninth month, prevalence of anemia was 27.8% in the breast-fed group and 7.1% in the formula-fed group. Storage iron was absent in 27.8% of the breast-fed infants vs none of the formula-fed infants. These findings reinforce the recommendation that breast-fed infants be given supplemental iron from the fourth month of life.     

Protocolitis in exclusively breast-fed infants

We present nine exclusively breast-fed, full-term infants with mild rectal bleeding due to proctocolitis. The mean age at the onset of symptoms was 5 weeks (range 1–8 weeks). Rectosigmoidoscopic examination was performed in all the children within 2 days after admission, showing inflammatory changes such as oedematous mucosa with petechial haemorrhages. Rectal mucosal biopsy specimens, were obtained in eight cases and revealed intra-epithelial eosinophilic granulocytes in seven and a diffuse increase of eosinophils in the lamina propria in six. Allergy to cow's milk protein transferred to the infants via the breast milk was believed to be the cause of the inflammation. The intake of cow's milk protein was then restricted in seven mothers. Following this regimen, symptoms were relieved within 4 weeks in the six infants who were seen at follow up. One child recovered spontaneously without dietary restrictions. Considering the beneficial effect of the diet regimen in addition to the histological findings, allergy to cow's milk protein is possibly the aetiology of the proctocolitis seen in these nine exclusively breast-fed babies, although no challenge tests were performed to confirm this suspicion.Conclusion This report shows that proctocolitis occurs in exclusively breast-fed infants. It is speculated that allergy to cow's milk protein may have played a role in the pathogenesis.     

Impact of long-term oral iron supplementation in breast-fed infants

Objective To weigh benefits of oral iron supplements on infant’s growth against its potential hazards. Methods 248 exclusively breast-fed infants aged 4–6 months were consecutively enrolled and divided into treatment group given iron containing multivitamin (TG = 198) and control group (placebo, PG = 50) given the same multivitamin but without iron. TG is subdivided according to clinical assessment into group A (well nourished) and group B (malnourished); both were further stratified according to basal blood iron status. Assessment was done after 6 and 12 months with concurrent collection of morbidity parameters (diarrhea and fever). Data were normalized and analyzed using SPSS and Eurogrowth softwares. Results After 6 months treatment, weight and length gain was better in TG compared to placebo especially evident in anemic malnourished infants (P < 0.05, < 0.05 and < 0.01). After 12 months, the same result was obtained with the fading effect of anemia (P for anemic vs. non-anemic subgroups > 0.05). Morbidity risk was linked to immunologic background of infant; odds ratio for diarrhea and fever was higher in malnourished compared to well nourished (P < 0.05) with no special impact for basal iron (P for anemic vs. non-anemic subgroups > 0.05) or iron therapy (P for well-nourished non-anemic treatment vs PG > 0.05). Conclusion Oral iron supplementation resulted in better effects on growth velocity of breast fed infants especially those who were initially malnourished and anemic or at least iron depleted, with less marked morbidity than in iron replete infants.     

Allergic colitis in exclusively breast-fed infants

We report a case of a false negative diagnosis of HIV-1 infection in an African girl. Two HIV-1 DNA polymerase chain reaction (PCR) tests were negative at the second and fourth months of life. Because anti-HIV antibodies persisted when the patient was 18 months old, the HIV-1 RNA PCR test was performed with a positive result, confirming HIV-1 non-B subtype, recombinant A-G. The prevalence of non-B HIV-1 subtypes are increasing in Spain, which could be related to the phenomenon of immigration. Approximately one-third of HIV-infected foreigners have non-B subtypes and the percentage increases to 70 % of the African population in Spain. In non-B HIV-1 subtypes, false negative results and inconsistencies between viral load and CD4 count are more frequent. These subtypes also show a higher rate of resistance to protease inhibitors, which can have therapeutic implications.     

Hemorrhagic colitis in exclusively breast-fed infants]

INTRODUCTION: Authors report clinical, biological and endoscopic data of six children aged less 3 months with bloody stools while they were exclusively breast-fed. RESULTS: Two girls and four boys aged 1 to 2 months presented with isolated but recurrent rectal bleeding. All were explored by fiberoptic rectosigmoidoscopy between 1 and 3,2 months. Macroscopic aspects were congestion (6 cases), petechial and ecchymotic (4 cases), with normal mucosal areas (5 cases). Histopathology showed eosinophilic infiltrates in all 5 children with rectal biopsy. Evolution was satisfactory after cow's milk protein exclusion in maternal diet for five children and after weaning in 1. All children were weaned with protein hydrolysate. Cow's milk protein were later introduced without adverse reactions at 6 to 23 months. CONCLUSION: Food allergy can be considered in proctocolitis including exclusive breast-fed children. Evolution after maternal diet is, as usual, simple.     

Human milk intake and growth in exclusively breast-fed infants

Milk intake and growth in 45 exclusively breast-fed infants were documented during the first 4 months of life. Energy and protein intakes were substantially less than current nutrient allowances. Energy intake declined significantly from 110 +/- 24 kcal/kg/day at 1 month to 71 +/- 17 kcal/kg/day at 4 months. Protein intake decreased from 1.6 +/- 0.3 gm/kg/day at 1 month to 0.9 +/- 0.2 gm/kg/day at 4 months. Infant growth progressed satisfactorily, compared with National Center for Health Statistics standards. A reevaluation of energy and protein intakes and allowances during infancy is merited.     

Efficacy of twice weekly iron supplementation in anemic adolescent girls

Two hundred and forty four girls with different hemoglobin levels were selected, of which forty-one were non-anemic. The rest were graded as mildly, moderately or severely anemic and supplemented with 60 mg of iron daily or twice weekly for twelve weeks. There was no significant difference in the increase in hemoglobin levels between daily and twice weekly-supplemented subjects at the end of the study. Unpleasant side effects of supplementation were experienced by 57.8% of the daily supplemented subjects as against 5.9% of twice weekly-supplemented ones. Twice weekly supplementation could be recommended for overcoming anemia in adolescent girls.     

Iodine nutrition status of exclusively breast-fed infants and their mothers in New Delhi, India

OBJECTIVE: To assess the iodine nutrition status of exclusively breast-fed infants and their mothers. HYPOTHESIS: In the presence of environmental and maternal iodine deficiency, an exclusively breast-fed baby is likely to receive a suboptimal iodine supply during the period of rapid brain growth. METHODS: Spot urinary iodine (UI) and serum TSH levels were measured in 175 healthy, exclusively breast-fed infants and their mothers. Iodine content of salt used by participants for domestic consumption was also analyzed. RESULTS: The median UI levels in mothers and infants was 124 microg/l and 162 microg/l, respectively. 34% of mothers and 21% of infants had UI levels <100 microg/l indicating iodine deficiency. Serum TSH was elevated in 29% of mothers and 2% of infants. No correlation was observed between individual mother-infant UI or serum TSH levels (r = -0.036, r = -0.1 for UI excretion and serum TSH, respectively). 96% of the salt samples tested had adequate iodine concentration, i.e. >15 ppm. CONCLUSION: The present study demonstrated significant iodine deficiency in both mothers and infants despite consumption of adequately iodized salt. The iodine nutrition status of the infants was better compared to the mothers, indicating a preferential iodine supply to the infants over the mothers.     

Incidence of dehydration and hypernatremia in exclusively breast-fed infants.

OBJECTIVES: To verify in exclusively breast-fed, term infants the incidence of hypernatremic dehydration and identify possible maternal and/or infant factors that interfere with successful breast-feeding. STUDY DESIGN: We prospectively included all healthy breast-fed neonates referred to our Neonatology Unit between October 1999 and March 2000. All neonates with a weight loss > or = 10% of birth weight had a breast-feeding test and a determination of serum sodium, urea, and base excess. Student t test and chi-square test were used for statistical analysis of the data. RESULTS: Of 686 neonates, 53 (7.7%) had a weight loss > or = 10% of the birth weight, and 19 also had hypernatremia. These 53 neonates had a significantly higher incidence of caesarean delivery and lower maternal education than neonates with a weight loss < 10%. CONCLUSION: Our prospective study demonstrates that a weight loss > or = 10% during the first days of life is frequent. Daily weight evaluation, careful breast-feeding assessment, and early routine postpartum follow-up are effective methods to prevent hypernatremic dehydration and promote breast-feeding.     

Early onset of hypernatraemic dehydration and fever in exclusively breast-fed infants

Five cases of moderately severe hypernatraemic dehydration were identified within a 5-month period between two regional hospitals in Hong Kong. Unlike previous reported cases, these exclusively breast-fed infants presented with the unusual triad of fever, absence of overt signs of dehydration and within the first week of life. Three of the cases also had high serum bilirubin concentrations at presentation. The fever subsided quickly and the serum bilirubin concentration fell rapidly within a few hours of rehydration. All infants made an uneventful recovery without permanent neurological sequelae. Fever, presumably secondary to dehydration, is an useful early warning sign. These cases emphasize the importance of early and regular measurement of bodyweight in exclusively breast-fed infants so that prompt identification of affected cases may prevent potentially detrimental complications.     

Serum zinc concentration in exclusively breast-fed infants and in infants fed an adapted formula

Serum zinc concentrations have been determined in 28 healthy full-term Italian infants of both sexes at birth, as well as at 3 and at 5 months of age. Fourteen exclusively breast-fed infants who served as a control group were compared with 14 infants fed a cow's milk based adapted infant formula. No significant differences in serum zinc concentration between the breast-fed and the bottle-fed group became apparent during the study. The results of this study suggest a similar zinc nutriture in both groups. The availability of zinc from the adapted infant formula was not significatly different from that of human milk. These findings may be explained by the composition of the adapted formula tested, e.g. by a protein composition fairly close to that of human milk, by the presence of zinc derived from the natural ingredients only, by the low Fe/Zn ratio and by the elevated citrate content.     

Iron status in breast-fed full-term infants

The aim of this study was to evaluate the iron status of full-term babies breast-fed exclusively for four months and the importance of iron supplementation. One hundred sixteen term infants followed up since the newborn period by a well baby clinic were included in the study. Iron deficient and/or anemic infants were excluded from the study at four months. Some of the infants (51) were later given appropriate complementary food besides breast-feeding (Group A) and some (42) were given ferrous sulfate (1 mg/kg/d) (Group B). Blood count and serum iron and ferritin measurements were done at four and six months of age. At the 4th month, iron deficiency was found in 23 (19.8%) infants, 11 of which had iron deficiency anemia. At the 6th month, 23 (45%) infants in Group A were iron deficient and 11 (21.6%) of them had iron deficiency anemia. In Group B, three (7.1%) infants were iron deficient and one (2.4%) of them also had iron deficiency anemia (p < 0.0001). Significant iron deficiency and iron deficiency anemia have been found in four-month-old exclusively breast-fed full-term infants. It is observed that complementary food alone is insufficient; there is need for iron supplementation.     

Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants

The relationship between serum 25-hydroxyvitamin D (25-OHD) concentrations and sunshine exposure in 61 term, exclusively breast-fed infants younger than 6 months of age was investigated. Sunshine exposure was quantitated using a sunshine and clothing diary, which was verified by infant-adapted ultraviolet dosimetry. By multiple regression techniques, infant serum 25-OHD concentrations were significantly related to UV exposure and maternal serum 25-OHD concentrations. Infant 25-OHD concentrations correlated with sunshine exposure in infants whose mothers had low (less than 35 ng/ml) or high (greater than 35 ng/ml) serum concentrations of 25-OHD (r = 0.70, P less than 0.001 and r = 0.53, P = 0.004, respectively). Estimates were made to determine sunshine exposure conditions necessary to maintain serum 25-OHD concentrations above the lower limit of the normal range (11 ng/ml). A conservative estimate would be 30 minutes per week wearing only a diaper or 2 hours a week fully clothed without a hat.     

Vitamin E supplementation in exclusively breastfed VLBW infants

We conducted this study to evaluate the adequacy of breastmilk as a source of vitamin E in exclusively breastfed VLBW infants. Such infants (n=44) were randomly allotted to receive vitamin E supplementation (n = 23); the rest (n = 21) did not receive vitamin E. After 21 days, the vitamin E level in the supplemented group was 0.78 ± 0.26 mg/dL as compared to 0.77 ± 0.25 mg/dL in the unsupplemented group (P=0.69). The ratio of Vitamin E to lipids was also comparable in the two groups, (P=0.65). We concluded that vitamin E supplementation is not routinely needed in VLBW infants.