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Liu HW, Gao LM, Liu GY, Tai WJ, Xie CY, Wu X. Effects of Maternal Dietary Enteromorpha prolifera Polysaccharide Iron Supplement on Mineral Elements and Iron Level of Neonatal Piglets. Biol Trace Elem Res 2024; 202:2588-2597. [PMID: 37758982 DOI: 10.1007/s12011-023-03874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Iron plays a key role in maternal health during pregnancy and fetal growth. Enteromorpha polysaccharide-iron (EP-Fe) as an organic iron chelate may improve the iron transmission of mother and offspring, ameliorate the poor pregnancy outcomes of sows, and alleviate the growth restriction of piglets caused by iron deficiency. This study aimed to evaluate the effects of maternal dietary supplementation with EP-Fe on reproductive performance and placental iron transmission of sows, as well as growth performance of piglets. Sixty pregnant sows at the 95th day of gestation were randomly divided into control group and EP-Fe group (EP-Fe, 139 mg kg-1). Blood samples of sows and neonatal piglets, colostrum, and tissue samples were collected on the day of delivery. The animal experiment ended at the 21st day of post-delivery. Results showed that maternal dietary EP-Fe increased colostrum iron (P < 0.05) of sows, as well as final litter weight (P < 0.05) and average daily weight of piglets (P < 0.05) during days 1-21 of lactation, as well as iron and manganese content in umbilical cord blood (P < 0.05) and hepatic iron of neonatal piglets (P < 0.01), and decreased fecal iron (P < 0.001), serum calcium (P < 0.05), phosphorus (P < 0.05), and zinc (P < 0.01) in the parturient sow. RT-qPCR results showed that Fpn1 and Zip14 in placenta, as well as TfR1 and Zip14 in duodenum of neonatal piglets, were activated by maternal EP-Fe supplement. These findings suggest that maternal dietary EP-Fe could increase iron storage of neonatal piglets via improving placental iron transport and iron secretion in colostrum, thus enhancing the growth performance of sucking piglets.
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Affiliation(s)
- Hong-Wei Liu
- College of Environment and Ecology, Hunan Agricultural University, Changsha, 410128, China
- CAS Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China
| | - Lu-Min Gao
- CAS Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China
| | - Gang-Yi Liu
- CAS Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China
| | - Wen-Jing Tai
- Qingdao Seawin Biotech Group Co., Ltd., Qingdao, 266071, China
| | - Chun-Yan Xie
- Tianjin Key Laboratory of Animal Molecular Breeding and Biotechnology, Tianjin Livestock and Poultry Health Breeding Technology Engineering Center, Institute of Animal Science and Veterinary, Tianjin Academy of Agricultural Sciences, Tianjin, 300381, China.
| | - Xin Wu
- CAS Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China
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2
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Iddrisu I, Monteagudo-Mera A, Poveda C, Shahzad M, Walton GE, Andrews SC. A review of the effect of iron supplementation on the gut microbiota of children in developing countries and the impact of prebiotics. Nutr Res Rev 2024:1-9. [PMID: 38586996 DOI: 10.1017/s0954422424000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Iron is essential for many physiological functions of the body, and it is required for normal growth and development. Iron deficiency (ID) is the most common form of micronutrient malnutrition and is particularly prevalent in infants and young children in developing countries. Iron supplementation is considered the most effective strategy to combat the risk of ID and ID anaemia (IDA) in infants, although iron supplements cause a range of deleterious gut-related problems in malnourished children. The purpose of this review is to assess the available evidence on the effect of iron supplementation on the gut microbiota during childhood ID and to further assess whether prebiotics offer any benefits for iron supplementation. Prebiotics are well known to improve gut-microbial health in children, and recent reports indicate that prebiotics can mitigate the adverse gut-related effects of iron supplementation in children with ID and IDA. Thus, provision of prebiotics alongside iron supplements has the potential for an enhanced strategy for combatting ID and IDA among children in the developing world. However, further understanding is required before the benefit of such combined treatments of ID in nutritionally deprived children across populations can be fully confirmed. Such enhanced understanding is of high relevance in resource-poor countries where ID, poor sanitation and hygiene, alongside inadequate access to good drinking water and poor health systems, are serious public health concerns.
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Affiliation(s)
- Ishawu Iddrisu
- Rose Ward, Prospect Park Hospital, Berkshire Healthcare NHS Foundation Trust, Reading, RG30 4EJ, UK
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
- School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6EX, UK
| | - Andrea Monteagudo-Mera
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Carlos Poveda
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Muhammed Shahzad
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Faculty of Dentistry, Zarqa University, Zarqa, 13110, Jordan
| | - Gemma E Walton
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Simon C Andrews
- School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6EX, UK
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3
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Kim HH, Lee EJ, Kim JK. Rapid increase in the body mass index of very preterm infants is a risk factor for iron deficiency during infancy. Sci Rep 2023; 13:15526. [PMID: 37726416 PMCID: PMC10509161 DOI: 10.1038/s41598-023-42531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
Iron deficiency (ID) in very preterm infants born at 28-32 weeks of gestational age (GA) can lower mental and motor test scores. This study aimed to determine whether the rapid growth of very preterm infants might be associated with ID. Among 134 very preterm born between January 2014 and December 2020 at Jeonbuk National University Hospital and discharged home, 93 were included in this study. Rapid BMI increase (RBI) was defined as a z-score difference of > 1 standard deviation between birth and 8 months. ID occurred in 23 of 93 (24.7%) infants at 8 months of corrected age (CA). ID was more common in the RBI group (50%) than in the non-RBI group (18.7%). In the multivariate logistic regression corrected for GA, infants small for gestational age (SGA) (odds ratio [OR] 6.06, 95% confidence interval [CI] 1.34-30.21) and RBI by z-score (OR 4.26, 95% CI 1.28-14.65) were identified as independent risk factors for ID at 8 months of CA. Conclusively, both SGA and RBI in the early life of very preterm were risk factors for ID at 8 months of CA.
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Affiliation(s)
- Hyun Ho Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Statistics and Data Science, Korea National Open University, Seoul, South Korea
| | - Eun Jee Lee
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, South Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
- Department of Pediatrics, Jeonbuk National University Children's Hospital, 20 Geonjiro, Jeonju, 54907, South Korea.
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4
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Bäckström F, Chmielewska A, Domellöf M, Berglund SK. Normal range and predictors of serum erythroferrone in infants. Pediatr Res 2023; 94:965-970. [PMID: 37069224 PMCID: PMC10444606 DOI: 10.1038/s41390-023-02594-2] [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] [Received: 10/13/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Erythroferrone (ERFE) has been identified as a hepcidin-regulating hormone synthetized by erythroblasts correlating to the erythropoietic activity and the needs for iron substrate in bone marrow of adults. The present study aimed to assess the ERFE serum concentrations and its predictors in infants. METHODS ERFE was explored at 4 time points during the first year of life in 45 healthy, breastfed, normal birth weight (NBW) infants, and 136 marginally low birth weight infants (LBW, 2000-2500 g) receiving iron (N = 58) or placebo (N = 78) between 6 weeks and 6 months of age. RESULTS ERFE concentrations were low at birth, increasing gradually during the first year of life. In NBW infants, reference ranges (5th to 95th percentile) were at 6 weeks <0.005-0.99 ng/mL and at 12 months <0.005-33.7 ng/mL. ERFE was higher in LBW infants at 6 weeks but lower at 12 months compared to NBW and minimally affected by iron supplementation among LBW infants. Correlations of ERFE with erythropoietic and iron status markers were weak and inconsistent. CONCLUSIONS The role of ERFE in the crosstalk of erythropoiesis and iron homeostasis remains unclear in infants and further studies on ERFE in infants and older children are warranted within the framework of the erythropoietin-ERFE-hepcidin axis. IMPACT Normal range of erythroferrone in healthy infants is described for the first time. Erythroferrone in infants lacks correlation to iron status and markers of erythropoiesis. The findings indicate differences in infant regulation of iron homeostasis as compared to adults. The findings point to a need to study infant erythropoiesis separately from its adult counterpart. The findings may have clinical impact on management strategies of iron-loading anemia in infancy.
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Affiliation(s)
- Fredrik Bäckström
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Anna Chmielewska
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden.
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Chung Y, Desiraju S, Namachivayam K, Guzman P, He L, MohanKumar K. Hematological changes in neonatal mice with phlebotomy-induced anemia. Pediatr Res 2022; 92:1575-1579. [PMID: 35322186 PMCID: PMC9500113 DOI: 10.1038/s41390-022-02023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/18/2021] [Accepted: 03/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anemia is a nearly universal diagnosis in preterm infants, caused by phlebotomy, and exacerbated by the underlying erythropoietic immaturity. Newborn infants are exposed to the unique stressor of fetal-to-neonatal transition, which requires significant adaptation ex utero. Accordingly, the preterm infant's response to anemia may alter the ability to confront underlying illness. This study utilized our preclinical mouse model of phlebotomy-induced anemia (PIA) to comprehensively investigate associated hematological changes. METHODS C57BL/6 mice were subjected to timed phlebotomy between postnatal days 2--10 to induce severe anemia. Complete blood counts were determined by the Sysmex XT-2000iV analyzer. RESULTS Anemic pups showed a gradual reduction of RBC and hemoglobin (Hb) and increased reticulocyte (RET) counts and red cell distribution width (RDW), however, with reduced RET-Hb from postnatal day (P) of 4 onwards. Elevated levels of high fluorescent RET and immature reticulocyte fraction (IRF) were noted in anemic mouse pups, but low and medium fluorescent RET were reduced. Also, the reduction of mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were noted in anemic pups. No changes were seen in lymphocytes, but monocytes and neutrophils were significantly elevated from P4-P6. CONCLUSIONS PIA in mouse pups is associated with hematological changes that may be exacerbating factors in neonatal diseases. IMPACT Anemia is common and often severe in premature infants. Investigation of hematological parameters in settings of preclinical anemia may be an index of therapeutic strategies. Preclinical model evaluating the effects of neonatal anemia on the remainder of complete blood count. Detailed time kinetic phlebotomy-induced anemic mice enable us to study the impact on developmental delays in erythropoiesis and possible strategic intervention. Hematological effects of severe anemia in mice might provide insight on how best to investigate anemia in preterm infants.
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Affiliation(s)
- Yerin Chung
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Suneetha Desiraju
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | | | - Pierre Guzman
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Ling He
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Department of Pharmacology & Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Krishnan MohanKumar
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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6
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Manapurath RM, Gadapani Pathak B, Sinha B, Upadhyay RP, Choudhary TS, Chandola TR, Mazumdar S, Taneja S, Bhandari N, Chowdhury R. Enteral Iron Supplementation in Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188640. [PMID: 35921671 DOI: 10.1542/peds.2022-057092i] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Iron is needed for growth and development of infants globally, but preterm and low birth weight (LBW) infants are at risk for severe iron deficiencies. To assess the effect of enteral iron supplementation on mortality, morbidity, growth, and neurodevelopment outcomes in preterm or LBW infants fed human milk. Secondary objectives were to assess the effect on biomarkers and dose and timing. METHODS Data sources include PubMed, Embase and Cochrane Library databases to March 16, 2021. Study Selection includes controlled or quasi experimental study designs. Two reviewers independently extracted data. RESULTS Eight trials (eleven reports; 1093 participants, 7 countries) were included. No trials reported mortality. At latest follow-up, there was little effect on infection (very low certainty evidence, 4 studies, 401 participants, relative risk [RR] 0.98, 95% confidence interval [95% CI] 0.56 to 1.73, I2 = 0.00%) and necrotising enterocolitis (3 studies, 375 participants, RR 1.47, 95% CI 0.68 to 3.20, I2 = 0.00%). There was an increase in linear growth (length) (moderate certainty evidence, 3 studies, 384 participants, mean difference 0.69 cm, 95% CI 0.01 to 1.37, I2 = 0%) but little effect on weight, head circumference, or cognitive development. There was an improvement in anemia (moderate certainty evidence, 2 studies, 381 participants, RR 0.25, 95% CI 0.10 to 0.62, I2 = 0.00%) but no effect on serum ferritin. Limitations include heterogeneity in the included studies. CONCLUSIONS There are important benefits for human milk-fed preterm and LBW infants from enteral iron supplementation. However, more randomized control trials are required to improve the certainty of evidence.
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Affiliation(s)
- Rukman M Manapurath
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Barsha Gadapani Pathak
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bireshwar Sinha
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.,DBT and Wellcome India Alliance Clinical and Public Health Fellow, Hyderabad, India
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.,DBT and Wellcome India Alliance Clinical and Public Health Fellow, Hyderabad, India
| | - Tarun Shankar Choudhary
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Sarmila Mazumdar
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.,DBT and Wellcome India Alliance Clinical and Public Health Fellow, Hyderabad, India
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7
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M K AK, Pournami F, Prabhakar J, Nandakumar A, Jain N. Iron Status of the Moderate and Late Preterm Infant: A Prospective Cohort Study. J Trop Pediatr 2021; 67:6401040. [PMID: 34664076 DOI: 10.1093/tropej/fmab088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Guidelines on micronutrient supplementation in moderate to late preterm infants (MLP) are mostly extrapolated from those for smaller preterms, largely due to lack of systematic studies on physiological status in this special group of infants. Actual practices vary widely. We prospectively studied iron status by measurement of serum ferritin (SF) and haematological indices at 4 months corrected age in infants born between 32 and 36 weeks gestation (MLP), after they received 2 mg/kg/day oral iron from 6 weeks of postnatal age. Proportion of MLP having normal iron status (iron replete), i.e., neither iron deficiency (ID) nor iron excess was measured. ID anaemia, growth and development, risk factors for ID were also analysed. Of the 82 infants studied, 78% babies were late preterm. Seventy-four (90.3%) were iron replete (no deficiency or excess) at 4 months. High variability in SF levels (minimum of 9.8 to maximum of 252.2 μg/l) with median (IQR) of 57.45 μg/l (37.02-98.85) was noted in the entire cohort; and also within those who were iron deficient with median (IQR) of 17.50 μg/l (11.70-18.90). There was no difference in haematological indices of ID infants when compared to those with normal iron status. Inspite of oral iron supplementation with reasonable compliance, 8.5% MLP were iron deficient at 4 months corrected age. The high variability noted in SF levels could justify the need for monitoring iron status in this group of preterm infants. This could quintessentially aid individualization of iron supplementation advice.
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Affiliation(s)
- Alok Kumar M K
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Femitha Pournami
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Jyothi Prabhakar
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Anand Nandakumar
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Naveen Jain
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, India
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8
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Iron deficiency during the first 1000 days of life: are we doing enough to protect the developing brain? Proc Nutr Soc 2021; 81:108-118. [PMID: 34548120 DOI: 10.1017/s0029665121002858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Iron is essential for the functioning of all cells and organs, most critically for the developing brain in the fundamental neuronal processes of myelination, energy and neurotransmitter metabolism. Iron deficiency, especially in the first 1000 days of life, can result in long-lasting, irreversible deficits in cognition, motor function and behaviour. Pregnant women, infants and young children are most vulnerable to iron deficiency, due to their high requirements to support growth and development, coupled with a frequently inadequate dietary supply. An unrecognised problem is that even if iron intake is adequate, common pregnancy-related and lifestyle factors can affect maternal-fetal iron supply in utero, resulting in an increased risk of deficiency for the mother and her fetus. Although preterm birth, gestational diabetes mellitus and intrauterine growth restriction are known risk factors, more recent evidence suggests that maternal obesity and delivery by caesarean section further increase the risk of iron deficiency in the newborn infant, which can persist into early childhood. Despite the considerable threat that early-life iron deficiency poses to long-term neurological development, life chances and a country's overall social and economic progress, strategies to tackle the issue are non-existent, too limited or totally inappropriate. Prevention strategies, focused on improving the health and nutritional status of women of reproductive age are required. Delayed cord clamping should be considered a priority. Better screening strategies to enable the early detection of iron deficiency during pregnancy and early-life should be prioritised, with intervention strategies to protect maternal health and the developing brain.
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9
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Carlsson Y, Bergman L, Zaigham M, Linden K, Andersson O, Veje M, Sandström A, Wikström AK, Östling H, Fadl H, Domellöf M, Blomberg M, Brismar Wendel S, Åden U, Sengpiel V. COVID-19 in Pregnancy and Early Childhood (COPE): study protocol for a prospective, multicentre biobank, survey and database cohort study. BMJ Open 2021; 11:e049376. [PMID: 34521667 PMCID: PMC8441224 DOI: 10.1136/bmjopen-2021-049376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is limited knowledge on how the SARS-CoV-2 affects pregnancy outcomes. Studies investigating the impact of COVID-19 in early pregnancy are scarce and information on long-term follow-up is lacking.The purpose of this project is to study the impact of COVID-19 on pregnancy outcomes and long-term maternal and child health by: (1) establishing a database and biobank from pregnant women with COVID-19 and presumably non-infected women and their infants and (2) examining how women and their partners experience pregnancy, childbirth and early parenthood in the COVID-19 pandemic. METHODS AND ANALYSIS This is a national, multicentre, prospective cohort study involving 27 Swedish maternity units accounting for over 86 000 deliveries/year. Pregnant women are included when they: (1) test positive for SARS-CoV-2 (COVID-19 group) or (2) are non-infected and seek healthcare at one of their routine antenatal visits (screening group). Blood, as well as other biological samples, are collected at different time points during and after pregnancy. Child health up to 4 years of age and parent experience of pregnancy, delivery, early parenthood, healthcare and society in general will be examined using web-based questionnaires based on validated instruments. Short- and long-term health outcomes will be collected from Swedish health registers and the parents' experiences will be studied by performing qualitative interviews. ETHICS AND DISSEMINATION Confidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with ethical committee requirements. This study has been granted national ethical approval by the Swedish Ethical Review Authority (dnr 2020-02189 and amendments 2020-02848, 2020-05016, 2020-06696 and 2021-00870) and national biobank approval by the Biobank Väst (dnr B2000526:970). Results from the project will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04433364.
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Affiliation(s)
- Ylva Carlsson
- Department of Obstetrics and Gynaecologyhe, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lina Bergman
- Department of Obstetrics and Gynaecologyhe, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Mehreen Zaigham
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of obstetrics and gynecology, Skåne University Hospital, Malmö, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Pediatrics, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Malin Veje
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Sandström
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Childen's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Östling
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
- Department of Women's Health, Danderyd Hospital, Stockholm, Sweden
| | - Ulrika Åden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal unit, Karolinska University Hospital, Stockholm, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecologyhe, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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10
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Li M, Lv Y, Ying J, Xu L, Chen W, Zheng Q, Ji C, Shao J. Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants. Front Pediatr 2021; 9:687119. [PMID: 34123978 PMCID: PMC8192839 DOI: 10.3389/fped.2021.687119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of this study was to investigate the effects of unified iron supplementation and identify the factors related to the iron homeostasis among preterm infants. Method: A total of 250 preterm infants were divided into neonatal anemic (NA, n = 154) and non-neonatal anemic group (NNA, n = 96). Iron supplements at a dose of 2 mg/kg per day were given from 40 weeks' gestational age to 6 months. Iron status parameters were measured at 3 and 6 months, respectively. Prevalence of iron deficiency (ID) and iron deficiency anemia (IDA), and the correlated factors were analyzed. Growth and side-effects were monitored. Results: There were no significant differences for the prevalence of ID or IDA between the two groups. Multivariate regression analyses showed that higher Hb at birth and early treatment of blood transfusion reduced the risk of ID/IDA at 3 months (all p < 0.05); while higher level of Hb at 3 months (p = 0.004) and formula feeding reduced the occurrence of ID/IDA at 6 months (p < 0.05); males had a 3.35 times higher risk to develop ID/IDA than girls (p = 0.021). No differences in growth and side effects were found. Conclusion: A daily dose of 2 mg/kg iron supplement is beneficial to maintain iron homeostasis in majority preterm infants within 6 months regardless of their neonatal anemia history. Under the routine iron supplementation, Hb level at birth and at 3 months, early treatment of blood transfusion, gender and feeding patterns are the major factors affecting the prevalence of ID/IDA among preterm infants in infancy.
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Affiliation(s)
- Mingyan Li
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ying Lv
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jionghuan Ying
- Department of Pediatrics, Cixi People's Hospital, Cixi, China
| | - Lin Xu
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weijun Chen
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Quan Zheng
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chai Ji
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jie Shao
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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11
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Salvatori G, Martini L. Complementary Feeding in the Preterm Infants: Summary of Available Macronutrient Intakes and Requirements. Nutrients 2020; 12:nu12123696. [PMID: 33266017 PMCID: PMC7760975 DOI: 10.3390/nu12123696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/07/2023] Open
Abstract
Limited data are available regarding the nutritional needs for preterm infants. In most cases, guidelines refer to the acquisition of neuromotor skills, adequate weight and corrected chronological age. While waiting for the establishment of specific nutritional indications for premature infants we proposed the weaning recommendations for term infants of the Italian Society of Human Nutrition with LARNs (Reference intake Levels of Nutrients and energy for the Italian population) of 2014, the Dietary Reference Values for nutrients of European Food Safety Authority (EFSA) of 2017 and the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes of 2017.
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12
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Koim-Puchowska B, Drozdz-Afelt JM, Lamparski R, Menka A, Kaminski P. Antioxidant defence barrier of great tit Parus major nestlings in response to trace elements. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:20321-20334. [PMID: 32239412 PMCID: PMC7244610 DOI: 10.1007/s11356-020-08495-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/17/2020] [Indexed: 04/12/2023]
Abstract
Metals can have direct and indirect effects on the generation of reactive oxygen species in wild birds. The aim of this work has been to examine the effect of exposure to trace metals (copper Cu, iron Fe, cobalt Co, manganese Mn) on oxidative stress biomarkers such as lipoperoxidation TBARS and level of superoxide dismutase SOD, catalase CAT, and reduced glutathione GSH in the livers and kidneys of great tit Parus major nestlings (n = 165, 63 broods) living in polluted environments associated with soda plants and agricultural activities (Kujawy region) and from a reference site (Tuchola Forest), both in the north of Poland. As we predicted, the level of TBARS in both organs of chicks from polluted areas was higher than in those from reference site. This could be connected with Fe concentrations, particularly in areas adjacent to soda plants (livers Rs = 0.49, p < 0.002; kidneys Rs = 0.69, p < 0.001). We also showed differences in the level of antioxidants depending on the environment. CAT activity was higher in nestlings from Kujawy than in those from Tuchola. Meanwhile SOD activity (both organs) and GSH levels (kidneys) were lower in the polluted area compared to the reference site. Concentrations of Cu, Fe, Co, and Mn may play a role in regulating the antioxidant system components' activity.
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Affiliation(s)
- Beata Koim-Puchowska
- Department of Biotechnology, Kazimierz Wielki University, K.J. Poniatowski St12, 85-671, Bydgoszcz, Poland
| | - Joanna M. Drozdz-Afelt
- Department of Biotechnology, Kazimierz Wielki University, K.J. Poniatowski St12, 85-671, Bydgoszcz, Poland
| | - Robert Lamparski
- Department of Biology and Plant Protection, UTP University of Science and Technology, Prof. S. Kaliski St. 7, 85-796 Bydgoszcz, Poland
| | - Aleksandra Menka
- Department of Biotechnology, Kazimierz Wielki University, K.J. Poniatowski St12, 85-671, Bydgoszcz, Poland
| | - Piotr Kaminski
- Collegium Medicum in Bydgoszcz, Department of Ecology and Environmental Protection, Nicolaus Copernicus University, M. Skłodowska-Curie St. 9, 85-094 Bydgoszcz, Poland
- Faculty of Biological Sciences, Institute of Biotechnology and Environmental Protection, Department of Biotechnology, University of Zielona Góra, Prof. Szafran St. 1, 65-516 Zielona Góra, Poland
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13
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McCarthy EK, Dempsey EM, Kiely ME. Iron supplementation in preterm and low-birth-weight infants: a systematic review of intervention studies. Nutr Rev 2020; 77:865-877. [PMID: 31532494 PMCID: PMC6888764 DOI: 10.1093/nutrit/nuz051] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Context Enteral iron supplementation in preterm infants is recommended to supply sufficient iron for growth and development without increasing the risk of iron overload. However, the current recommendations date from 2010 and are based on limited evidence. Objective This systematic review aimed to investigate the effects of enteral iron supplementation on iron status, growth, neurological development, and adverse clinical outcomes in preterm (<37 weeks’ gestation) and low-birth-weight (LBW, <2500 g) infants. Data sources The PubMed/Medline and Cochrane Library databases were searched to 31 October 2018. Data extraction Of the 684 records identified, 27 articles, describing 18 randomized controlled trials (RCTs) plus 4 nonrandomized interventions, were included. Using the Cochrane Collaboration’s criteria, study quality was found to be poor to fair overall. Results Most articles (23/27) reported iron status indices; supplementation for ≥8 weeks resulted in increased hemoglobin and ferritin concentrations and a reduction in iron deficiency and anemia. No article reported on iron overload. Growth-related parameters reported in 12 articles were not affected by supplementation. Among the 7 articles on neurological development, a positive effect on behavior at 3.5 and 7 years was observed in one Swedish RCT. No association was found between supplementation and adverse clinical outcomes in the 9 articles reporting on studies in which such data was collected. Conclusions Long-term iron supplementation appears to result in improved iron status and a reduction in iron deficiency and anemia in preterm and LBW infants. However, high-quality evidence regarding the long-term effects of supplementation on functional health outcomes is lacking. Iron overload has largely been ignored. Well-designed, long-term, dose-response RCTs are required to ascertain the optimal dose and delivery method for the provision of dietary iron in preterm infants, with consideration of short- and long-term health effects. Systematic Review Registration PROSPERO registration no. CRD42018085214.
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Affiliation(s)
- Elaine K McCarthy
- INFANT Research Centre, University College Cork, Cork, Republic of Ireland.,Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
| | - Eugene M Dempsey
- INFANT Research Centre, University College Cork, Cork, Republic of Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Republic of Ireland
| | - Mairead E Kiely
- INFANT Research Centre, University College Cork, Cork, Republic of Ireland.,Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
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Oliver C, Watson C, Crowley E, Gilroy M, Page D, Weber K, Messina D, Cormack B. Vitamin and Mineral Supplementation Practices in Preterm Infants: A Survey of Australian and New Zealand Neonatal Intensive and Special Care Units. Nutrients 2019; 12:E51. [PMID: 31878077 PMCID: PMC7019934 DOI: 10.3390/nu12010051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022] Open
Abstract
Preterm infants are at increased risk of micronutrient deficiencies as a result of low body stores, maternal deficiencies, and inadequate supplementations. The aim of this survey was to investigate current vitamin and mineral supplementation practices and compare these with published recommendations and available evidence on dosages and long-term outcomes of supplementations in preterm infants. In 2018, a two-part electronic survey was emailed to 50 Australasian Neonatal Dietitians Network (ANDiN) member and nonmember dietitians working in neonatal units in Australia and New Zealand. For inpatients, all units prescribed between 400 and 500 IU/day vitamin D, compared to a recommended intake range of 400-1000 IU/day. Two units prescribed 900-1000 IU/day at discharge. For iron, 83% of respondents prescribed within the recommended intake range of 2-3 mg/kg/day for inpatients. Up to 10% of units prescribed 6 mg/kg/day for inpatients and at discharge. More than one-third of units reported routine supplementations of other micronutrients, including calcium, phosphate, vitamin E, and folic acid. There was significant variation between neonatal units in vitamin and mineral supplementation practices, which may contribute to certain micronutrient intakes above or below recommended ranges for gestational ages or birth weights. The variations in practice are in part due to differences in recommended vitamin and mineral intakes between expert groups and a lack of evidence supporting the recommendations for supplementations.
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Affiliation(s)
- Colleen Oliver
- Department of Dietetics and Nutrition, The Royal Women’s Hospital, Melbourne, VIC 3052, Australia
| | - Caitlin Watson
- Department of Dietetics and Nutrition, Monash Children’s Hospital, Melbourne, VIC 3168, Australia;
| | - Elesa Crowley
- Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, NSW 2340, Australia;
- Department of Dietetics and Nutrition, Tamworth Rural Referral Hospital, Tamworth, NSW 2340, Australia
| | - Melissa Gilroy
- Department of Dietetics and Food Services, Mater Group, South Brisbane, QLD 4101, Australia; (M.G.); (D.P.)
| | - Denise Page
- Department of Dietetics and Food Services, Mater Group, South Brisbane, QLD 4101, Australia; (M.G.); (D.P.)
| | - Katrina Weber
- Department of Dietetics and Nutrition, Fiona Stanley Hospital, Perth, WA 6150, Australia; (K.W.); (D.M.)
| | - Deanna Messina
- Department of Dietetics and Nutrition, Fiona Stanley Hospital, Perth, WA 6150, Australia; (K.W.); (D.M.)
| | - Barbara Cormack
- Department of Dietetics and Nutrition, Starship Child Health, Auckland City Hospital, Auckland 1023, New Zealand;
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
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15
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Igweze ZN, Ekhator OC, Nwaogazie I, Frazzoli C, Orisakwe OE. Appropriateness of Essentials Trace Metals in Commonly Consumed Infant Formulae in Nigeria. Open Access Maced J Med Sci 2019; 7:4168-4175. [PMID: 32165971 PMCID: PMC7061406 DOI: 10.3889/oamjms.2019.706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mothers who feed their children with infant food have increased have over the years leaving a large percentage of children who consume other types of liquid food for supplementation or as alternatives. AIM Determining the levels of essential trace metals in these formulae with the aim of ascertain their appropriateness is considered important. METHODS Iron, zinc, manganese, chromium and cobalt in 26 infant formulae purchased from Port Harcourt city, Nigeria were determined by Atomic Absorption Spectrophotometry. The estimated daily intake EDI and percentage of EDI to the recommended daily allowance of these essential trace metals were used in the exposure assessment. RESULTS The highest mean concentration of Mn, Cr and Co was found in the milk based (0.15 ± 0.09 mg/kg), (0.61 ± 0.70 mg/kg), (0.12 ± 0.32 mg/kg) compared to the cereal based and cereal mix based but the differences was also not significant. The EDI of chromium in the infant formulae exceeded the RDA. CONCLUSION Infant formulae may add to the chromium body burden of infants in Nigeria.
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Affiliation(s)
- Zelinjo Nkeiruka Igweze
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Madonna University Elele, Rivers State, Nigeria
| | - Osazuwa Clinton Ekhator
- Department of Science Laboratory Technology, Faculty of Life Sciences, University of Benin, Benin, Nigeria
| | - Ify Nwaogazie
- Department of Civil & Environmental Engineering, Faculty of Engineering, University of Port Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria
| | - Chiara Frazzoli
- Department for Cardiovascular, Dysmetabolic and Aging Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Orish Ebere Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, Rivers State, Nigeria
- World Bank Africa Centre of Excellence in Oilfield Chemicals Research, University of Port Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria
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16
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McCarthy EK, Kiely ME. The neonatal period: A missed opportunity for the prevention of iron deficiency and its associated neurological consequences? NUTR BULL 2019. [DOI: 10.1111/nbu.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. K. McCarthy
- Cork Centre for Vitamin D and Nutrition Research School of Food and Nutritional Sciences University College Cork and INFANT Research Centre Cork Ireland
| | - M. E. Kiely
- Cork Centre for Vitamin D and Nutrition Research School of Food and Nutritional Sciences University College Cork and INFANT Research Centre Cork Ireland
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17
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Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2019; 69:259-270. [PMID: 31095091 DOI: 10.1097/mpg.0000000000002397] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.
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18
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Bora R, Ramasamy S, Brown B, Wolfson J, Rao R. Effect of iron supplementation from neonatal period on the iron status of6-month-old infants at-risk for early iron deficiency: a randomized interventional trial. J Matern Fetal Neonatal Med 2019; 34:1421-1429. [PMID: 31258019 DOI: 10.1080/14767058.2019.1638358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the effects of iron supplementation from the second day after birth on 6-month hemoglobin (Hb), serum ferritin and motor development in infants at risk of early iron deficiency. STUDY DESIGN Term (37-41 weeks) infants of anemic (Hb ≤ 100 g L-1; N = 100) and non-anemic (Hb > 100 g L-1; N = 100) mothers were randomized to daily iron supplementation at a dose of 2 mg kg-1 from 36 h of age (N = 50, each of anemic and non-anemic mothers) or no iron-supplementation (N = 50 each of anemic and non-anemic mothers). Hb, serum ferritin and motor development at 6 months were compared in the two groups. RESULTS Iron-supplemented infants had higher Hb (103.7 ± 9.3 g L-1 versus 97.0 ± 9.4 g L-1, p < .0001) and serum ferritin (133.93 ± 52.41 ng mL-1 versus 78.09 ± 42.03 ng mL-1, p < .001) concentrations, compared with the no iron-supplementation group. Their motor development was closer to age-appropriate norms than the no iron-supplementation group (5.83 ± 0.69 versus 5.18 ± 1.35, p < .01). CONCLUSION Early Iron supplementation is effective for improving iron status and motor development at 6 months in infants at risk for early iron deficiency.
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Affiliation(s)
- Reeta Bora
- Neonatal Unit, Assam Medical College, Dibrugarh, India
| | | | - Benjamin Brown
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Raghavendra Rao
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA
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19
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Iron Deficiency and Iron Homeostasis in Low Birth Weight Preterm Infants: A Systematic Review. Nutrients 2019; 11:nu11051090. [PMID: 31100900 PMCID: PMC6566715 DOI: 10.3390/nu11051090] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 02/08/2023] Open
Abstract
Iron is an essential micronutrient that is involved in many functions in humans, as it plays a critical role in the growth and development of the central nervous system, among others. Premature and low birth weight infants have higher iron requirements due to increased postnatal growth compared to that of term infants and are, therefore, susceptible to a higher risk of developing iron deficiency or iron deficiency anemia. Notwithstanding, excess iron could affect organ development during the postnatal period, particularly in premature infants that have an immature and undeveloped antioxidant system. It is important, therefore, to perform a review and analyze the effects of iron status on the growth of premature infants. This is a transversal descriptive study of retrieved reports in the scientific literature by a systematic technique. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adapted for the review strategy. The inclusion criteria for the studies were made using the PICO (population, intervention, comparison, outcome) model. Consequently, the systematic reviews that included studies published between 2008–2018 were evaluated based on the impact of iron status on parameters of growth and development in preterm infants.
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20
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Starnberg J, Norman M, Westrup B, Domellöf M, Berglund SK. Cardiometabolic risk factors in children born with marginally low birth weight: A longitudinal cohort study up to 7 years-of-age. PLoS One 2019; 14:e0215866. [PMID: 31002705 PMCID: PMC6474616 DOI: 10.1371/journal.pone.0215866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/09/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Low birth weight (LBW, <2500 g) may predict an increased risk of an adverse cardiometabolic profile later in life, but long-term effects in different populations and birth weight strata are still unclear. We explored laboratory markers of cardiometabolic risk in children born with marginally LBW (2000–2500 g). Methods This was a prospective longitudinal cohort study including 285 Swedish marginally LBW children and 95 normal birth weight (NBW, 2501–4500 g) controls. At 3.5 and 7 years of age, blood samples for glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), cholesterol, triglycerides, high- and low density lipoprotein (HDL and LDL), apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) were assessed and compared between the groups. Results No significant differences in levels of insulin, HOMA-IR, hs-CRP or blood lipids were observed between marginally LBW and NBW children. At 7 years there was a higher proportion of marginally LBW children with elevated levels of insulin, defined as above the 90th percentile of the control group (21% vs 8.6%, p = 0.038). This association was, however, confounded by maternal ethnicity. In marginally LBW children born small for gestational age (SGA), mean fasting glucose was significantly higher compared to controls (4.7 vs 4.5 mmol/L, p = 0.020). Conclusions There were no significant differences in insulin, insulin resistance, hs-CRP or blood lipids between the marginally LBW children and controls. The subgroup of marginally LBW children born SGA may present early signs of glucose imbalance already at school age.
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Affiliation(s)
- Josefine Starnberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- * E-mail:
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Westrup
- Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K. Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
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21
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Kim HA, Park SH, Lee EJ. Iron status in small for gestational age and appropriate for gestational age infants at birth. KOREAN JOURNAL OF PEDIATRICS 2018; 62:102-107. [PMID: 30360035 PMCID: PMC6434228 DOI: 10.3345/kjp.2018.06653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE This study compared the iron statuses of small for gestational age (SGA) and appropriate for gestational age (AGA) infants at birth. METHODS The clinical data of 904 newborn infants admitted to the neonatal intensive care unit were reviewed. Blood samples were drawn from the infants within 24 hours after birth. Serum ferritin level was used as a marker of total iron status. RESULTS In this study, 115 SGA (GA, 36.5±2.9 weeks; birth weight [BW], 1,975±594.5 g) and 717 AGA (GA, 35.1±3.5 weeks; BW, 2,420.3±768.7 g) infants were included. The SGA infants had higher hematocrit levels (50.6%±5.8% vs. 47.7%±5.7%, P<0.05) than the AGA infants. No difference in serum ferritin level (ng/mL) was found between the groups (mean [95% confidence interval]: SGA vs. AGA infants, 139.0 [70.0-237.0] vs. 141.0 [82.5-228.5]). After adjusting for gestational age, the SGA infants had lower ferritin levels (147.1 ng/mL [116.3-178.0 ng/mL] vs. 189.4 ng/mL [178.0-200.8 ng/ mL], P<0.05). Total body iron stores were also lower in the SGA infants than in the AGA infants (185.6 [153.4-211.7] vs 202.2 [168.7-241.9], P<0.05). CONCLUSION The SGA infants had lower ferritin and total body iron stores than the AGA infants. The SGA infants affected by maternal hypertension who were born at late preterm had an additional risk of inadequate iron store. Iron deficiency should be monitored in these infants during follow-up.
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Affiliation(s)
- Hyeon A Kim
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sook-Hyun Park
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eun Joo Lee
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Yrjänä JMS, Koski T, Törölä H, Valkama M, Kulmala P. Very early introduction of semisolid foods in preterm infants does not increase food allergies or atopic dermatitis. Ann Allergy Asthma Immunol 2018; 121:353-359. [PMID: 29981439 DOI: 10.1016/j.anai.2018.06.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The optimal age for the introduction of solid foods for infants has long been a controversial issue. OBJECTIVE To determine whether the early introduction of semisolid foods influences the incidence of food allergy or atopic dermatitis among preterm infants. METHODS Retrospective data from 464 preterm infants born in Oulu University Hospital between 2008 and 2012 were analyzed. Age- and sex-matched full-term control children from the general population were identified. The primary outcome of the study was the difference in timing of the introduction of complementary feeding between preterm and full-term infants. The secondary outcomes were the incidences of food allergies and atopic dermatitis by the ages of 1 and 2 years. RESULTS Semisolid food was introduced at the median corrected age of 1.4 months for all preterm infants, at 1.9 months for late preterm, at 0.9 months for very preterm, and at 0.1 months for extremely preterm infants. The cumulative incidence, either of food allergies or of atopic dermatitis, did not differ significantly between preterm infants and controls by the ages of 1 and 2 years. CONCLUSION The very early introduction of complementary foods into the diet of preterm babies did not increase the incidence of food allergies or atopic dermatitis even among the most preterm infants. This finding supports the hypothesis that the gut-associated lymphoid tissue of preterm infants is ready to encounter food proteins and to begin the maturation process within 3 to 6 months of birth, regardless of gestational age.
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Affiliation(s)
- Jaakko M S Yrjänä
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Teppo Koski
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Helena Törölä
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marita Valkama
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Petri Kulmala
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Biomedicine Research Unit, Medical Microbiology and Immunology, University of Oulu, Oulu, Finland
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Starnberg J, Norman M, Westrup B, Domellöf M, Berglund SK. Lower cognitive test scores at age 7 in children born with marginally low birth weight. Pediatr Res 2018. [PMID: 29538361 DOI: 10.1038/pr.2018.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BackgroundBeing born with very low birth weight (<1500 g) is associated with poorer neurocognition later in life. The aim of this study was to explore neurodevelopmental functions in those born with marginally LBW (2000-2500 g).MethodsThis was originally a randomized controlled trial investigating the effects of early iron supplementation in 285 marginally LBW children. Herein, we explored the combined marginally LBW group and compared their results to 95 normal birth weight (NBW; 2501-4500 g) controls in an observational design. At 7 years, a pediatric psychologist tested the children using Wechsler Intelligence Scale for Children (WISC IV), Beery-Buktenica developmental test of Visual-Motor Integration (Beery VMI), and Test of Everyday Attention for Children (TEA-Ch).ResultsThe marginally LBW children had lower verbal comprehension intelligence quotient (IQ) (104 vs. 107, P=0.004), lower VMI scores (96.5 vs. 100, P=0.028), and lower total mean TEA-Ch scores (8.5 vs. 9.7, P=0.006), compared to controls. Also, the marginally LBW children group had a higher proportion of children below -1 SD for VMI and TEA-Ch.ConclusionsMarginally LBW children had lower verbal comprehension IQ, lower visual-motor integration, and lower attention performance than NBW children, suggesting an increased risk of cognitive difficulties in early school age.
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Affiliation(s)
- Josefine Starnberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Westrup
- Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Maternal dietary supplementation with ferrous N-carbamylglycinate chelate affects sow reproductive performance and iron status of neonatal piglets. Animal 2018; 12:1372-1379. [DOI: 10.1017/s1751731117003172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial. Pediatr Res 2018; 83:111-118. [PMID: 28953856 DOI: 10.1038/pr.2017.235] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/16/2017] [Indexed: 02/07/2023]
Abstract
BackgroundLow-birth-weight infants (LBW) are at an increased risk of iron deficiency that has been associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants improves cognitive scores and reduces behavioral problems until school age.MethodsWe randomized 285 marginally LBW (2,000-2,500 g) infants to receive 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 7 years of age, 205 participants were assessed regarding cognition using Wechsler Intelligence Scale for Children (WISC-IV) and behavior using the parental questionnaires Child Behavior Checklist (CBCL) and Five to Fifteen (FTF).ResultsThere were no significant differences between the intervention groups in WISC-IV or FTF. However, the CBCL scores for externalizing problems were significantly different, in favor of supplemented children (P=0.045). When combining the supplemented groups, they had significantly lower scores for externalizing behavior compared with placebo (median (interquartile range): 44 [34;51] vs. 48.5 [41;56] P=0.013), and their risk ratio (95% confidence interval) for a total behavioral score above the cutoff for clinical problems was 0.31 (0.09-1.0), P=0.054.ConclusionLower scores of externalizing behavior in supplemented children support our previous findings at 3 years, and suggest that iron supplementation may have long-lasting effects on behavioral functions.
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Bagna R, Spada E, Mazzone R, Saracco P, Boetti T, Cester EA, Bertino E, Coscia A. Efficacy of Supplementation with Iron Sulfate Compared to Iron Bisglycinate Chelate in Preterm Infants. Curr Pediatr Rev 2018; 14:123-129. [PMID: 29366419 PMCID: PMC6416193 DOI: 10.2174/1573396314666180124101059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/24/2017] [Accepted: 01/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Strategies to prevent anaemia in preterm infants include drawing fewer blood samples, the use of recombinant human erythropoietin and iron supplementation. Although iron sulfate is the most commonly used pharmaceutical formulation for iron supplementation, there are few studies comparing different iron salts in infants. OBJECTIVE This is a study of retrospective data comparison of two groups of preterm infants receiving erythropoietin to evaluate the efficacy of iron bisglycinate chelate to iron sulfate. SUBJECTS AND METHODS Three-hundred infants of gestational age ≤32 weeks were enrolled: 225 were supplemented with iron sulfate (3 mg/kg/day) and 75 were supplemented with iron bisglycinate chelate (0.75 mg/kg/day). The effect on erythropoiesis was assessed with a general linear model that estimates the response variables (values for Haemoglobin, Haematocrit, absolute values and percentage Reticulocytes, Reticulocyte Haemoglobin content) based on treatment, time, birth weight, and gestational age. RESULTS Supplementation with iron bisglycinate chelate at a dose of 0.75 mg/kg/day demonstrated an efficacy comparable to iron sulfate at a dose of 3 mg/kg/day in both populations of preterm infants. The two cohorts had similar erythropoietic response, without significant differences. CONCLUSIONS The higher bioavailability of iron bisglycinate chelate resulted in a lower load of elemental iron, a quarter of the dose, and achieved equivalent efficacy compared to iron sulfate. Iron bisglycinate chelate may appear to be an alternative to iron sulfate in the prevention and treatment of preterm newborn anaemia.
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Affiliation(s)
- Rossana Bagna
- Neonatology and Neonatal Intensive Care Unit, University Hospital, Citta della Salute e della Scienza, Turin, Italy
| | - Elena Spada
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Raffaela Mazzone
- SS Haematology and Coagulation, Department of Laboratory Medicine, Citta della Salute e della Scienza, Turin, Italy
| | - Paola Saracco
- SS Paediatric Haematology, University Department of Paediatric Science, Citta della Salute e della Scienza, Turin, Italy
| | - Tatiana Boetti
- Paediatrics and Neonatology Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Elena Andrea Cester
- Neonatology and Neonatal Intensive Care Unit, University Hospital, Citta della Salute e della Scienza, Turin, Italy
| | - Enrico Bertino
- Neonatology and Neonatal Intensive Care Unit, University Hospital, Citta della Salute e della Scienza, Turin, Italy
| | - Alessandra Coscia
- Neonatology and Neonatal Intensive Care Unit, University Hospital, Citta della Salute e della Scienza, Turin, Italy
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Diurnal variations in iron concentrations and expression of genes involved in iron absorption and metabolism in pigs. Biochem Biophys Res Commun 2017; 490:1210-1214. [DOI: 10.1016/j.bbrc.2017.06.187] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/30/2017] [Indexed: 01/30/2023]
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Lindberg J, Norman M, Westrup B, Domellöf M, Berglund SK. Lower systolic blood pressure at age 7 y in low-birth-weight children who received iron supplements in infancy: results from a randomized controlled trial. Am J Clin Nutr 2017; 106:475-480. [PMID: 28659293 DOI: 10.3945/ajcn.116.150482] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Low birth weight (LBW) (≤2500 g) is associated with iron deficiency in infancy and high blood pressure (BP) later in life.Objective: We investigated the effect of iron supplementation that was given to LBW infants on midchildhood BP.Design: The study was a randomized, double-blind, controlled trial that included 285 marginally LBW (2000-2500-g) infants at 2 Swedish centers between May 2004 and November 2007. The infants were randomly assigned to receive a placebo or 1 or 2 mg Fe · kg-1 · d-1 from 6 wk to 6 mo of age. In secondary analyses at the age of 7 y, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the prevalence of children with BP within the hypertensive range (>90th percentile) were compared between the groups.Results: BP was analyzed via intention to treat in 189 children (66%). The mean ± SD SBP was 103 ± 8.1, 101 ± 7.5, and 101 ± 7.8 mm Hg in children who had received the placebo (n = 70), 1 mg Fe · kg-1 · d-1 (n = 54), or 2 mg Fe · kg-1 · d-1 (n = 65), respectively. When the iron-supplemented groups were combined in covariate-adjusted analyses, the mean SBP in LBW children who had received iron supplementation in infancy was 2.2 mm Hg (95% CI: 0.3, 4.2 mm Hg) lower than in those who were unsupplemented (P = 0.026). Multivariate logistic regression showed that iron supplementation in infancy reduced the odds of having an SBP within the hypertensive range at 7 y of age (OR: 0.32; 95% CI: 0.11, 0.96). For DBP, there were no significant differences between the intervention groups.Conclusions: LBW children who receive iron supplementation (1 or 2 mg Fe · kg-1 · d-1) in infancy have lower SBP at 7 y. This (to our knowledge) novel observation suggests that the increased risk of hypertension that is observed in children and adults who are born small might be reduced with early micronutrient interventions. This trial was registered at clinicaltrials.gov as NCT00558454.
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Affiliation(s)
- Josefine Lindberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden; and
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, and
| | - Björn Westrup
- Division of Neonatology, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden; and
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden; and
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Abstract
Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children. In developing countries, iron deficiency is caused by poor iron intake and parasitic infection. Poor iron intake linked to inadequate diets, low iron intestinal absorption, chronic blood losses and increased requirements are common causes in high-income countries.
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Affiliation(s)
- J-P Olives
- Gastroentérologie et nutrition, Hôpital des enfants, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse Cedex, France.
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Zinc protoporphyrin/heme ratio as parameter of iron status in moderately preterm infants: natural course and associations in the first 4 months. J Perinatol 2017; 37:690-694. [PMID: 28181998 DOI: 10.1038/jp.2017.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/06/2017] [Accepted: 01/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the natural course of zinc protoporphyrin/heme ratio (ZnPP/H) and its role in the detection of iron deficiency (ID) and iron-deficiency anemia (IDA) in the first 4 months of life in moderately preterm infants. STUDY DESIGN ZnPP/H was measured at 1 week, 6 weeks and 4 months postnatal age in a prospective cohort of 161 Dutch infants born at a gestational age of 32+0 to 36+6 weeks who did not receive an erythrocyte transfusion or iron supplementation. RESULTS ZnPP/H levels decreased in the first 6 weeks and increased thereafter. At 4 months postnatal age, ZnPP/H was higher in the 11 (8.5%) infants with IDA (mean (s.d.): 260.8 (16.1)) but not in the 27 (21.3%) infants with ID (mean (s.d.): 177.0 (15.1)) compared with normal infants (mean (s.d.): 157.3 (12.5)). CONCLUSION In moderately preterm infants, ZnPP/H can be of additional value to detect infants at risk for IDA due to iron-deficient erythropoiesis at 4 months of age.
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Lapillonne A, Becquet O. Recommandations pour les apports en fer pendant les six premiers mois de vie. Arch Pediatr 2017. [DOI: 10.1016/s0929-693x(17)24008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Enteral Iron Supplementation in Preterm Infants Has No Adverse Effect on Growth: Evidence From Randomized Trials. J Pediatr Gastroenterol Nutr 2017; 64:e26. [PMID: 28027217 DOI: 10.1097/mpg.0000000000001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Đermanović M, Miletić I, Pavlović Z. A Comparative Analysis of the Contents Of Iron, Zinc, Copper, Manganese, and Calcium in the Collective Diet Of Preschool Children in the Northwestern Region of Bosnia. Biol Trace Elem Res 2017; 175:27-32. [PMID: 27250494 DOI: 10.1007/s12011-016-0755-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/19/2016] [Indexed: 02/02/2023]
Abstract
Researches conducted worldwide indicate a frequent deficiency in mineral matters. Due to the increased need during the period of accelerated growth and development, children belong to the group that is exposed to the highest risk of mineral matter deficiency. Our objectives were to determine the iron, zinc, copper, manganese, and calcium intake in the collective diet of the preschool population in the in the northwestern region of Bosnia- in the Republic of Srpska and to estimate the adequacy of the application of the international food composition tables for nutrition planning relating to mineral matters. Samples of food intended for children's diet were collected in the preschool institution "Radost" (a kindergarten), in the city of Prijedor. In daily portions, Fe, Zn, Cu, Mn, and Ca contents were determined by flame atomic absorption spectrophotometry. Contents of mineral matters in daily meals were also calculated by the food composition tables. An average daily meal contained 2.86 mg of Fe, 1.71 mg of Zn, 0.19 mg of Cu, 0.21 mg of Mn, and 83.5 mg of Ca. With calculation method, contents of all minerals are significantly higher than the experimental data for all used food composition tables. The obtained results indicate a significant deficiency in mineral matters in the collective diet of the preschool population in the Republic of Srpska, a certain non-compliance with the applicable recommendations, and also suggest a need to create food composition tables for food being consumed in our region.
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Affiliation(s)
- Mirjana Đermanović
- Public Health Institute, Jovana Dučića 1, 78 000, Banja Luka, Bosnia and Herzegovina.
| | - Ivanka Miletić
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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Joo EY, Kim KY, Kim DH, Lee JE, Kim SK. Iron deficiency anemia in infants and toddlers. Blood Res 2016; 51:268-273. [PMID: 28090490 PMCID: PMC5234236 DOI: 10.5045/br.2016.51.4.268] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/20/2016] [Accepted: 11/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background In Korea, the prevalence of anemia and iron deficiency anemia (IDA) among older infants and young children remains high. To detect IDA early and to reduce its adverse impact, we assessed the characteristics of infants and young children who had IDA or were at risk of developing IDA, or who exhibited characteristics associated with severe anemia. Methods Among the 1,782 IDA-affected children aged 6 months to 18 years who visited the hospital, we retrospectively analyzed the medical records and laboratory data of 1,330 IDA-affected children aged 6–23 months who were diagnosed between 1996 and 2013. We excluded patients with a C-reactive protein level ≥5 mg/dL. Results IDA was predominant in boys (2.14:1) during infancy and early childhood. The peak IDA incidence was noted among infants aged 9–12 months. Only 7% patients exhibited symptoms of IDA, while 23.6% patients with severe IDA demonstrated classic symptoms/signs of IDA. Low birth weight (LBW) infants with IDA demonstrated low adherence to iron supplementation. In a multivariate analysis, prolonged breastfeeding without iron fortification (odds ratio [OR] 5.70), and a LBW (OR 6.49) were identified as risk factors of severe anemia. Conclusion LBW infants need more attention in order to increase their adherence to iron supplementation. For the early detection of IDA, nutritional status of all infants, and iron batteries of high-risk infants (LBW infants, infants with prolonged breastfeeding, picky eaters, and/or infants with the presence of IDA symptoms) should be evaluated at their health screening visits.
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Affiliation(s)
- Eun Young Joo
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Keun Young Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Dong Hyun Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Ji-Eun Lee
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Soon Ki Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
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Mode of oral iron administration and the amount of iron habitually consumed do not affect iron absorption, systemic iron utilisation or zinc absorption in iron-sufficient infants: a randomised trial. Br J Nutr 2016; 116:1046-60. [PMID: 27546308 DOI: 10.1017/s0007114516003032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Different metabolic pathways of supplemental and fortification Fe, or inhibition of Zn absorption by Fe, may explain adverse effects of supplemental Fe in Fe-sufficient infants. We determined whether the mode of oral Fe administration or the amount habitually consumed affects Fe absorption and systemic Fe utilisation in infants, and assessed the effects of these interventions on Zn absorption, Fe and Zn status, and growth. Fe-sufficient 6-month-old infants (n 72) were randomly assigned to receive 6·6 mg Fe/d from a high-Fe formula, 1·3 mg Fe/d from a low-Fe formula or 6·6 mg Fe/d from Fe drops and a formula with no added Fe for 45 d. Fractional Fe absorption, Fe utilisation and fractional Zn absorption were measured with oral (57Fe and 67Zn) and intravenous (58Fe and 70Zn) isotopes. Fe and Zn status, infection and growth were measured. At 45 d, Hb was 6·3 g/l higher in the high-Fe formula group compared with the Fe drops group, whereas serum ferritin was 34 and 35 % higher, respectively, and serum transferrin 0·1 g/l lower in the high-Fe formula and Fe drops groups compared with the low-Fe formula group (all P<0·05). No intervention effects were observed on Fe absorption, Fe utilisation, Zn absorption, other Fe status indices, plasma Zn or growth. We concluded that neither supplemental or fortification Fe nor the amount of Fe habitually consumed altered Fe absorption, Fe utilisation, Zn absorption, Zn status or growth in Fe-sufficient infants. Consumption of low-Fe formula as the only source of Fe was insufficient to maintain Fe stores.
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Iron Stores in Term and Late Preterm Small for Gestational Age and Appropriate for Gestational Age Neonates at Birth and in Early Infancy. Indian J Pediatr 2016; 83:622-7. [PMID: 26666906 DOI: 10.1007/s12098-015-1960-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 11/09/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare body iron stores in late preterm and term small for gestational age (SGA) infants with gestation matched appropriate-for-gestational age (AGA) infants at birth and at 2 mo of age. METHODS In this prospective observational study, live births of 34-42 wk gestation and SGA (<10th centile for GA) were enrolled along with gestation matched AGA (10th-90th centile for GA) infants. Infants' blood samples were taken within 2 h of delivery, and repeated at 60 ± 7 d of life. Primary outcome was serum ferritin at birth and 60 d of age. Secondary outcomes were hematocrit at birth and 60 d and need for transfusion until 60 d of life. RESULTS A total of 37 SGA (gestation 37.2 ± 1.9 wk, birth weight 1861 ± 401 g) and 30 AGA infants (gestation 37.3 ± 1.9 wk, birth weight 2607 ± 405 g) were enrolled in the study. There was no difference in the serum ferritin between AGA and SGA infants at birth {median [IQR]: 254.0 [214.3-293.8] vs. 259.7 [217.8-301.5] μg/L; p = 0.85} or 60 d of life {147.2 [101.4-193.0] vs. 155.0 [106.6-203.6] μg/L; p = 0.81}. Mean hematocrit was 55.5 ± 9.6 vs. 52.4 ± 5.0 at birth (p = 0.10) and 32.1 ± 4.9 vs. 31.6 ± 3.8 at 60 d (p = 0.77) in SGA and AGA infants respectively. No infant required blood transfusion during the study period. CONCLUSIONS Iron stores of late preterm and term SGA infants are comparable to term AGA infants at birth and 2 mo of age. Recommendations on iron supplementation to these infants need to be formulated through appropriately designed randomized trials.
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Berglund SK, Kriström B, Björn M, Lindberg J, Westrup B, Norman M, Domellöf M. Marginally low birthweight increases the risk of underweight and short stature at three and a half years of age. Acta Paediatr 2016; 105:610-7. [PMID: 26849678 DOI: 10.1111/apa.13356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/23/2015] [Accepted: 02/02/2016] [Indexed: 12/27/2022]
Abstract
AIM Little is known about the long-term health of marginally low birthweight (LBW) children. This study characterised growth among infants weighing 2000 g-2500 g and explored the prevalence and predictors of sustained growth restriction. METHOD This prospective observational trial followed the weight and height of 281 Swedish marginally LBW children from birth to 3.5 years of age. Children with a standard deviation score (SDS) for body mass index or height below -2 were considered underweight and short, respectively. RESULTS The mean SDS for weight and height showed a rapid increase before 12-19 weeks of age. The most rapid weight gain was in infants born small for gestational age. However, at 3.5 years of age, 9.5% of the children remained underweight and 6.5% had short stature. Regression models showed that slow weight gain before 19 weeks of age was the strongest predictor for lasting underweight, while slow height gain before 19 weeks of age and male sex were associated with short stature. CONCLUSION Marginally LBW infants were more likely to be underweight and have a short stature at 3.5 years of age and the absence of catch-up growth during the first five months after birth identified those at highest risk.
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Affiliation(s)
| | - Berit Kriström
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
| | - Matias Björn
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
| | - Josefine Lindberg
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
| | - Björn Westrup
- Department of Women's and Children's Health; Division of Neonatology; Karolinska Institutet Stockholm Sweden
| | - Mikael Norman
- Department of Clinical Science; Intervention and Technology; Division of Pediatrics; Karolinska Institutet; Stockholm Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
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Akkermans MD, Uijterschout L, Abbink M, Vos P, Rövekamp-Abels L, Boersma B, van Goudoever JB, Brus F. Predictive factors of iron depletion in late preterm infants at the postnatal age of 6 weeks. Eur J Clin Nutr 2016; 70:941-6. [DOI: 10.1038/ejcn.2016.34] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/27/2016] [Accepted: 02/24/2016] [Indexed: 01/01/2023]
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Abstract
Breast milk is a dynamic fluid with compositional changes occurring throughout the period of lactation. Some of these changes in nutrient concentrations reflect the successively slowing growth rate and developmental changes in metabolic requirements that infants undergo during the first year of life. Infant formula, in contrast, has a static composition, intended to meet the nutritional requirements of infants from birth to 6 or 12 months of age. To better fit the metabolic needs of infants and to avoid nutrient limitations or excesses, we suggest that infant formulas should change in composition with the age of the infant, that is, different formulas are created/used for different ages during the first year of life. We propose that specific formulas for 0 to 3 months (stage 1), 3 to 6 months (stage 2), and 6 to 12 months (stage 3) of age may be nutritionally and physiologically advantageous to infants. Although this initially may impose some difficult practical/conceptual issues, we believe that this staging concept would improve nutrition of formula-fed infants and, ultimately, improve outcomes and make their performance more similar to that of breast-fed infants.
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Lindberg J, Norman M, Westrup B, Öhrman T, Domellöf M, Berglund SK. Overweight, Obesity, and Body Composition in 3.5- and 7-Year-Old Swedish Children Born with Marginally Low Birth Weight. J Pediatr 2015; 167:1246-52.e3. [PMID: 26394823 DOI: 10.1016/j.jpeds.2015.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/28/2015] [Accepted: 08/21/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the prevalence of overweight/obese children and to explore body composition in a Swedish cohort of preschool children born with marginally low birth weight (MLBW, ie, 2000-2500 g). STUDY DESIGN We included 285 Swedish children with MLBW (44% small for gestational age), and 95 control children with normal birth weights. At 3.5 years and 7 years of age, we assessed anthropometrics, including the prevalence of overweight/obese children. At 7 years, dual-energy X-ray was used for body composition. RESULTS There were no significant differences between groups in the prevalence of overweight/obesity or in skinfold thickness; however, at 3.5 years, mean height, weight, and BMI in children with MLBW were 2.1 cm (95% CI 1.2-3.1), 1.2 kg (95% CI 0.7-1.6), and 0.47 kg/m(2) (95% CI 0.17-0.76) lower compared with controls. The corresponding mean differences also were lower in children with MLBW compared with control children at 7 years; 2.5 cm (95% CI 0.9-4.1), 1.6 kg (95% CI 0.6-2.8), and 0.48 kg/m(2) (95% CI 0.01-0.94). The differences were greater in those born small for gestational age. Dual-energy X-ray analyses showed lower fat-free mass index in MLBW infants and a similar trend in fat mass index. Within children with MLBW, BMI at 7 years correlated positively to growth velocity in infancy. CONCLUSION Children with MLBW had lower BMI and did not show increased risk of overweight or obesity up to 7 years. Nevertheless, the BMI in MLBW children was positively correlated to growth-velocity in infancy. TRIAL REGISTRATION Clinicaltrials.gov: NCT00558454.
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Affiliation(s)
- Josefine Lindberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Westrup
- Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tove Öhrman
- Department of Medical Physics, Danderyd Hospital, Stockholm, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
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Pratt O. A review of the strategies used to reduce the prevalence of iron deficiency and iron deficiency anaemia in infants aged 6-36 months. NUTR BULL 2015. [DOI: 10.1111/nbu.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Choudhury V, Amin SB, Agarwal A, Srivastava LM, Soni A, Saluja S. Latent iron deficiency at birth influences auditory neural maturation in late preterm and term infants. Am J Clin Nutr 2015; 102:1030-4. [PMID: 26310540 DOI: 10.3945/ajcn.115.113084] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/03/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In utero latent iron deficiency has been associated with abnormal neurodevelopmental outcomes during childhood. Its concomitant effect on auditory neural maturation has not been well studied in late preterm and term infants. OBJECTIVE The objective was to determine whether in utero iron status is associated with auditory neural maturation in late preterm and term infants. DESIGN This prospective cohort study was performed at Sir Ganga Ram Hospital, New Delhi, India. Infants with a gestational age ≥34 wk were eligible unless they met the exclusion criteria: craniofacial anomalies, chromosomal disorders, hemolytic disease, multiple gestation, third-trimester maternal infection, chorioamnionitis, toxoplasmosis, other infections, rubella, cytomegalovirus infection, and herpes simplex virus infections (TORCH), Apgar score <5 at 5 min, sepsis, cord blood not collected, or auditory evaluation unable to be performed. Sixty consecutive infants with risk factors for iron deficiency, such as small for gestational age and maternal diabetes, and 30 without risk factors for iron deficiency were enrolled. Absolute wave latencies and interpeak latencies, evaluated by auditory brainstem response within 48 h after birth, were measured and compared between infants with latent iron deficiency (serum ferritin ≤75 ng/mL) and infants with normal iron status (serum ferritin >75 ng/mL) at birth. RESULTS Twenty-three infants had latent iron deficiency. Infants with latent iron deficiency had significantly prolonged wave V latencies (7.10 ± 0.68 compared with 6.60 ± 0.66), III-V interpeak latencies (2.37 ± 0.64 compared with 2.07 ± 0.33), and I-V interpeak latencies (5.10 ± 0.57 compared with 4.72 ± 0.56) compared with infants with normal iron status (P < 0.05). This difference remained significant on regression analyses after control for confounders. No difference was noted between latencies I and III and interpeak latencies I-III. CONCLUSION Latent iron deficiency is associated with abnormal auditory neural maturation in infants at ≥34 wk gestational age. This trial was registered at clinicaltrials.gov as NCT02503397.
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Affiliation(s)
| | - Sanjiv B Amin
- Department of Pediatrics, Division of Neonatology, University of Rochester, Rochester, NY
| | - Asha Agarwal
- Department of Otorhinology and Cochlear Implant Unit, and
| | - L M Srivastava
- Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India; and
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Affiliation(s)
- Magnus Domellöf
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Michael K Georgieff
- University of Minnesota Masonic Children's Hospital, Division of Neonatology, University of Minnesota School of Medicine, Minneapolis, MN.
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D’Agostino JA, Passarella M, Saynisch P, Martin AE, Macheras M, Lorch SA. Preterm Infant Attendance at Health Supervision Visits. Pediatrics 2015; 136:e794-802. [PMID: 26416939 PMCID: PMC4586727 DOI: 10.1542/peds.2015-0745] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the adherence of premature infants with the American Academy of Pediatrics health supervision visit schedule, factors affecting adherence, and the association of adherence with preventive care. METHODS Retrospective cohort of all infants ≤35 weeks' gestation, born 2005 to 2009, receiving care at a 30-site primary care network for at least 24 months (n = 1854). Adherence was defined as having a health supervision visit within each expected time period during the first 18 months of life. Logistic regression identified sociodemographic and medical factors associated with nonadherence and risk-adjusted association between nonadherence and outcomes. RESULTS Only 43% received all expected health supervision visits. Those with Medicaid insurance (adjusted odds ratio [AOR] 0.46, 95% confidence interval [CI] 0.35-0.60), a visit without insurance (AOR 0.46, 95% CI 0.32-0.67), chronic illness (AOR 0.7, 95% CI 0.51-0.97), and black race (AOR 0.7, 95% CI 0.50-0.98) were less adherent, whereas provider continuity of care (AOR 2.89, 95% CI 1.92-4.37) and lower birth weight (AOR 1.67, 95% CI 1.02-2.73) increased adherence. Infants <100% adherent were less likely to be up to date with immunizations and receive recommended preventive care. In nearly half of missed visit windows, no health supervision visit was scheduled. CONCLUSIONS Fewer than half of premature infants were fully adherent with the preventive health schedule with associated gaps in health monitoring and immunization delays. These data suggest the importance of health supervision visits and the need to explore scheduling facilitators for those at risk for nonadherence.
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Affiliation(s)
- Jo Ann D’Agostino
- Department of Pediatrics, and,Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Molly Passarella
- Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Philip Saynisch
- Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ashley E. Martin
- Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle Macheras
- Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Department of Pediatrics, and,Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Hare DJ, Arora M, Jenkins NL, Finkelstein DI, Doble PA, Bush AI. Is early-life iron exposure critical in neurodegeneration? Nat Rev Neurol 2015; 11:536-44. [DOI: 10.1038/nrneurol.2015.100] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lorenz L, Arand J, Büchner K, Wacker-Gussmann A, Peter A, Poets CF, Franz AR. Reticulocyte haemoglobin content as a marker of iron deficiency. Arch Dis Child Fetal Neonatal Ed 2015; 100:F198-202. [PMID: 25491423 DOI: 10.1136/archdischild-2014-306076] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 11/18/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate reticulocyte haemoglobin content (CHr), compared with ferritin, transferrin saturation (TS) and mean corpuscular volume (MCV), as a marker of iron deficiency (ID). DESIGN Retrospective analysis of clinically indicated blood samples taken between February 2010 and October 2012. SETTING Single-centre neonatal care unit. PATIENTS 210 very preterm (gestational age <32 weeks) or very low birthweight infants (birth weight <1500 g) at 3-4 months corrected age. MAIN OUTCOME MEASURES Complete blood count, CHr, ferritin and TS determined as part of a standard follow-up examination. To detect the optimal CHr cut-off, ID was defined by the presence of more than two of the following three criteria: MCV <75 fL, TS <10%, ferritin <30 µg/L. RESULTS 210 preterm infants were included at a corrected age of (median (IQR)) 3.5 (3.0-4.0) months and with a CHr of 29.7 (28.6-30.7) pg. There were correlations between CHr and MCV (r=0.54, p <0.0001) and between CHr and TS (r=0.44, p <0.0001). There were 27 (13.4%) iron-deficient infants, and two infants (1%) fulfilled criteria of ID-anaemia. CHr was lower in infants with ID (26.4 (23.8-28.7) pg) than in those without (29.9 (29.0-30.8) pg, p <0.0001). The optimal CHr cut-off for detecting ID was 29 pg (sensitivity 85%, specificity 73%). Areas under the receiver operating characteristic curve for detection of ID tended to be higher for CHr compared with ferritin (0.92 vs 0.75), TS (0.90 vs 0.82) and MCV (0.81 vs 0.72). CONCLUSIONS CHr seems to be a suitable marker for latent ID in preterm infants at 3-4 months corrected age and may be superior to ferritin, TS and MCV.
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Affiliation(s)
- Laila Lorenz
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Jörg Arand
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Katja Büchner
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Annette Wacker-Gussmann
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Andreas Peter
- Department of Internal Medicine, Division of Endocrinology, Metabolism, Pathobiochemistry and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany Center for Pediatric Clinical Studies, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
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McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C. Screening and routine supplementation for iron deficiency anemia: a systematic review. Pediatrics 2015; 135:723-33. [PMID: 25825534 DOI: 10.1542/peds.2014-3979] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Supplementation and screening for iron-deficiency anemia (IDA) in young children may improve growth and development outcomes. The goal of this study was to review the evidence regarding the benefits and harms of screening and routine supplementation for IDA for the US Preventive Services Task Force. METHODS We searched Medline and Cochrane databases (1996-August 2014), as well as reference lists of relevant systematic reviews. We included trials and controlled observational studies regarding the effectiveness and harms of routine iron supplementation and screening in children ages 6 to 24 months conducted in developed countries. One author extracted data, which were checked for accuracy by a second author. Dual quality assessment was performed. RESULTS No studies of iron supplementation in young children reported on the diagnosis of neurodevelopmental delay. Five of 6 trials sparsely reporting various growth outcomes found no clear benefit of supplementation. After 3 to 12 months, Bayley Scales of Infant Development scores were not significantly different in 2 trials. Ten trials assessing iron supplementation in children reported inconsistent findings for hematologic measures. Evidence regarding the harms of supplementation was limited but did not indicate significant differences. No studies assessed the benefits or harms of screening or the association between improvement in impaired iron status and clinical outcomes. Studies may have been underpowered, and control factors varied and could have confounded results. CONCLUSIONS Although some evidence on supplementation for IDA in young children indicates improvements in hematologic values, evidence on clinical outcomes is lacking. No randomized controlled screening studies are available.
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Affiliation(s)
- Marian S McDonagh
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Ian Blazina
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Amy Cantor
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Christina Bougatsos
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
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Iron supplementation until 6 months protects marginally low-birth-weight infants from iron deficiency during their first year of life. J Pediatr Gastroenterol Nutr 2015; 60:390-5. [PMID: 25406528 DOI: 10.1097/mpg.0000000000000633] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Low-birth-weight (LBW) infants (<2500 g) have an increased risk of iron deficiency (ID) during their first 6 months of life. The optimal dose and duration of iron supplementation to LBW infants are, however, unknown. The objective of the present study was to investigate the long-term effect on iron status and growth in marginally LBW (2000-2500 g) infants, of iron supplements given until 6 months of life. METHODS In a randomized controlled trial, 285 healthy marginally LBW infants received 0, 1, or 2 mg · kg(-1) · day(-1) of iron supplements from 6 weeks to 6 months of age. At 12 months and 3.5 years of life we measured length, weight, head circumference, and indicators of iron status (hemoglobin, ferritin, mean corpuscular volume, and transferrin saturation) and assessed the prevalence of iron depletion, functional ID, and ID anemia. RESULTS At 12 months of age, there was a significant difference in ferritin between the groups (P = 0.006). Furthermore, there was a significant difference in the prevalence of iron depletion (23.7%, 10.6%, and 6.8%, respectively, in the placebo, 1-mg, and 2-mg groups, P = 0.009) and similar nonsignificant trends for functional ID and ID anemia. At 3.5 years of life there were no significant differences in iron status and the mean prevalence of iron depletion was 3.2%. Anthropometric data were not affected by the intervention. CONCLUSIONS Iron supplements with 2 mg · kg(-1) · day(-1) until 6 months of life effectively reduces the risk of ID during the first 12 months of life and is an effective intervention for preventing early ID in marginally LBW infants.
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Luo R, Shi Y, Zhou H, Yue A, Zhang L, Sylvia S, Medina A, Rozelle S. Anemia and feeding practices among infants in rural Shaanxi Province in China. Nutrients 2014; 6:5975-91. [PMID: 25533008 PMCID: PMC4277010 DOI: 10.3390/nu6125975] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 11/16/2022] Open
Abstract
Anemia is one of the most prevalent public health problems among infants and iron deficiency anemia has been related to many adverse consequences. The overall goal of this study is to examine the prevalence of anemia among infants in poor rural China and to identify correlates of anemia. In April 2013, we randomly sampled 948 infants aged 6-11 months living in 351 villages across 174 townships in nationally-designated poverty counties in rural areas of southern Shaanxi Province, China. Infants were administered a finger prick blood test for hemoglobin (Hb). Anthropometric measurement and household survey of demographic characteristics and feeding practices were conducted in the survey. We found that 54.3% of 6-11 month old infants in poor rural China are anemic, and 24.3% of sample infants suffer from moderate or severe anemia. We find that children still breastfed over 6 months of age had lower Hb concentrations and higher anemia prevalence than their non-breastfeeding counterparts (p < 0.01), and that children who had ever been formula-fed had significantly higher Hb concentrations and lower anemia prevalence than their non-formula-fed counterparts (p < 0.01). The results suggest the importance of iron supplementation or home fortification while breastfeeding.
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Affiliation(s)
- Renfu Luo
- Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, No. Jia 11, Datun Road, Chaoyang, Beijing 100101, China.
| | - Yaojiang Shi
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 620 Chang'an Rd West, Xi'an 710119, China.
| | - Huan Zhou
- West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu 610041, China.
| | - Ai Yue
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 620 Chang'an Rd West, Xi'an 710119, China.
| | - Linxiu Zhang
- Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, No. Jia 11, Datun Road, Chaoyang, Beijing 100101, China.
| | - Sean Sylvia
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing 100872, China.
| | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA.
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50
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Effects of iron supplements and perinatal factors on fetal hemoglobin disappearance in LBW infants. Pediatr Res 2014; 76:477-82. [PMID: 25119339 DOI: 10.1038/pr.2014.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/04/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND The homeostatic mechanisms of iron metabolism and erythropoiesis in infants are unclear. Infants synthesize both fetal hemoglobin (HbF) and adult hemoglobin (HbA), and it is not known how the hemoglobin switch is regulated. We hypothesized that iron supplements to infants affect the disappearance of HbF. METHODS We randomized 285 low-birth-weight infants (2,000-2,500 g) into three intervention groups receiving 0, 1, or 2 mg/kg/d of iron supplements from 6 wk to 6 mo of age. In the present secondary analysis, we analyzed iron status, total hemoglobin (Hb), and HbF fraction at 6 wk, 12 wk, and at 6 mo and calculated absolute levels of HbF. RESULTS We observed dose-dependent increased levels of Hb in iron-supplemented groups at 6 mo of age. However, for absolute HbF concentration, there was no similar effect of intervention. Mean (SD) HbF was 81.2 (16.8), 37.0 (13.8), and 8.1 (5.6) g/l at 6 wk, 12 wk, and 6 mo, respectively, similar in all groups. In linear regression analyses, postconceptional age turned out as the major predictor of HbF, independent of gestational age at birth. CONCLUSION Our hypothesis was rejected. Instead, we confirmed a close correlation to postconceptional age, supporting a genetically programmed switch, insensitive to most environmental factors including birth.
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