High prevalence of anemia in 10-month-old breast-fed Japanese infants

Anaemia in infants and young children- Risk factor analysis: Case control study

Introduction and Aim: Anaemia is a global problem with 42% prevalence. Analysis of risk factors of anaemia will be useful in formulating health programs. This case control study was done to analyse the risk factors for anaemia in infants and young children. Materials and Methods: This study was done in hospitalised children in a University hospital. Children with anaemia in age group between 6 and 24 months. Age and sex matched children without anaemia were controls. Demographic details, maternal details and feeding practices were compared. Results: 147 children were recruited in both groups. There was no significant difference in demographic factors. Exclusive breast feeding (EBF) more than four months (95.2% vs 70.1%, p value<0.001), vegetarian diet (53.7% vs 40.1%, p value=0.019), complimentary diet containing either cereals or pulses alone (83% vs 47.6%, p value< 0.001), cow’s milk intake more than 400 ml (36.1% vs 18.4%, p value=0.001) and birth order more than one (62.6% vs 32%, p value<0.001) were identified as risk factors. Conclusion: Iron supplements are essential in infants, if EBF is practised beyond 4 months and additional vitamin b12 supplements if vegetarian diet is followed. Cow’s milk intake should be less than 400 ml, to protect against anaemia.

Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial

BACKGROUND

Japanese infants have relatively higher risk of anemia and neonatal jaundice. This study aimed to assess the effects of delayed cord clamping (DCC) on the incidence of anemia during early infancy in low-risk Japanese term infants with planned exclusive breastfeeding for 4 months. This study also aimed to explore the effects of DCC on neonatal jaundice.

METHODS

We conducted an open-label, parallel-arm, multicenter randomized controlled trial of DCC (clamping the cord after more than a minute or pulsation stops) vs. early cord clamping (ECC; clamping the cord within 15 s) at one birth center and two clinics in Japan. Low-risk pregnant women planning to have a vaginal birth and to exclusively breastfeed and term singleton infants delivered in cephalic presentation were included in this study. The primary outcome was spectrophotometric estimation of hemoglobin at 4 months. Secondary outcomes were anemia incidence at 4 months, four outcomes related to neonatal jaundice, hematocrit levels, and related outcomes.

RESULTS

Overall, 150 pregnant women were recruited. Participants (N = 138) were randomly allocated to two groups (DCC n = 68, ECC n = 70). There were no significant differences between the two groups in spectrophotometric estimation of hemoglobin at 4 months: mean difference = 0.1 g/dL, 95% confidence interval - 0.14, 0.35, DCC 12.4 g/dL, ECC 12.3 g/dL. Only the hematocrit levels on days 3 to 5 were significantly higher in the DCC group than in the ECC group: DCC 57.0%, ECC 52.6%, mean difference = 4.4, 95% confidence interval 2.61, 6.20. There were no significant differences in other secondary outcomes, including outcomes related to neonatal jaundice.

CONCLUSION

Among low-risk Japanese term infants with planned exclusive breastfeeding, DCC showed no significant effects on spectrophotometric hemoglobin levels at 4 months compared with ECC. We observed significantly higher hematocrit levels on days 3 to 5 in infants who underwent DCC, while these levels were within the normal range. Jaundice outcomes remained similar to those of infants who underwent ECC. Although a larger sample size is required to assess the effects of cord clamping on neonatal jaundice, DCC may prevent anemia in newborn infants.

TRIAL REGISTRATION

UMIN-CTR; UMIN000022573, 06/01/2016 - retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000023056.