1
|
Mohammadi M, Ghazizadeh H, Mohammadi-Bajgiran M, Kathryn Bohn M, Yaghooti-Khorasani M, Kamel Khodabandeh A, Steele S, Torabzadeh Khorasani N, Ferns GA, Boskabadi H, Esmaily H, Adeli K, Assaran Darban R, Ghayour-Mobarhan M. Pediatric reference intervals for hematology parameters in healthy infants and young children in Iran. Int J Lab Hematol 2023; 45:845-852. [PMID: 37442636 DOI: 10.1111/ijlh.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Defining accurate age- and sex-specific reference intervals (RIs) for hematology parameters, especially for the pediatric population, is important for making an appropriate clinical diagnosis. To address gaps, we established age-specific RIs for 11 hematologic parameters in Iranian children younger than 30 months for the first time. METHODS Fresh whole blood samples collected from a total of 344 participants (males: 158 and females: 186) ages 3 days to 30 months, with a mean age of 12.91 ± 7.15 months, were recruited from healthcare centers in Mashhad, Iran. Hematologic parameters, including complete blood count (CBC), were analyzed on the Sysmex auto-analyzer system (KX-21 N). RIs were calculated with 90% confidence intervals using the direct method based on CLSI Ep28-A3 and C28-A3 guidelines. RESULTS None of the CBC parameters required sex partitioning. Of 11 CBC parameters, six required age partitions of 3 days-<4 months, 4-<10, 10-<15, and 4-<30 months. Five parameters (i.e., white blood cell count, mean corpuscular hemoglobin concentration, mean platelet volume, red cell distribution width, and platelet distribution width) did not demonstrate age-specific changes. RIs of red blood cell count and hematocrit, as well as hemoglobin, increased with age, while mean corpuscular volume, mean corpuscular hemoglobin, and platelet count, decreased with age. CONCLUSION In this study, we established RIs for 11 hematology parameters in young children. Age partitioning was required for six parameters demonstrating marked changes during the early period of growth and development and necessitating the use of pediatric-specific reference standards.
Collapse
Affiliation(s)
- Maliheh Mohammadi
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Hamideh Ghazizadeh
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mohammadi-Bajgiran
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mary Kathryn Bohn
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
| | - Mahdiyeh Yaghooti-Khorasani
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atieh Kamel Khodabandeh
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shannon Steele
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
| | | | - Gordon A Ferns
- Division of Medical Education, Falmer, Brighton & Sussex Medical School, Brighton, UK
| | - Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical sciences, Mashhad, Iran
| | - Khosrow Adeli
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Canada
| | - Reza Assaran Darban
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
2
|
Elimeleh Y, Zittan E, Levy M, Rinawi F. Adherence to ECCO Guidelines for Management of Iron Deficiency and Anemia in Inflammatory Bowel Diseases Among Israeli Adult and Pediatric Gastroenterologists. J Pediatr Gastroenterol Nutr 2023; 77:634-639. [PMID: 37580868 DOI: 10.1097/mpg.0000000000003913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVES The consensus guidelines of the European Crohn's and Colitis Organization (ECCO) for the diagnosis and treatment of iron deficiency anemia (IDA) were published in 2015. We examined the management practices of both adult gastroenterologists (AGs) and pediatric gastroenterologists (PGs) in Israel in treating ID among patients with inflammatory bowel disease (IBD). METHODS An 18-question multiple-choice anonymous questionnaire was electronically delivered to AGs and PGs. Questions explored 3 areas of interest: physician demographics, adherence to ECCO guidelines, and management practices of IDA in patients with IBD. RESULTS Completed questionnaires were returned by 72 AGs and 89 PGs. Practice setting and years of practice were similar. A large majority of AGs and PGs (89% and 92%, respectively) measure complete blood count (CBC) and serum ferritin (S-Fr) at least every 3 months in outpatients with active IBD, as recommended by the ECCO guidelines. In contrast, in IBD patients in remission, only 53% and 26% of AGs and PGs, respectively ( P < 0.001), reported adherence to ECCO guidelines, measuring CBC and S-Fr every 6 months. The ECCO treatment guidelines recommend that intravenous (IV) iron should be considered the first-line treatment in patients with clinically active IBD, with previous oral iron intolerance and those with a hemoglobin level <10 g/dL. Study results indicate that only 43% of AGs recommend IV iron for these indications, compared to 54% of PGs ( P > 0.1). CONCLUSIONS In this study we have demonstrated a relatively low level of adherence to ECCO guideline recommendations among both AGs and PGs, regarding the management of IDA in patients with IBD.
Collapse
Affiliation(s)
- Yotam Elimeleh
- From The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
| | - Eran Zittan
- From The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Matthew Levy
- From The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Firas Rinawi
- the Pediatric Gastroenterology Unit, Emek Medical Center, Afula, Israel
- the Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
3
|
Bijelić V, Potter B, Parkin PC, Momoli F, Liebman M, Hamid JS. Paediatric reference intervals and curves for haemoglobin and ferritin: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e073783. [PMID: 37793936 PMCID: PMC10551989 DOI: 10.1136/bmjopen-2023-073783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Reference intervals and reference curves provide clinicians with a point of reference when evaluating patients' laboratory test results. In practical applications, the 2.5th and 97.5th percentiles of healthy reference population are typically used as lower and upper reference limits. Guidelines outlining analytical and methodological steps involved in reference intervals and curves estimation are available and there have been large-scale world-wide initiatives to provide reference intervals and curves for children. However, there is a lack of synthesised evidence regarding the results of such initiatives in general, but specifically in iron-related biomarkers, ferritin (in serum and plasma) and haemoglobin. Objectives of this review are to identify studies that have produced reference intervals and curves for ferritin and haemoglobin in paediatric populations and to synthesise all available evidence. We also aim to quantify heterogeneity across reference intervals and curves and identify and elucidate sources of heterogeneity, including heterogeneity in the methods employed in their development. METHODS AND ANALYSIS Using a comprehensive search strategy, we will identify eligible studies. Following electronic databases will be searched from inception: EMBASE, MEDLINE, SCOPUS and The Cochrane Library. We will also perform grey literature search to capture unpublished reference intervals and curves from healthy cohorts. Two researchers will independently screen retrieved citations against eligibility criteria in two stages, focusing first on titles and abstracts and then on full-text articles. Studies that provide reference intervals and curves for ferritin and haemoglobin for paediatric population will be eligible. Data extraction will include study characteristics, characteristics of reference population, methodological and analytical considerations and estimated reference intervals and curves. We will consider narrative synthesis and quantitative synthesis when appropriate. ETHICS AND DISSEMINATION Ethical approval is not required as data from already published studies will be used. Results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42023399802.
Collapse
Affiliation(s)
- Vid Bijelić
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Beth Potter
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Patricia C Parkin
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mira Liebman
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
4
|
Bevers N, Van de Vijver E, Aliu A, Rezazadeh Ardabili A, Rosias P, Stapelbroek J, Bertrams Maartens IA, van de Feen C, Escher H, Oudshoorn A, Teklenburg S, Vande Velde S, Winkens B, Raijmakers M, Vreugdenhil A, Pierik MJ, van Rheenen PF. Ferric Carboxymaltose Versus Ferrous Fumarate in Anemic Children with Inflammatory Bowel Disease: The POPEYE Randomized Controlled Clinical Trial. J Pediatr 2022; 256:113-119.e4. [PMID: 36563900 DOI: 10.1016/j.jpeds.2022.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/29/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine whether intravenous (IV) or oral iron suppletion is superior in improving physical fitness in anemic children with inflammatory bowel disease (IBD). STUDY DESIGN We conducted a clinical trial at 11 centers. Children aged 8-18 with IBD and anemia (defined as hemoglobin [Hb] z-score < -2) were randomly assigned to a single IV dose of ferric carboxymaltose or 12 weeks of oral ferrous fumarate. Primary end point was the change in 6-minute walking distance (6MWD) from baseline, expressed as z-score. Secondary outcome was a change in Hb z-score from baseline. RESULTS We randomized 64 patients (33 IV iron and 31 oral iron) and followed them for 6 months. One month after the start of iron therapy, the 6MWD z-score of patients in the IV group had increased by 0.71 compared with -0.11 in the oral group (P = .01). At 3- and 6-month follow-ups, no significant differences in 6MWD z-scores were observed. Hb z-scores gradually increased in both groups and the rate of increase was not different between groups at 1, 3, and 6 months after initiation of iron therapy (overall P = .97). CONCLUSION In this trial involving anemic children with IBD, a single dose of IV ferric carboxymaltose was superior to oral ferrous fumarate with respect to quick improvement of physical fitness. At 3 and 6 months after initiation of therapy, no differences were discovered between oral and IV therapies. The increase of Hb over time was comparable in both treatment groups. TRIAL REGISTRATION NTR4487 [Netherlands Trial Registry].
Collapse
Affiliation(s)
- Nanja Bevers
- Department of Paediatrics, Zuyderland Medical Center, Sittard, The Netherlands.
| | - Els Van de Vijver
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Antwerp University Hospital, Edegem, Belgium
| | - Arta Aliu
- Department of Paediatrics, Zuyderland Medical Center, Sittard, The Netherlands
| | | | - Philippe Rosias
- Department of Paediatrics, Zuyderland Medical Center, Sittard, The Netherlands
| | | | | | | | - Hankje Escher
- Erasmus Medical Center, Children's Hospital Department of Paediatric Gastroenterology, Rotterdam, The Netherlands
| | | | - Sarah Teklenburg
- Department of Paediatrics, Isala Hospitals, Zwolle, The Netherlands
| | | | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Maarten Raijmakers
- Laboratory of Clinical Chemistry and Haematology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
| | - Anita Vreugdenhil
- Department of Paediatrics and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marieke J Pierik
- Division of Gastroenterology-Hepatology and NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patrick F van Rheenen
- University of Groningen, University Medical Centre Groningen - Beatrix Children's Hospital, Department of Paediatric Gastroenterology Hepatology and Nutrition, Groningen, The Netherlands
| |
Collapse
|
5
|
Serum Ferritin Threshold for Iron Deficiency Screening in One-Year-Old Children. J Pediatr 2022; 245:217-221. [PMID: 35114287 DOI: 10.1016/j.jpeds.2022.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
Abstract
The American Academy of Pediatrics recommends universal hemoglobin screening for iron deficiency anemia using hemoglobin <110 g/L at the 1-year-old well child visit. Our retrospective study suggests the need for combined hemoglobin and serum ferritin iron deficiency screening and raising the diagnostic serum ferritin threshold to 24-25 μg/L.
Collapse
|
6
|
Bardwell C, El Demellawy D, Oltean I, Murphy M, Agarwal A, Hamid JS, Reddy D, Barrowman N, de Nanassy J, Nasr A. Establishing normal ranges for fetal and neonatal small and large intestinal lengths: results from a prospective postmortem study. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000397. [DOI: 10.1136/wjps-2021-000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/22/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo establish reference intervals (RIs) for fetal and neonatal small and large intestinal lengths.MethodsLinear measurements on small and large intestines were made upon postmortem examination of 131 preterm and term infants with gestational ages between 13 and 41 weeks. All cases were referred from the Eastern Ontario and Western Québec regions to a tertiary care hospital. Age and sex partitions were considered and RI limits were estimated.ResultsData consisted of 72 male (54.96%) and 59 female (45.04%) fetuses and neonates with mean gestational age of 25.6 weeks. Results showed that small and large intestinal lengths increased linearly with gestational age. RIs for small intestinal length (cm) of fetuses and neonates aged 13–20 weeks were (21.1, 122.4); of those aged 21–28 weeks were (57.7, 203.8); of those aged 29–36 weeks were (83.6, 337.1); and of those aged 37–41 weeks were (132.8, 406.4). RIs for large intestinal length (cm) of fetuses and neonates from the same four age groups were (5.1, 21.4), (12.7, 39.7), (32.4, 62.4), and (29.1, 82.2).ConclusionsEstablishing accurate RIs for premature and term infants has clinical relevance for pathologists performing postmortem analysis and for surgeons planning postoperative management of patients. The results of this study reaffirm that fetal small and large intestinal lengths increase linearly with gestational age irrespective of sex. Future studies should aim to further investigate the role of possible confounders on growth of fetal intestinal length, including maternal factors such as age and substance use during pregnancy.
Collapse
|
7
|
Tanous O, Levin C, Suchdev PS, Luo H, Rinawi F. Resolution of iron deficiency following successful eradication of Helicobacter pylori in children. Acta Paediatr 2022; 111:1075-1082. [PMID: 35028968 DOI: 10.1111/apa.16255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/26/2022]
Abstract
AIM To assess correlation between successful Helicobacter pylori (HP) eradication and resolution of iron deficiency in children, without iron supplementation. METHODS Medical records of children diagnosed with HP infection based on endoscopy were retrospectively reviewed. Among those with non-anaemic iron deficiency (NAID) or iron deficiency anaemia (IDA), haemoglobin, ferritin and CRP levels were compared prior and 6-9 months' post-successful HP eradication. Predictors of resolution of iron deficiency following HP eradication were assessed. RESULTS Among 60 included children (median age 14.8, IQR12.3-16 years; 62% males), 35% had IDA while the remaining 65% had NAID. Following successful HP eradication, iron normalised in 60% of patients with iron deficiency (ID), without iron supplementation. There were significant improvements in haemoglobin and ferritin concentrations following HP eradication with haemoglobin increasing from 12.3 g/dL to 13.0 g/dL and ferritin increasing from 6.3 μg/L to 15.1 μg/L (p < 0.001). In multiple logistic regression, older age was the only factor associated with resolution of anaemia following HP eradication (OR 1.65, 95% CI 1.16-2.35, p = 0.005). CONCLUSION Successful HP eradication could be helpful in improving iron status among children with refractory NAID or IDA. Older age may predict this outcome. Screening for HP might be considered in the workup of refractory IDA or ID.
Collapse
Affiliation(s)
- Osama Tanous
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Carina Levin
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Pediatric Hematology Unit, Emek Medical Centre, Afula, Israel
| | - Parminder S Suchdev
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Pediatrics, Emory Global Health Institute, Atlanta, Georgia, USA
| | - Hanqi Luo
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Firas Rinawi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Pediatric Gastroenterology Unit, Emek Medical Center, Afula, Israel
| |
Collapse
|
8
|
Holmlund-Suila EM, Hauta-Alus HH, Enlund-Cerullo M, Rosendahl J, Valkama SM, Andersson S, Mäkitie O. Iron status in early childhood is modified by diet, sex and growth: Secondary analysis of a randomized controlled vitamin D trial. Clin Nutr 2021; 41:279-287. [PMID: 34999321 DOI: 10.1016/j.clnu.2021.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS During early childhood the risk of iron deficiency (ID) is high. Serum ferritin serves as a marker of iron status. We explored prevalence of ID and iron deficiency anemia (IDA), and identified determinants of iron status in infants and toddlers. METHODS We performed a secondary analysis of the Vitamin D intervention in infants (VIDI) study in Finnish healthy term infants. According to study protocol, at 12- and 24-months of age iron status, growth and dietary intakes were evaluated. ID was defined as serum ferritin <10 μg/L and IDA as serum ferritin <10 μg/L and Hb <112 g/L. For the present study, altogether 766 children provided data (N = 498 infants at 12 months, N = 508 toddlers at 24 months). RESULTS ID prevalence increased from 14% in infants to 20% in toddlers. IDA prevalence was 3% at both time points. In infants, ID and IDA were more common in boys than in girls (19% vs. 9%, p = 0.001 and 5% vs. 1%, p = 0.039) but no sex-difference in toddlers was observed. Of infants, 30% had daily iron intake below average requirement of 5 mg/day. Higher daily iron intake per body weight (mg/kg) independently associated with higher infant serum ferritin (B (95% CI) 0.30 (0.04, 0.56), p = 0.026). Correlation between iron intake and ferritin was stronger in infants with ID than in infants without ID. Breastfeeding was more common (63% vs. 35%, p < 0.001) among ID infants than in infants without ID. In toddlers, frequent consumption of milk products independently associated with lower ferritin (B (95% CI) -0.03 (-0.05, -0.01), p = 0.001). Consumption of meat and fish associated with better iron status. Serum ferritin at both time points associated with duration of gestation and growth. The association of growth and ferritin was age-dependent in boys, while in girls, faster growth associated consistently with lower ferritin. CONCLUSIONS In Northern European healthy infants and toddlers ID is common. The intake of iron remains below recommendations and food consumption and iron intake associate with iron status. Further studies are warranted to assess significance of ID on child development and clinical health outcomes. The project protocol is registered at ClinicalTrials.gov: NCT01723852.
Collapse
Affiliation(s)
- Elisa M Holmlund-Suila
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Biomedicum 2 C, P.O. Box 705, 00020 HUS, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, P.O. Box 63, 00014, Helsinki, Finland.
| | - Helena H Hauta-Alus
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Biomedicum 2 C, P.O. Box 705, 00020 HUS, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, P.O. Box 63, 00014, Helsinki, Finland; Finnish Institute for Health and Welfare (THL), Population Health Unit, P.O. Box 30, FI-00271, Helsinki, Finland; PEDEGO Research Unit, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland.
| | - Maria Enlund-Cerullo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Biomedicum 2 C, P.O. Box 705, 00020 HUS, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, P.O. Box 63, 00014, Helsinki, Finland; Folkhälsan Institute of Genetics, Helsinki, Finland.
| | - Jenni Rosendahl
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Biomedicum 2 C, P.O. Box 705, 00020 HUS, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, P.O. Box 63, 00014, Helsinki, Finland.
| | - Saara M Valkama
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Biomedicum 2 C, P.O. Box 705, 00020 HUS, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, P.O. Box 63, 00014, Helsinki, Finland.
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Biomedicum 2 C, P.O. Box 705, 00020 HUS, Helsinki, Finland.
| | - Outi Mäkitie
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Biomedicum 2 C, P.O. Box 705, 00020 HUS, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, P.O. Box 63, 00014, Helsinki, Finland; Folkhälsan Institute of Genetics, Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, SE-17176, Stockholm, Sweden.
| |
Collapse
|
9
|
Pérez-Acosta A, Duque X, Trejo-Valdivia B, Flores-Huerta S, Flores-Hernández S, Martínez-Andrade G, González-Unzaga M, Turnbull B, Escalante-Izeta E, Klünder-Klünder M, Carranco-Hernández T, Mendoza E, Sotelo-Ham EI, Pineda A, Medina-Escobedo C, Martinez H. Cut-off points for serum ferritin to identify low iron stores during the first year of life in a cohort of Mexican infants. MATERNAL AND CHILD NUTRITION 2021; 17:e13205. [PMID: 34036744 PMCID: PMC8476433 DOI: 10.1111/mcn.13205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/08/2021] [Accepted: 04/28/2021] [Indexed: 12/31/2022]
Abstract
The aim of this study was to identify serum ferritin (SF) cut‐off points (COPs) in a cohort of healthy full‐term normal birth weight infants who had repeated measurements of SF and haemoglobin every 3 months during the first year of life. The study included 746 full‐term infants with birth weight ≥2,500 g, having uncomplicated gestations and births. Participants received prophylactic iron supplementation (1 mg/day of iron element) from the first to the 12th month of life and did not develop anaemia during the first year of life. Two statistical methods were considered to identify COPs for low iron stores at 3, 6, 9 and 12 months of age: deviation from mean and cluster analysis. According to the K‐means cluster analysis results by age and sex, COPs at 3 and 6 months for girls were 39 and 21 μg/L and for boys 23 and 11 μg/L, respectively. A single COP of 10 μg/L was identified, for girls and boys, at both 9 and 12 months. Given the physiological changes in SF concentration during the first year of life, our study identified dynamic COPs, which differed by sex in the first semester. Adequate SF COPs are necessary to identify low iron stores at an early stage of iron deficiency, which represents one of the most widespread public health problems around the world, particularly in low‐ and middle‐income countries.
Collapse
Affiliation(s)
- Azucena Pérez-Acosta
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ximena Duque
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Belem Trejo-Valdivia
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Samuel Flores-Huerta
- Unidad de Investigación en Salud Comunitaria, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, México
| | - Sergio Flores-Hernández
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Gloria Martínez-Andrade
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Marco González-Unzaga
- Unidad de Investigación en Epidemiología Nutricional, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Bernardo Turnbull
- Académico de tiempo, Universidad Iberoamericana, Ciudad de México, México
| | - Ericka Escalante-Izeta
- Departamento de Ciencias de la Salud, Universidad Iberoamericana, San Andrés Cholula, Puebla, Mexico
| | - Miguel Klünder-Klünder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, México
| | - Tania Carranco-Hernández
- Dirección de Prestaciones Económicas y Sociales, Coordinación del Servicio de Guardería para el Desarrollo Integral Infantil, División de Desarrollo Integral Infantil, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eugenia Mendoza
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Elma Ivonne Sotelo-Ham
- Coordinación Delegacional de Investigación de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, México
| | - Alicia Pineda
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, México
| | - Carolina Medina-Escobedo
- Dirección de Educación e Investigación en Salud. Unidad Médica de Alta Especialidad, Hospital de Especialidades Centro Médico Nacional "Ignacio García Téllez" en Mérida, Instituto Mexicano del Seguro Social, Mérida, México
| | - Homero Martinez
- Dirección de Investigación, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, México.,Global Technical Services, Nutrition International, Ottawa, Ontario, Canada
| |
Collapse
|
10
|
Hamid JS, Atenafu EG, Borkhoff CM, Birken CS, Maguire JL, Bohn MK, Adeli K, Abdelhaleem M, Parkin PC. Reference intervals for hemoglobin and mean corpuscular volume in an ethnically diverse community sample of Canadian children 2 to 36 months. BMC Pediatr 2021; 21:241. [PMID: 34011305 PMCID: PMC8132375 DOI: 10.1186/s12887-021-02709-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To establish reference intervals for hemoglobin and mean corpuscular volume (MCV) in an ethnically diverse community sample of Canadian children 36 months and younger. Methods We collected blood samples from young children at scheduled primary care health supervision visits at 2 weeks, 2, 4, 6, 9, 12, 15, 18, 24, and 36 months of age. Samples were analyzed on the Sysmex XN-9000 Hematology Analyzer. We followed the Clinical and Laboratory Standards Institute guidelines in our analysis. Data were partitioned by sex and also combined. We considered large age partitions (3 and 6 months) as well as monthly partitions. Reference intervals (lower and upper limits) and 90% confidence intervals were calculated. Results Data from 2106 children were included. The age range was 2 weeks to 36 months, 46% were female, 48% were European and 23% were of mixed ethnicity. For hemoglobin, from 2 to 36 months of age, we found a wide reference interval and the 90% confidence intervals indicated little difference across age groups or according to sex. For MCV, from 2 to 7 months of age there was considerable decrease in the reference interval, which was lowest during the second year of life, followed by a slight increase in the last months of the third year of life. Conclusion These findings suggest adoption of a single hemoglobin reference interval for children 2–36 months of age. Further studies in children under 4 months of age are needed. Trial registration TARGet Kids! cohort is registered at ClinicalTrials.gov. www.clinicaltrials.gov. Identifier: NCT01869530. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02709-w.
Collapse
Affiliation(s)
- Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Canada
| | - Eshetu G Atenafu
- Biostatistics Department, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Catherine S Birken
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mohamed Abdelhaleem
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Haematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Patricia C Parkin
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. .,The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
| |
Collapse
|
11
|
Sezgin G, Loh TP, Markus C. Functional reference limits: a case study of serum ferritin. J LAB MED 2021. [DOI: 10.1515/labmed-2020-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Reference intervals depend on the distribution of results within a reference population and can be influenced by subclinical disease. Functional reference limits present an opportunity to derive clinically relevant reference limits from routinely collected data sources, which consist of mixed populations of unhealthy and healthy groups. Serum ferritin is a good example of the utility of functional reference limits. Several studies have identified clinically relevant reference limits through examining the relationship between serum ferritin and erythrocyte parameters. These ferritin functional limits often represent the inflection point at which erythrocyte parameters change significantly. Comparison of ferritin functional reference limits with those based on population distributional reference limits reveals that the lower reference limit may fall below the point at which patients become clinically unwell. Functional reference limits may be considered for any biomarker that exhibits a correlated relationship with other biomarkers.
Collapse
Affiliation(s)
- Gorkem Sezgin
- Faculty of Medicine, Health, and Human Sciences , Macquarie University , Sydney , Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine , National University Hospital , Buona Vista , Singapore
| | - Corey Markus
- International Centre for Point-of-Care Testing , Flinders University , Adelaide , Australia
| |
Collapse
|
12
|
Population-based reference intervals for ferritin, iron, transferrin and transferrin saturation and prevalence of iron deficiency in 6-12-year-old children: the Health Oriented Pedagogical Project (HOPP). Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:208-212. [PMID: 33607925 DOI: 10.1080/00365513.2021.1884893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Appropriate reference intervals are important for correct interpretation of laboratory test results. The primary objective of the present study was to establish pediatric reference intervals for biochemical markers essential in the assessment of iron status. As a secondary objective we calculated the prevalence of iron deficiency according to WHO recommendations. Blood samples were obtained from 1355 healthy children 6-12 years of age participating in the Health Oriented Pedagogical Project (HOPP). For our primary objective, data from 1333 children were used to establish reference intervals for ferritin, iron, transferrin and transferrin saturation. Following the CLSI C28-A3 guidelines, the 2.5th and 97.5th percentiles with corresponding 90% confidence intervals, were estimated by the nonparametric method. None of the measured analytes required partitioning for age or sex. The prevalence of iron deficiency was 8.2%, which is higher than reported in other populations.
Collapse
|
13
|
Ozsahin H, Schaeppi M, Bernimoulin M, Allard M, Guidard C, van den Ouweland F. Intravenous ferric carboxymaltose for iron deficiency anemia or iron deficiency without anemia after poor response to oral iron treatment: Benefits and risks in a cohort of 144 children and adolescents. Pediatr Blood Cancer 2020; 67:e28614. [PMID: 32729200 DOI: 10.1002/pbc.28614] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/21/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this single-center observational study was to determine the clinical and hematologic responses to intravenous ferric carboxymaltose (FCM) in a cohort of pediatric patients with poor response to oral iron therapy. The occurrence of adverse events was systematically recorded for up to 96 hours after infusion. STUDY DESIGN A retrospective cohort of 144 consecutive patients aged 18 months to < 18 years with iron deficiency anemia (IDA) or iron deficiency (ID) without anemia was investigated. All patients had failed oral iron therapy. The assessments before and after FCM treatment followed a predefined protocol. RESULTS One hundred of 117 (85 %) of patients with complete data achieved the target ferritin level ≥ 30 µg/L after a single FCM dose. Of 77 patients with IDA and complete data, 38 (49%) showed a complete hematological response within 6-12 weeks; a complete or partial response was achieved by 83%. Clinical symptoms improved in 85% of all patients. In 92% of patients (n = 133 /144), FCM infusion was uneventful. During the 96-hour follow-up, five patients reported potentially related symptoms. No serious adverse events occurred. CONCLUSION The study confirms the safety and efficacy of FCM in children (aged 18 months and older) and adolescents unresponsive to oral therapy, in real-world experience. Single-dose FCM treatment was followed by clinical improvement with advantages of safety, compliance, and lower cost compared with previous generation parenteral iron preparations that had to be administered in fractionated sessions.
Collapse
Affiliation(s)
- Hulya Ozsahin
- Centre de Pédiatrie, Clinique des Grangettes, Chêne-Bougeries, Switzerland
| | - Michela Schaeppi
- Centre de Pédiatrie, Clinique des Grangettes, Chêne-Bougeries, Switzerland
| | - Michael Bernimoulin
- Department of Oncology and Hematology, Hôpital de La Tour, Meyrin, Switzerland.,Dianalabs Medical Laboratory, Geneva, Switzerland
| | - Magali Allard
- Centre de Pédiatrie, Clinique des Grangettes, Chêne-Bougeries, Switzerland
| | - Clémence Guidard
- Centre de Pédiatrie, Clinique des Grangettes, Chêne-Bougeries, Switzerland
| | | |
Collapse
|
14
|
Anemia in Children With Inflammatory Bowel Disease: A Position Paper by the IBD Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2020; 71:563-582. [PMID: 32947565 DOI: 10.1097/mpg.0000000000002885] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anemia is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). It can be asymptomatic or associated with nonspecific symptoms, such as irritability, headaches, fatigue, dizziness, and anorexia. In IBD patients, the etiology of anemia is often multifactorial. Various causes include iron deficiency, anemia of inflammation and chronic disease, vitamin deficiencies, hemolysis, or myelosuppressive effect of drugs. Anemia and iron deficiency in these patients may be underestimated because of their insidious onset, lack of standardized screening practices, and possibly underappreciation that treatment of anemia is also required when treating IBD. Practitioners may hesitate to use oral preparations because of their intolerance whereas intravenous preparations are underutilized because of fear of adverse events, availability, and cost. Several publications in recent years have documented the safety and comparative efficacy of various intravenous preparations. This article reviews management of anemia in children with IBD, including diagnosis, etiopathogenesis, evaluation of a patient, protocol to screen and monitor patients for early detection and response to therapy, treatment including parenteral iron therapy, and newer approaches in management of anemia of chronic disease. This report has been compiled by a group of pediatric gastroenterologists serving on the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) IBD committee, in collaboration with a pediatric hematologist, pharmacist, and a registered dietician who specializes in pediatric IBD (IBD Anemia Working Group), after an extensive review of the current literature. The purpose of this review is to raise awareness of under-diagnosis of anemia in children with IBD and make recommendations for screening, testing, and treatment in this population.
Collapse
|
15
|
Bayoumi I, Parkin PC, Birken CS, Maguire JL, Borkhoff CM. Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children. JAMA Netw Open 2020; 3:e208603. [PMID: 32729920 DOI: 10.1001/jamanetworkopen.2020.8603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Iron deficiency (ID) has the greatest prevalence in early childhood and has been associated with poor developmental outcomes. Previous research examining associations of income and food insecurity (FI) with ID is inconsistent. OBJECTIVE To examine the association of family income and family risk of FI with iron status in healthy young children attending primary care. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 1245 children aged 12 to 29 months who attended scheduled primary care supervision visits from 2008 to 2018 in Toronto, Canada, and the surrounding area. EXPOSURES Family income and risk of FI were collected from parent-reported questionnaires. Children whose parents provided an affirmative response to the 1-item FI screen on the Nutrition Screening Tool for Every Toddler or at least 1 item on the 2-item Hunger Vital Sign FI screening tool were categorized as having family risk of FI. MAIN OUTCOMES AND MEASURES Iron deficiency (serum ferritin level <12 ng/mL) and ID anemia (IDA; serum ferritin level <12 ng/mL and hemoglobin level <11.0 g/dL). All models were adjusted for age, sex, birth weight, body mass index z score, C-reactive protein level, maternal education, breastfeeding duration, bottle use, cow's milk intake, and formula feeding in the first year. RESULTS Of 1245 children (595 [47.8%] girls; median [interquartile range] age, 18.1 [13.3-24.0] months), 131 (10.5%) were from households with a family income of less than CAD $40 000 ($29 534), 77 (6.2%) were from families at risk of FI, 185 (14.9%) had ID, and 58 (5.3%) had IDA. The odds of children with a family income of less than CAD $40 000 having ID and IDA were 3 times higher than those of children in the highest family income group (ID: odds ratio [OR], 3.08; 95% CI, 1.66-5.72; P < .001; IDA: OR, 3.28; 95% CI, 1.22-8.87; P = .02). Being in a family at risk of FI, compared with all other children, was not associated with ID or IDA (ID: OR, 0.43; 95% CI, 0.18-1.02; P = .06; IDA: OR, 0.16; 95% CI, 0.02-1.23; P = .08). CONCLUSIONS AND RELEVANCE In this study, low family income was associated with increased risk of ID and IDA in young children. Risk of FI was not a risk factor for ID or IDA. These findings suggest that targeting income security may be more effective than targeting access to food to reduce health inequities in the prevention of iron deficiency.
Collapse
Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
- Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- St Michael's Hospital, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | | |
Collapse
|
16
|
Gunaseelan V, Parkin PC, Wahi G, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. Maternal ethnicity and iron status in early childhood in Toronto, Canada: a cross-sectional study. BMJ Paediatr Open 2020; 4:e000635. [PMID: 32509978 PMCID: PMC7254107 DOI: 10.1136/bmjpo-2020-000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between maternal ethnicity and iron deficiency (ID) in early childhood, and to evaluate whether infant feeding practices linked to ID differ between maternal ethnic groups. METHODS This was a cross-sectional study of healthy children 1-3 years of age. Adjusted multivariable logistic regression analyses were used to evaluate the association between maternal ethnicity and ID (serum ferritin <12 µg/L) and the association between maternal ethnicity and five infant feeding practices (breastfeeding duration; bottle use beyond 15 months; current formula use; daily cow's milk intake >2 cups; meat consumption). RESULTS Of 1851 children included, 12.2% had ID. Compared with the European referent group, we found higher odds of ID among children of South Asian and West Asian/North African maternal ethnicities, and lower odds of ID among children of East Asian maternal ethnicity. Statistically significant covariates associated with higher odds of ID included longer breastfeeding duration and daily cow's milk intake >2 cups. Current infant formula use was associated with lower odds of ID. Children of South Asian maternal ethnicity had higher odds of bottle use beyond 15 months of age and lower odds of meat consumption. CONCLUSIONS We found increased odds of ID among children of South Asian and West Asian/Northern African maternal ethnicities. We found a higher odds of feeding practices linked to ID in children of South Asian maternal ethnicity, but not in children of West Asian/North African maternal ethnicity. Culturally tailored approaches to providing guidance to parents on healthy infant feeding practices may be important to prevent ID in early childhood. TRIAL REGISTRATION NUMBER NCT01869530.
Collapse
Affiliation(s)
- Vinusha Gunaseelan
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada
| | | |
Collapse
|
17
|
Hanna M, Fogarty M, Loughrey C, Thompson A, Macartney C, Thompson A, McNaughten B. How to use… iron studies. Arch Dis Child Educ Pract Ed 2019; 104:321-327. [PMID: 30504447 DOI: 10.1136/archdischild-2018-315234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/04/2022]
Abstract
Iron studies are frequently requested in paediatric practice. They are useful both as a diagnostic tool and as a way of monitoring certain conditions, particularly those causing iron overload. This article outlines the physiology of iron metabolism and discusses laboratory aspects of performing iron studies, including factors influencing interpretation. Clinical scenarios are used to highlight how the tests can be used in different clinical situations.
Collapse
Affiliation(s)
- Martin Hanna
- Children's Haematology Unit, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Michael Fogarty
- College of Science, National University of Ireland Galway, Galway, Ireland
| | - Clodagh Loughrey
- Clinical Biochemistry Department, Belfast Health and Social Care Trust, Belfast, UK
| | - Anthony Thompson
- Children's Haematology Unit, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Christine Macartney
- Children's Haematology Unit, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew Thompson
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Ben McNaughten
- General Paediatric Department, Altnagelvin Hospital, Londonderry, UK
| |
Collapse
|
18
|
Larsson SM, Hillarp A, Hellström-Westas L, Domellöf M, Lundahl T, Andersson O. When age really matters; ferritin reference intervals during infancy revisited. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:590-594. [DOI: 10.1080/00365513.2019.1681028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sara Marie Larsson
- Department of Clinical Chemistry, Hospital of Halland, Varberg Sweden
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden
| | - Andreas Hillarp
- Department of Clinical Chemistry, Hospital of Halland, Varberg Sweden
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Tom Lundahl
- Department of Clinical Chemistry, Hospital of Halland, Varberg Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden
| |
Collapse
|
19
|
Gromark C, Harris RA, Wickström R, Horne A, Silverberg-Mörse M, Serlachius E, Mataix-Cols D. Establishing a Pediatric Acute-Onset Neuropsychiatric Syndrome Clinic: Baseline Clinical Features of the Pediatric Acute-Onset Neuropsychiatric Syndrome Cohort at Karolinska Institutet. J Child Adolesc Psychopharmacol 2019; 29:625-633. [PMID: 31170007 PMCID: PMC6786340 DOI: 10.1089/cap.2018.0127] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a descriptive clinical entity defined by the abrupt onset of psychiatric and somatic symptoms leading to significant loss of function. Data on well-characterized PANS patients are limited, biomarkers have yet to be identified, and a solid evidence base to guide treatment is lacking. In this study, we present our experience of a systematic evaluation of the first 45 patients included in a Swedish cohort. Methods: During the period 2014-2018, our clinic received 100 referrals regarding suspected PANS. All patients underwent a standardized psychiatric/medical evaluation by a child/adolescent psychiatrist and a clinical psychologist or a nurse. Those with severe symptoms were also assessed by a pediatric neurologist and a pediatric rheumatologist. Laboratory tests were obtained at different time points in an attempt to capture an active disease state. Results: Of the 100 referrals, 45 met strict PANS criteria and consented to participate in a long-term follow-up study. The median age at intake was 7.2 years (range 3.0-13.1) and 56% were male. Ninety-three percent fulfilled both criteria for acute/atypical onset of PANS symptoms and having had an infection in relation to onset. Sixteen percent had an onset of an autoimmune or inflammatory disorder in temporal relation to the onset of PANS-related symptoms. The most common onset symptoms were obsessive-compulsive disorder (89%), anxiety (78%), and emotional lability (71%). Twenty-four percent had a preexisting autoimmune disease (AD) and 18% a preexisting psychiatric/neuropsychiatric diagnosis. Sixty-four percent of biological relatives had at least one psychiatric disorder and 76% at least one AD or inflammatory disorder. Complement activation (37%), leukopenia (20%), positive antinuclear antibodies (17%), and elevated thyroid antibodies (11%) were the most common laboratory findings. Conclusions: In our PANS cohort, there was a strong indication of an association with AD. Further work is needed to establish whether any of the potential biomarkers identified will be clinically useful. Long-term follow-up of these patients using the Swedish national registers will enable a deeper understanding of the course of this patient group.
Collapse
Affiliation(s)
- Caroline Gromark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- BUP OCD and Related Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Robert A. Harris
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ronny Wickström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Division of Pediatric Neurology, Karolinska University Hospital, Solna, Sweden
| | - AnnaCarin Horne
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Division of Pediatric Rheumatology, Karolinska University Hospital, Solna, Sweden
| | - Maria Silverberg-Mörse
- BUP OCD and Related Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- BUP OCD and Related Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
20
|
Sypes EE, Parkin PC, Birken CS, Carsley S, MacArthur C, Maguire JL, Borkhoff CM. Higher Body Mass Index Is Associated with Iron Deficiency in Children 1 to 3 Years of Age. J Pediatr 2019; 207:198-204.e1. [PMID: 30630632 DOI: 10.1016/j.jpeds.2018.11.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/11/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the association between body mass index (BMI) and iron deficiency in early childhood, while considering the influence of low-grade systemic inflammation. STUDY DESIGN Healthy children ages 1-3 years were included in a cross-sectional analysis. Age- and sex-standardized World Health Organization BMI z score (zBMI) was calculated using height/length and weight measurements; iron status was assessed by serum ferritin; inflammation was assessed by C-reactive protein (CRP). Children with CRP ≥10 mg/L were excluded because this may indicate acute systemic inflammation. Adjusted multivariable regression analyses were used to investigate the association between zBMI and both serum ferritin (µg/L), and iron deficiency (serum ferritin <12 µg/L). We performed prespecified subgroup analyses according to CRP level (normal [≤1.0 mg/L] and low-grade inflammation [>1.0 mg/L to <10.0 mg/L]). RESULTS Of 1607 children included, 20% were categorized as with zBMI >1, 13% had iron deficiency, and 18% had low-grade inflammation. Higher zBMI was associated with lower serum ferritin (-1.51 µg/L, 95% CI -2.23, -0.76, P < .0001) and increased odds of iron deficiency (OR 1.28, 95% CI 1.10, 1.50, P = .002). Though there was no interaction between zBMI and CRP for the adjusted linear regression model (P = .79) or logistic regression model (P = .43), children with low-grade inflammation had a higher serum ferritin (P < .0001). CONCLUSIONS Higher zBMI is associated with increased risk for iron deficiency in children between 1 and 3 years, and should be considered as a risk factor in targeted screening. Further research is needed to better understand the relationship between serum ferritin and CRP for children in all weight categories. TRIAL REGISTRATION ClinicalTrials.gov: NCT01869530.
Collapse
Affiliation(s)
- Emma E Sypes
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Sick Kids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Sick Kids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Carsley
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Sick Kids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Colin MacArthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Sick Kids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Sick Kids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
21
|
Oatley H, Borkhoff CM, Chen S, Macarthur C, Persaud N, Birken CS, Maguire JL, Parkin PC. Screening for Iron Deficiency in Early Childhood Using Serum Ferritin in the Primary Care Setting. Pediatrics 2018; 142:peds.2018-2095. [PMID: 30487142 DOI: 10.1542/peds.2018-2095] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The American Academy of Pediatrics recommends universal screening for anemia using hemoglobin at 12 months. However, hemoglobin lacks diagnostic accuracy for iron deficiency, and the optimal age for screening has not been determined. Our objective was to assess a screening strategy for iron deficiency using serum ferritin. METHODS We conducted a cross-sectional study of children 1 to 3 years old attending a health supervision visit. We examined the relationship between child age and serum ferritin, age and hemoglobin, hemoglobin and serum ferritin, and the prevalence of elevated C-reactive protein (CRP). RESULTS Restricted cubic spline analysis (n = 1735) revealed a nonlinear relationship between age and serum ferritin (P < .0001). A linear spline model revealed that from 12 to 15 months, for each 1-month increase in age, serum ferritin levels decreased by 9% (95% confidence interval [CI]: 5 to 13). From 15 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each month increase in age, serum ferritin increased by 2% (95% CI: 1 to 2). For hemoglobin, from 12 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each 1-month increase in age, hemoglobin increased by 20% (95% CI: 9 to 32). Compared with the serum ferritin cutoff of <12 μg/L, the hemoglobin cutoff of <110 g/L had a sensitivity of 25% (95% CI: 19 to 32) and a specificity of 89% (95% CI: 87 to 91). Elevated CRP ≥10 mg/L occurred in 3.3% (95% CI: 2.5 to 4.2). CONCLUSIONS Screening for iron deficiency using serum ferritin at 15 or 18 months may be a promising strategy. For children at low risk for acute inflammation, concurrent measurement of CRP may not be necessary.
Collapse
Affiliation(s)
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Shiyi Chen
- Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Colin Macarthur
- Department of Pediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Navindra Persaud
- Joannah & Brian Lawson Centre for Child Nutrition, and.,Departments of Family Medicine and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and.,Joannah & Brian Lawson Centre for Child Nutrition, and
| | - Jonathon L Maguire
- Department of Pediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Joannah & Brian Lawson Centre for Child Nutrition, and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Pediatrics, and
| | - Patricia C Parkin
- Department of Pediatrics, Faculty of Medicine, .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and.,Joannah & Brian Lawson Centre for Child Nutrition, and
| | | |
Collapse
|