Milk versus medicine for the treatment of iron deficiency anaemia in hospitalised infants

Aims: To compare iron fortified follow-on milk (iron follow-on), iron fortified partially modified cows'' milk (iron milk), and iron medicine for the treatment of iron deficiency anaemia (IDA) in hospitalised infants. Methods: In a randomised controlled trial, infants aged 9–23 months with IDA and who were hospitalised with an acute illness received iron follow-on (12 mg/l ferrous iron), iron milk (12.9 mg/l ferrous iron), or iron medicine (ferrous gluconate at 3 mg/kg of elemental iron once daily). All interventions were given for three months. Changes in measures of iron status three months after hospital discharge were determined. Results: A total of 234 infants were randomised. Iron status was measured at follow up in 59 (70%) iron medicine, 49 (66%) iron follow-on, and 54 (70%) iron milk treated infants. There was a significant (mean, 95% CI) increase in haemoglobin (15 g/l, 13 to 16) and iron saturation (9%, 8 to 10) and decrease in ferritin (–53 µg/l, –74 to –31) in all three groups. Mean cell volume increased in iron follow-on (2 fl, 1 to 3) and iron milk (1 fl, 0.1 to 3) treated infants, but not in the iron medicine group (1 fl, –1 to 2). The proportion with IDA decreased in all three groups: iron medicine 93% to 7%, iron follow-on 83% to 8%, and iron milk 96% to 30%. Adverse effects, primarily gastrointestinal, occurred in 23% of the iron medicine, 14% of the iron follow-on, and 13% of the iron milk group. Conclusions: Iron fortified follow-on milk, iron fortified partially modified cows'' milk, and iron medicine all effectively treat IDA in infancy.     

Dietary education and iron deficiency anaemia in the inner city

Accepted 26 October 1996
OBJECTIVES—To assess if a dietary health education programme could be used within existing health resources to reduce the incidence of iron deficiency anaemia in an inner city population.
DESIGN—Prospective cohort study.
SETTING—Inner city areas of west and south Birmingham.
SUBJECTS—A total of 1000 children recorded on the child health computer register.
INTERVENTION—Children were recruited at birth and randomised into control and intervention groups. Families in the intervention group received specific health education information at key ages by face to face contact using a range of materials. The control group received standard health education as delivered by the health visitors at the time.
MAIN OUTCOME MEASURES—Haemoglobin estimation and iron content of the diet at 18 months of age.
RESULTS—A total of 455 children completed the study. Sixty nine (27%) of the control group and 55 (28%) of the intervention group were anaemic as defined by haemoglobin less than 110 g/l. There was no difference in the iron content of the diets offered to the two groups of children.
CONCLUSION—In this deprived population we have shown no reduction in anaemia using a targeted nutritional programme and have highlighted the difficulties in conducting health education programmes within the scope of current health resources.

     

Severe iron deficiency anaemia and ischaemic stroke in children

Iron deficiency anaemia (IDA) has a peak prevalence of 4-8% in children aged 1-3 years of age and is known to be associated with developmental delay, lethargy, irritability and cognitive problems. Rarely, IDA has also been reported as a risk factor for stroke in otherwise healthy children. We report a series of four young children aged 14 months to 48 months with significant IDA. Three children had venous sinus thrombosis and one had arterial ischaemic stroke, without other risk factors. We discuss the potential underlying mechanisms and review the relevant literature. This report further consolidates the evidence for a strong association between IDA and childhood stroke and highlights an easily treatable (and preventable) risk factor.     

Milk consumption in 10-month-old infants. Effects on iron intake

A study was conducted in 278 10-month-old infants, examined in 2 health care centres in Paris. The dietary history method was used to evaluate their food consumption: 54.5% were receiving usual cow's milk (semi-skimmed or whole milk), 44% adapted infant formulas, and 1.5% cow milk products only. There was no relationship between the quality of milk consumption of these infants and the socio-economic level or the nationality of their parents. Infants receiving usual cow milk had an iron intake lower than the recommended daily amounts while those who were fed with the adapted infant formulas had an adequate daily iron intake.     

静脉补充铁剂防治早产儿缺铁性贫血的价值

贫血是早产儿临床常见疾病之一,不仅影响患儿生长、发育,还对运动、认知学习、行为等产生不可逆影响,静脉铁剂对于无法经口服补铁或口服补铁无效的患儿是一种有效防治早产儿贫血的方法.但目前静脉铁剂用于早产儿的安全性及开始时间仍存在争议.现就静脉铁剂对于防治早产儿缺铁性贫血的有效性、安全性进行阐述.     

Phagocyte metabolic functions in iron deficiency anaemia of Indian children

Nitroblue tetrazolium test (NBT) and bactericidal activity of polymorphonuclear leucocytes was studied in 40 patients with iron deficiency anaemia (aged 0-12 years). NBT test had a significant correlation with serum iron (P less than 0.001) in all cases of iron deficiency anemia. Haemoglobin levels less than 4 g/dl also correlated significantly with NBT score. Bactericidal activity with opsonin-coated Staphylococcus aureus was considerably decreased in severe anaemia, but no significant correlation was found with serum iron concentration (P less than 0.1). The phagocytic and bactericidal activity of polymorphonuclear leucocytes is dependent upon serum iron levels and is considerably reduced in iron deficient state in anaemic children.     

Effect of twice weekly versus daily iron treatment in Turkish children with iron deficiency anemia

This study was designed to propose a more practical, effective, safer, inexpensive, and manageable alternative treatment of iron deficiency anemia (IDA) for the developing countries. The study involves 94 children between the ages of 5 months and 6 years who had been seen in the authors' hospital and diagnosed as having iron deficiency anemia. Ninety-four children with IDA were randomly divided into two groups: 48 children comprised the first group, which was administered conventional treatment, and 46 children comprised the second group, which was administered intermittent treatment involving iron administration 2 days a week. Twenty-three children whose age and gender distribution were compatible with the other groups were included in the study as the control group. Both groups were reevaluated for their initial hematologic parameters at the end of the treatment. When the parameters of both groups were compared with the parameters of the control group after the treatment, there were no differences between hemoglobin, hematocrit, red blood cell, mean corpuscular volume, mean corpuscular hemoglobin concentration, serum iron, and ferritin levels of conventional and intermittent treatment groups. With respect to certain parameters, such as red cell distribution, serum iron binding capacity, transferrin saturation, transferrin receptor, and transferrin receptor/log ferritin, however, intermittent treatment was superior to the conventional treatment method (p <.05). In IDA, when a conventional treatment method or an intermittent treatment method is used, there are no differences between the hematological parameters. In fact, the intermittent treatment method has been found to be superior in many parameters.     

儿童缺铁和缺铁性贫血防治建议

一、前言 铁缺乏症(iron deficiency,ID)是最常见的营养素缺乏症和全球性健康问题,据估计世界1/3人口缺铁.由于健康教育和广泛采用铁强化食品等措施,目前欧美发达国家儿童缺铁性贫血(iron deficiency anemia,IDA)患病率已显著降低[1].