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Rea CJ, Bottino C, Chan Yuen J, Conroy K, Cox J, Epee-Bounya A, Kamalia R, Meleedy-Rey P, Pethe K, Samuels R, Schubert P, Starmer AJ. Improving rates of ferrous sulfate prescription for suspected iron deficiency anaemia in infants. BMJ Qual Saf 2019; 28:588-597. [PMID: 30971434 DOI: 10.1136/bmjqs-2018-009098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Iron deficiency anaemia (IDA) in infancy is prevalent and associated with impaired neurodevelopment; however, studies suggest that treatment and follow-up rates are poor. OBJECTIVES To improve the rate of ferrous sulfate prescription for suspected IDA among infants aged 8-13 months to 75% or greater within 24 months. METHODS We implemented a multidisciplinary process improvement effort aimed at standardising treatment for suspected IDA at two academic paediatric primary care clinics. We developed a clinical pathway with screening and treatment recommendations, followed by multiple plan-do-study-act cycles including provider education, targeted reminders when ferrous sulfate was not prescribed and development of standardised procedures for responding to abnormal lab values. We tracked prescription and screening rates using statistical process control charts. In post hoc analyses, we examined rates of haemoglobin (Hgb) recheck and normalisation for the preintervention versus postintervention groups. RESULTS The prescription rate for suspected IDA increased from 41% to 78% following implementation of the intervention. Common reasons for treatment failure included prescription of a multivitamin instead of ferrous sulfate, and Hgb not flagged as low by the electronic medical record. Screening rates remained stable at 89%. Forty-one per cent of patients with anaemia in the preintervention group had their Hgb rechecked within 6 months, compared with 56% in the postintervention group (p<0.001). Furthermore, 30% of patients with anaemia in the postintervention group had normalised their Hgb by 6 months, compared with 20% in the preintervention group (p<0.05). CONCLUSIONS A multipronged interdisciplinary quality improvement intervention enabled: (1) development of standardised practices for treating suspected IDA among infants aged 8-13 months, (2) improvement of prescription rates and (3) maintenance of high screening rates. Rates of Hgb recheck and normalisation also increased in the intervention period..
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Affiliation(s)
- Corinna J Rea
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Clement Bottino
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenny Chan Yuen
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kathleen Conroy
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Joanne Cox
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Epee-Bounya
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Radhika Kamalia
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Patricia Meleedy-Rey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kalpana Pethe
- Department of Pediatrics, Columbia University Medical Center-Vagelos College of Physicians and Surgeons, New York City, New York, USA.,New York Presbyterian Hospital, New York City, New York, USA
| | - Ronald Samuels
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Schubert
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy J Starmer
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Powers JM, Buchanan GR. Potential for Improved Screening, Diagnosis, and Treatment for Iron Deficiency and Iron Deficiency Anemia in Young Children. J Pediatr 2017; 188:8-10. [PMID: 28549635 DOI: 10.1016/j.jpeds.2017.04.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jacquelyn M Powers
- Section of Hematology/Oncology Department of Pediatrics Baylor College of Medicine Houston, Texas
| | - George R Buchanan
- Division of Hematology/Oncology Department of Pediatrics The University of Texas Southwestern Medical Center Dallas, Texas.
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Green RJ, Samy G, Miqdady MS, Salah M, Sleiman R, Abdelrahman HMA, Al Haddad F, Reda MM, Lewis H, Ekanem EE, Vandenplas Y. How to Improve Eating Behaviour during Early Childhood. Pediatr Gastroenterol Hepatol Nutr 2015; 18:1-9. [PMID: 25866727 PMCID: PMC4391994 DOI: 10.5223/pghn.2015.18.1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/30/2015] [Indexed: 11/16/2022] Open
Abstract
Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.
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Affiliation(s)
- Robin John Green
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Gamal Samy
- Department of Child Health and Nutrition, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - Mohamad Saleh Miqdady
- Division of Hepatology and Nutrition, Department of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Rola Sleiman
- Doctor Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia
| | | | | | - Mona M Reda
- Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Humphrey Lewis
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Emmanuel E Ekanem
- Department of Pediatrics, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Abstract
BACKGROUND AND OBJECTIVES Chronic, severe iron-deficiency anemia (IDA) in the first years of life increases the risk of irreversibly compromised cognitive, affective, and motor development. While IDA in infants has decreased because of dietary changes (iron-fortified formula and delaying cow's milk), toddlers (13-36 months) are equally vulnerable to the adverse effects of IDA. We aimed to show that despite public health efforts, severe IDA remains a problem in toddlers and is associated with excess milk consumption. METHODS Retrospective chart review of children 6 to 36 months admitted to or evaluated by hematology at a children's hospital from January 1, 2005 to December 31, 2010 with a severe microcytic anemia (hemoglobin [Hb] <9 g/dL and mean corpuscular volume (MCV) <75 fL). RESULTS We identified 68 infants and toddlers with severe IDA; most (84%) were 13 to 36 months old. The mean Hb and MCV were 6.0 g/dL (range = 2.2-8.9 g/dL) and 54.0 fL (range = 45.5-69.8 fL), respectively. Fatigue, poor appetite, and pica were the most common symptoms, found in 43%, 29%, and 22% of patients, respectively. Only 41% of parents reported pale skin while 77% of physicians recorded it on physical exam. Daily cow's milk consumption surpassed 24 ounces for 47 of 48 children with reported intake; 11 consumed more than 64 ounces per day. CONCLUSIONS Despite current screening recommendations, severe IDA continues to be a problem in toddlers and strongly correlates with excess cow's milk consumption. This reiterates the importance of screening for IDA into routine toddler care.
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Affiliation(s)
| | - Debra L Bogen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - A Kim Ritchey
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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Ferrara M, Coppola L, Coppola A, Capozzi L. Iron deficiency in childhood and adolescence: Retrospective review. Hematology 2013; 11:183-6. [PMID: 17325959 DOI: 10.1080/10245330600775105] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Two hundred and thirty-eight subjects of both sexes, age range 7.5 months-16 years, with iron deficiency (ID), were included in a retrospective review of ID causes, to determine the best treatment. Inadequate iron intake was the cause of ID or iron deficiency anemia (IDA) in 59 subjects from the first months of life to adolescence. Blood loss linked to cow's milk intolerance was the cause of ID or IDA in 37 younger children. Meckel's diverticulum (MD) (6 cases), reflux esophagitis (RE) (10 cases), some drugs such as acetyl salicylic acid (11 cases) induced bleeding with ID or IDA in children and adolescents. In pubertal females with ID or IDA, polymenorrhea was observed in 16 cases. Coelic disease (CD) (37 cases), Helicobacter pylori infection (HPI) (39 cases), association of HPI and CD (8 cases), enteromonas infection (15 cases), determining particularly malabsorption, were causes of ID or IDA in patients of a wide age range, unresponsive to iron therapy. Our findings show that iron replacement therapy was not always required and should not be prescribed until the diagnosis is certain.
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Affiliation(s)
- M Ferrara
- Department of pediatrics, The 2nd university of naples, Naples, Italy.
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Buchanan GR. Paucity of clinical trials in iron deficiency: lessons learned from study of VLBW infants. Pediatrics 2013; 131:e582-4. [PMID: 23339219 DOI: 10.1542/peds.2012-3365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- George R Buchanan
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA.
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Gulen H, Kasirga E, Yildirim SA, Kader S, Sahin G, Ayhan S. Diagnostic yield of upper gastrointestinal endoscopy in the evaluation of iron deficiency anemia in older children and adolescents. Pediatr Hematol Oncol 2011; 28:694-701. [PMID: 21728721 DOI: 10.3109/08880018.2011.572145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Iron deficiency anemia (IDA) is frequent in childhood. Inadequate nutrition and gastrointestinal malabsorption are the frequent causes of IDA in children. But reduced iron absorption and insidious blood loss from the gastrointestinal tract has been identified as the most frequent causes of IDA in older children and adolescents. Therefore the authors evaluated the frequency and etiologies of the upper gastrointestinal system pathologies causing IDA in older pediatric population. Patients with known hematological or chronic diseases, heavy menstrual flow, and obvious blood loss were excluded from the study. Forty-four children between the ages of 9.5 and 17.5 years and diagnosed with IDA were enrolled. They underwent upper gastrointestinal endoscopy and biopsy from esophagus, stomach, and duodenum. Mean age and hemoglobin (Hb) levels of study group (32 boys, and 12 girls) were 14.6 ± 2.0 years and 7.9 ± 1.8 g/dL, respectively. Only 1 patient had a positive serology testing with anti-tissue transglutaminase and small bowel biopsy correlating with celiac disease. Endoscopy revealed abnormal findings in 25 (56.8%) patients (21 endoscopic antral gastritis, 2 active duodenal ulcers, and 2 duodenal polyps). Helicobacter pylori (HP) infection was identified by using antral histopathological evaluation in 19 of 44 children (43.2%). In 2 of duodenal samples, one patient had celiac disease, and the other one was diagnosed as giardiasis. In conclusion, there are different etiologies resulting in IDA in older children and adolescents. When older children and adolescents are found to have iron deficiency, HP infection and other gastrointestinal pathologies should be ruled out before iron deficiency treatment.
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Affiliation(s)
- Huseyin Gulen
- Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey.
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Abstract
This study aimed to evaluate the frequency of the diverse causes of iron deficiency (ID) and iron deficiency anemia (IDA) and to investigate the treatment outcomes in children. ID was defined as a serum ferritin level<12 microg/L and a transferrin saturation<10%. IDA was established as ID combined with a low hemoglobin level judged by age and gender-specific reference intervals. A total of 116 ID patients were categorized into 4 groups: group I:<2 years old (n=45), group II: 2 to 10 years old (n=13), group III:>10 years old, male (n=18), and group IV: >10 years old, female (n=40). One hundred of them (86.2%) were diagnosed with IDA. The most common causes of ID were inadequate intake in group I (55.6%) and blood loss in groups II (46.1%) and IV (37.5%). Helicobacter pylori-associated ID mainly occurred in children more than 10 years old. Forty-five of 57 (78.9%) IDA patients who had underlying diseases treatment and/or iron supplementation for 3 months recovered their hemoglobin levels (follow-up range: 6-27 mo). In conclusion, the peak incidences of childhood ID were ages under 2 years old and 10-18 years old. Different age groups and sexes showed characteristic etiologies. The outcomes of childhood ID were good.
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Buchanan GR. Screening for iron deficiency during early infancy: is it feasible and is it necessary? Am J Clin Nutr 2009; 89:473-4. [PMID: 19116318 DOI: 10.3945/ajcn.2008.27284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gompakis N, Economou M, Tsantali C, Kouloulias V, Keramida M, Athanasiou-Metaxa M. The effect of dietary habits and socioeconomic status on the prevalence of iron deficiency in children of northern Greece. Acta Haematol 2007; 117:200-4. [PMID: 17199080 DOI: 10.1159/000098273] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 10/11/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite encouraging reports concerning the declining prevalence of iron deficiency, this easily preventable disorder is still an existing problem in presumably developed regions. OBJECTIVE To evaluate the prevalence of iron deficiency and relevant anemia in children residing in Northern Greece and to study possible associations. DESIGN 3,100 children aged 8 months to 15 years were evaluated. Socioeconomic status was determined based on the parents' profession and place of residence. Nutrition habits were also evaluated. RESULTS The incidence of iron deficiency was found to be 14% and that of iron deficiency anemia was 2.9%, with a higher prevalence in children younger than 2 years of age. The place of residence was the most significant factor in relation to the development of iron depletion in the children studied. Additional independent factors were revealed to be breast-feeding, meat-containing meal consumption and the consumption of non-home-cooked meals. CONCLUSION Iron deficiency remains prevalent in Northern Greece, mainly affecting the vulnerable toddler group. Nutritional iron deficiency is still a severe public health problem even in what are considered to be developed regions. An improvement of dietary habits and an upgrading of semiurban areas should contribute substantially to decreasing the prevalence of iron depletion in Greek children.
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Affiliation(s)
- Nikolaos Gompakis
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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A Diet Quality Index for American Preschoolers Based on Current Dietary Intake Recommendations and an Indicator of Energy Balance. ACTA ACUST UNITED AC 2006; 106:1594-604. [DOI: 10.1016/j.jada.2006.07.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Indexed: 11/20/2022]
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Pierce MB, Crowell RE, Ferris AM. Differing perspectives of inner-city parents and pediatric clinicians impact management of iron-deficiency anemia. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2006; 38:169-76. [PMID: 16731452 DOI: 10.1016/j.jneb.2006.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To ascertain the beliefs and experiences of inner-city pediatric clinicians and parents regarding anemia in young children. DESIGN Focus groups and in-depth interviews. SETTING Pediatric clinics and community agencies in Hartford, Connecticut. PARTICIPANTS Convenience sample of 41 pediatric clinicians (93% white, 73% female) and 85 parents (100% minority, 88% female, 47% < 12 years education). PHENOMENON OF INTEREST Identification, understanding, and management of anemia. ANALYSIS Researcher pairs coded complete transcriptions. Recurrent themes were identified, which were then contrasted and compared between clinicians and parents. RESULTS Both clinicians and parents were familiar with, but frustrated by the persistence of anemia. They noted time constraints and poor communication during office visits as contributing to the problem. Parents felt alarmed upon initial diagnosis; linked anemia with heredity, food patterns, and activity; reported culturally linked management strategies; but were uncertain of the seriousness. Health clinicians saw physiological processes as outside the parents' understanding and emphasized prevention through feeding recommendations. CONCLUSIONS AND IMPLICATIONS In order to address childhood anemia effectively, differing socio-cultural perspectives of clinicians and parents need to be incorporated into a unified health care plan. Nutritionists are well suited to collaborate on the health care team to effectively address this issue.
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Affiliation(s)
- Michelle B Pierce
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269-4017, USA.
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Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, Abdelatif A, Baranes C, Benoît S, Benssoussan A, Boussioux JL, Boyer P, Brunet E, Delorme J, François-Cecchin S, Gottrand F, Grassart M, Hadji S, Kalidjian A, Languepin J, Leissler C, Lejay D, Livon D, Lopez JP, Mougenot JF, Risse JC, Rizk C, Roumaneix D, Schirrer J, Thoron B, Kalach N. Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr 2005; 41:625-33. [PMID: 16254521 DOI: 10.1097/01.mpg.0000181188.01887.78] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To assess the safety of a polyethylene glycol (PEG) 4000 laxative without additional salts in pediatric patients. STUDY DESIGN This was a 3-month multicenter, randomized, double-blind, double-dummy, lactulose-controlled, parallel study enrolling 96 ambulatory constipated children aged 6 months to 3 years, treated daily with 4-8 g PEG or 3.33 g-6.66 g lactulose. Total protein, albumin, iron, electrolytes, and vitamins B9 (folates), A and D (25OHD3) were measured in blood before and after treatment (day 84) in a central laboratory. RESULTS The percentage of children with at least one value out of normal range at day 84 with respect to baseline status (with or without at least one value out of normal range), i.e. the primary endpoint, was 87% and 90% in the PEG and lactulose groups, respectively, without any difference between groups. The whole blood parameters showed no qualitative or quantitative treatment-related changes. Vitamin A values were above normal range in 56% and 41% of children at baseline versus 33% and 36% at day 84 in the PEG and lactulose groups, respectively. Iron values were similarly under normal range in 47% and 51% at baseline versus 42% and 51% at day 84. Clinical tolerance was similar for both treatments except for vomiting and flatulence, which were significantly higher with lactulose. Significantly higher improvements were evidenced with PEG regarding stool consistency, appetite, fecaloma and use of additional laxatives. CONCLUSION This 3-month study in 96 constipated children aged 6 months to 3 years confirms the long-term tolerance of PEG 4000 in pediatrics and indicates a PEG efficacy similar to or greater than that of lactulose.
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Affiliation(s)
- Christophe Dupont
- Hôpital Saint-Vincent-de-Paul, Service de Néonatologie, Paris, France.
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Delatycki MB, Powell LW, Allen KJ. Hereditary Hemochromatosis Genetic Testing of At-Risk Children: What Is the Appropriate Age? ACTA ACUST UNITED AC 2004; 8:98-103. [PMID: 15345104 DOI: 10.1089/gte.2004.8.98] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to consider the objective evidence and ethical arguments for the appropriate age to test children at risk of developing hereditary hemochromatosis. A literature search for information on iron overload in children, onset of disease expression for hemochromatosis, and recommendations for age of cascade screening was undertaken. We examined the objective evidence and arguments for testing in early childhood and those for delaying testing until later teenage years. Cascade testing of offspring of people with hemochromatosis is widely advocated because it is an easily preventable disease. The ideal age to test those offspring is a matter of debate. Some authorities advocate testing at a very young age whereas others recommend delaying testing until late teenage years. To date there has been no published overview of the objective evidence and arguments central to this debate. In children who are C282Y homozygous, iron overload is rare in the first two decades of life and associated morbidity has only been documented in 1 patient. In the cascade setting, genetic testing for hemochromatosis need not be offered until late teenage years.
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Affiliation(s)
- Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Victoria, Australia.
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Buchanan GR. Iron deficiency and blood lead levels. J Pediatr 2003; 143:281. [PMID: 12970653 DOI: 10.1067/s0022-3476(03)00284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Derossi SS, Raghavendra S. Anemia. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:131-41. [PMID: 12582350 DOI: 10.1067/moe.2003.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Scott S Derossi
- University of Pennsylvania School of Dental Medicine, Pennsylvania, USA
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Abstract
This is a case report of an otherwise healthy 2-year-old boy with a history of pica, associated with iron deficiency anemia. This boy was referred to our department for a neurologic evaluation because of an acute episode of sialorrhea, difficulty in speaking, dysphagia, and repeated swallowing movements. An uncertain episode of a brief-duration still gaze was also reported. In addition, the history revealed that the child had earlier ingested a leaf from a poisonous houseplant called Colocasia esculenta, also known as "elephant's ear." The habit of pica subsided after treatment with iron supplements. A 9-month follow-up period was uneventful. Neurologic manifestations can accompany accidental intoxications of some non-nutrient substances. Thus, pica must be suspected in children with acute behavior alterations.
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Affiliation(s)
- Helen Mihailidou
- Department of Pediatrics, University General Hospital, Heraklion, Crete, Greece.
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Nobili B, Perrotta S, Matarese SMR, Conte ML, del Giudice EM. Evaluation of body iron status in Italian carriers of beta-thalassemia trait. Nutr Res 2001. [DOI: 10.1016/s0271-5317(00)00295-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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