Auswahl der wissenschaftlichen Literatur zum Thema „Iron deficiency anemia in children Diet therapy“

Iron deficiency (ID) is common in the pediatric population, primarily due to inadequate iron intake from food and a high requirement due to rapid growth. The most significant for pediatric practice are latent iron deficiency and iron deficiency anemia. Hyposiderosis significantly impacts a child's physical and cognitive development and immunological reactivity. It can be an independent condition and complicate the course of several other diseases. The article presents data on the most significant factors contributing to the ID, risk groups, clinical presentation features (sideropenic and anemic syndromes), criteria of laboratory diagnostics of iron deficiency anemia according to the clinical guidelines "Iron deficiency anemia" approved by the Russian Ministry of Health in 2021, and the latent iron deficiency developed by the World Health Organization experts. Also, the algorithm of ID primary prevention, diet therapy approaches, and the use of functional products and dietary supplements to meet the iron requirement of a child's organism are discussed.

Objective: To evaluate the safety and efficacy of parental iron therapy to treat iron deficiency anemia in malnourished children. Study Design: Quasi experimental design. Place and Duration of Study: Stabilization Centre, Children Hospital and the Institute of Child Health, Multan from 1 December 2014 to 31 December 2020. Materials and Methods: A total of 250 malnourished children with iron deficiency were included in the study. The laboratory parameters i.e., Hemoglobin, Hematocrit, Red Blood Cells Count, mean corpuscular hemoglobin, mean corpuscular volume, and Serum ferritin of all patients were done. Using the iron deficit formula, all participants were given the measured iron sucrose complex. The iron sucrose complex was diluted with 0.9% normal saline and administered steadily for 3-4 hours. After 6 weeks of therapy, hemoglobin, RBC count , ferritin was measured. Comparison of mean ±SD of baseline laboratory parameters and after 6 weeks of iron supplementation was analyzed by using t-test. Results: A total of 250 participants were registered, male patients (57.2%) were more than female patients (42.8 %). Most of the 92(36.8%) participants were 12-24 months old. The key cause of anemia among 102(40.8%) admitted patients was inadequate diet or excessive milk consumption. The mean ±SD value of the Hb level at admission was 7.5±1.9 and it increased to 11±1.15g/dL after 6 weeks of active supplementation which is statistically significant (P-value < 0.05). Six weeks after giving intravenous iron therapy mean serum Ferritin increased from 11.5ml to 21.61 ng/ml. Conclusion: Current study concluded that controlled administration of IV iron sucrose for treatment of iron deficiency anemia among inpatients is efficacious and safe. IV iron sucrose should be considered for patient with severe IDA, those who are not compliant with oral formulations, and patients with malabsorption.

Abstract Abstract 5171 Introduction: One of the most common nutritional deficiencies in the world is iron-deficiency anemia and young children are at high risk of developing it. In spite of fortification of foods in the United States, there is a high prevalence of anemia in infants and toddlers increasing their risk of neuro-developmental effects. Constipation is defined as delay or difficulty in defecation ≥ 2 weeks. Around one year of age, various changes are commonly implemented in a child's diet including introduction of whole milk and solids. Children may then present with sub-clinical colitis, constipation and anemia secondary to blood loss in stool or develop anemia due to increased consumption of milk. The American Academy of Pediatrics (AAP) recommends screening for anemia at 1 year and 2 year visits. The only clue to intolerance to milk may be symptomatic constipation and treating the anemia and switching the type of milk often helps to resolve this problem. This study explores the relation between iron deficiency, constipation and milk. Methods: This is an ongoing prospective study, which has been extended from Cornell to different centers. Data presented here is only from the Cornell principal site. Children between 6 months and 30 months visiting the resident's pediatric clinic and having routine blood work drawn as a part of their visit were included in the study. The National Health Sciences (NHS) Constipation questionnaire was administered to the parents of these children; ≥ 2 was considered Constipation. In addition, a detailed diet history of the child, and history of medicines and illness was taken and questions were asked about family history of anemia, constipation and allergies. If the mother was breast feeding, questions were asked about her dairy intake. Comparisons were made between children with and without constipation/iron deficiency. If the child had Hemoglobin (Hgb) <11, the child was started on Iron as per clinic policy, and phone calls were made to check for compliance with Iron. In addition letters including a printed calendar and a note on Iron rich foods were mailed out to the parents. Results: Two hundred five children, 92 females and 113 males between 8 and 30 months mean age 16. 7 months, are enrolled in the study. Seventy-two children (35 %) were constipated (score ≥2). Forty-two children (20. 5%) had Hgb <11. Children who had Hgb < 11 were not more constipated (45%) than those who had Hgb ≥11 (35%). In the Hgb <11 group, there was no significant difference in Hgb between children with and without constipation (p = 0. 19), however there was a difference in Hgb between infants with a Constipation score 0 and score 1 (p = 0. 03). Of the 42 children who had Hgb <11, 3 were later found to have sickle trait or alpha thalassemia trait, which were identified when iron intake did not improve the Hgb level. Compliance with Iron: Of the 39 children who were on Iron, 9 parents could not be reached via phone. Only 6 parents gave no Iron at all but another 12 did not give Iron properly resulting in 18/30 or 60% of infants/toddlers not receiving an adequate trial of replacement Iron. Among the side effects of Iron, one parent felt Iron caused rash on back and wanted multivitamin with Iron after finishing a month's course, one child had discoloration of teeth, so the parent gave it with juice. Two parents with infants with apparent true milk protein allergy colitis said constipation improved with diet change and iron. Conclusions: The prevalence of mild anemia is high in infants and toddlers. There was no clear association of constipation and anemia. Compliance is one of the key factors for Iron replacement therapy and in view of how erratic compliance was, it is imperative to give proper instructions to the parent while prescribing Iron. Material to better indicate which foods were rich in iron and follow-up phone calls were included in the management to optimize iron intake of anemic children. We will include more patients, more closely monitor the change in the diet of the child, and monitor responses to Iron therapy in children with low Hgb. In addition, different practices at other involved centers e. g. Brooklyn hospital Center may allow comparison of the time of screening (9 months v/s 1 year) and testing with Hemoglobin/Hematocrit versus a full Complete Blood Count with indices. Disclosures: Bussel: Amgen: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Cangene: Research Funding; GlaxoSmithKline: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genzyme: Research Funding; IgG of America: Research Funding; Immunomedics: Research Funding; Ligand: Membership on an entity's Board of Directors or advisory committees, Research Funding; Eisai, Inc: Membership on an entity's Board of Directors or advisory committees, Research Funding; Shinogi: Membership on an entity's Board of Directors or advisory committees, Research Funding; Symphogen: Membership on an entity's Board of Directors or advisory committees; Sysmex: Research Funding; Portola: Consultancy.

Objective: The purpose of this study is to investigate the efficacy and safety of intravenous iron sucrose treatment in children with iron deficiency anemia who were unresponsive to or could not tolerate oral iron therapy. Material and Methods: Among patients determined to have iron deficiency anemia, and were intolerant or noncompliant with oral iron therapy, 92 patients who have received parenteral iron therapy between the ages of 6 months and 18 years have been investigated retrospectively. Age, gender, patient complaints at application, dietary characteristics, accompanying diseases and treatment complications, and safety, tolerability, and adverse events have been assessed from the information obtained from patient files. Treatment efficiency was evaluated with hemoglobin (Hb), mean corpuscular volume (MCV) and ferritin results from the blood samples taken before treatment, at the second week of treatment and after two months. Results: Mean age of patients was 12.5 ± 4.7 (age interval 1-17 years), and 21% was male while 79% was female. 72% of our patients were adolescents. From an etiological aspect, 56% of our patients was determined to have an iron-poor diet, 29% had functional menorrhagia, and 15% had chronic gastrointestinal system pathologies. Mean Hb, MCV and ferritin levels before and after treatment were found as: 7.72 ± 1.21 g/dl and 11.44 g/dl ± 0.68 g/dl; 63.2 ± 7.12 fL and 76.6 ± 3.81 fL; 3.87 ± 2.52 nmol/L and 57.94 ± 17.19 nmol/L, respectively (p< 0.001). 94% of patients were determined to have at least 2 g/dL (mean value 3.71 [range 1.6-6.3]) increase in their Hb levels. Anaphylaxis was observed in a patient who had a history of allergy despite applying premedication. Conclusion: Parenteral iron therapy is an efficient and safe treatment among indicated patients.

Iron deficiency anemia is the most frequent haematological disorder in children. Although much is already known about the diagnostic-therapeutic approach, new frontiers regarding its diagnosis and therapeutic options emerge every day. An adequate intake with the diet is essential and can also be obtained in compliance with vegetarian-type diets. The use of glycinate or lysosomal preparations could positively affect the efficacy of therapy reducing the side effects associated with commonly used iron preparations. Parenteral iron therapy in pediatric age, which is currently limited to selected conditions, may evolve further, as a consequence of the production of molecules such as ferrocarboxymaltose, the use of which is not currently permitted under the age of 14. Further studies are therefore necessary in order to implement the knowledge and diagnostic-therapeutic interventions related to this widespread nosological entity.

Abstract Abstract 3154 Background: Iron deficiency anemia (IDA) is a common hematologic problem worldwide, potentially leading to cognitive delays, fatigue, seizures, and, when severe, high output heart failure. While IDA frequently is encountered in both the primary care setting and specialty clinics, its management is not evidence based. As a result, the diagnosis and treatment of IDA is often suboptimal. To help inform future clinical trials, we retrospectively characterized the clinical course of IDA in young patients (pts) referred to our center. Methods: Using our comprehensive hematology database, the records of children ≤ 18 years (yrs) of age with IDA seen in our outpatient clinic between January 1, 2006 and June 30, 2010 were identified and carefully reviewed. Results: Of 217 IDA pts in the database, 215 had evaluable records, 20 of whom were determined to have an alternative diagnosis. Of 195 evaluable pts, 64% were ≤4 yrs old at their first clinic visit and 31% were age 11–18 yrs. Pts ≤ age 4 yrs were 63% male and 60% Hispanic, whereas those age 11–18 yrs were 83% female and 37% Hispanic, 35% African-American, and 15% Caucasian. Causes of IDA in 128 pts ≤ 4 yrs were excessive consumption of cow milk (68%), breast feeding without iron supplementation (13%), overall iron-poor diet beyond 12 months (16%), prematurity (5%), and suspected malabsorption (6%). Causes of IDA in 60 pts aged 11–18 yrs were menorrhagia (43%), other blood loss (20%), iron-poor diet (22%), and poor iron absorption (7%). Some pts in both age groups had multiple causes of IDA, and in 17 the cause of the anemia was not clear. 129 pts (66%) were referred to us directly by their primary care physician (PCP), and 49 (25%) by the emergency department (ED), 37 of whom had been sent there by their PCP for evaluation of anemia. Prior to their first visit to our center, 115 pts (59%) had received at least one trial of iron therapy, 62 with ferrous sulfate, 27 with carbonyl iron, 5 with iron polysaccharide, and 15 with an iron-containing multivitamin. For the pts ≤ 4 yrs of age where the precise dose of elemental iron prescribed by the PCP was known (n=59), greater than half of the pts were prescribed doses of iron outside of the accepted therapeutic range (3–6 mg/kg/day) (see figure). The pts' mean Hb concentration before referral to our clinic (last recorded Hb measured either by the PCP or the ED) was 7.8 g/dl (n=170). Following evaluation in our hematology clinic, 86% of patients were treated with ferrous sulfate. However, 17% of such pts ≤ 4 yrs of age still received iron doses outside of the accepted therapeutic range. At the time of their first and last visits to the hematology clinic the mean Hb values were 9.0 g/dl and 11.3 g/dl respectively. One third of pts had documented poor adherence with iron therapy, due to poor tolerability (19%), gastrointestinal upset (11%), misunderstanding of prescribed dose (14%), and use of a lower dose than prescribed due to parental discretion (41%). 40% of pts were lost to follow up. Summary and Conclusions: Among pts referred for IDA to our academic specialty clinic, Hispanic male toddlers and Hispanic or African-American female adolescents were disproportionately represented. Most toddlers had nutritional IDA while most adolescents had menorrhagia. Pts often received sub-therapeutic doses of iron before referral. After hematology clinic evaluation, most children demonstrated improvement of IDA; however, inappropriate dosing and non-adherence with oral iron therapy were high, and many pts were lost to follow up. Insufficient screening and prevention of IDA remains problematic. Additionally, when IDA is suspected it is often inadequately treated or inappropriately referred to the ED or the hematology clinic, where treatment is associated with poor adherence and high attrition rates. Future research must focus on all of these deficiencies to prevent the many immediate and long-term sequelae of IDA. Disclosures: No relevant conflicts of interest to declare.

Abstract Background Iron deficiency anemia (IDA) is prevalent in young children whose diet includes prolonged breast feeding without iron supplementation and/or excessive cow milk consumption. Oral iron therapy is recommended to correct the anemia and reconstitute iron stores, but few data exist to guide clinical decision-making. The recommended dosing of elemental iron has been inconsistent in the literature, ranging from 2 to 6 mg/kg/day, given one to three times daily. To address the paucity of treatment data, the BESTIRON study (Clinicaltrials.gov NCT01904864) was initiated to compare two liquid oral iron agents (ferrous sulfate and NovaFerrum, an iron polysaccharide) using a once daily, low-dose regimen. Methods This study is a single center, double-blinded, randomized controlled superiority trial. Inclusion criteria include: age 9 months to 4 years with nutritional IDA by history and laboratory indices (Hgb <10 g/dL, MCV <70 fl, reticulocyte hemoglobin equivalent (Ret He) <25 pg, serum ferritin <15 ng/mL and/or TIBC >425 mg/dL). Exclusion criteria include: evidence of blood loss, malabsorption, other cause of anemia, prematurity (gestational age <30 weeks), major co-morbidity, adequate response to prior iron therapy, or previous receipt of intravenous iron. Upon enrollment, subjects are randomized 1:1 to either ferrous sulfate (15 mg/mL) or NovaFerrum (15 mg/mL) dosed at 3 mg/kg elemental iron once daily at bedtime. Follow-up visits occur at 4, 8, and 12 weeks following study initiation. Definition of complete response at study exit is: Hgb >11 g/dL, MCV >70 fl, Ret He >25 pg, serum ferritin >15 ng/mL, and TIBC <425 mg/dL. The primary outcome, rate of change in hemoglobin concentration over 12 weeks, cannot yet be determined as enrollment is ongoing. Here we present the overall combined hematologic response to this "minimalist" treatment regimen for subjects who have completed the study to date. Results From 9/1/2013 to 8/1/2015, 72 patients (target accrual 80) enrolled in the study. Sixty-two subjects (56% male) completed it and are included in the analysis. Median age was 19 months (range 11 - 41 months). Subjects were predominantly Caucasian/White (Latino) (61%). Median baseline and week 12 laboratory values are shown in the Table. Thirteen patients received a transfusion for severe symptomatic anemia (median Hgb 3.6 g/dL, range 2.2 - 5.3 g/dL) prior to study entry. Forty-six of the 62 subjects (74%) completed all 3 study follow-up visits. Eleven subjects were lost to follow-up or discontinued study participation. Five others were considered treatment failures at 8 weeks (hemoglobin increment <0.5 g/dL above baseline) and removed from the study. Of the 46 subjects who completed all study visits, 20 (43%) met the definition of complete resolution (38% of subjects with baseline hemoglobin <8 g/dL compared to 50% among those with baseline hemoglobin >8 g/dL) and received no further iron therapy. Conclusion This analysis of children with nutritional IDA receiving a "patient-friendly" regimen of a single daily dose of 3 mg/kg elemental iron for 12 weeks demonstrates a good hematologic response and suggests that higher doses of iron therapy are not necessary to achieve resolution of anemia. While most subjects achieved a normal hemoglobin concentration, some required continued iron therapy to assure repletion of iron stores. Adverse effects ascribed to oral iron treatment may result in part from prescribing higher or more frequent iron doses, which may contribute to poor adherence and treatment failure. We acknowledge Gensavis Pharmaceuticals, LLC for their support of this investigator-initiated study. Table 1. Median Laboratory Values at Baseline and Week 12 Baseline (N=62) Median (Range) Week 12 (N=46) Median (Range) Hemoglobin concentration (g/dL) 8.0 (4.4 - 10.6) 11.9 (9.0 - 13.6) Mean cell volume (fl) 59.9 (47.3 - 69.8) 72.0 (54.7 - 81.9) Red cell distribution width (%) Baseline (n=56), Week 12 (n=46) 21.1 (15.5 - 36.5) 18.7 (12.5 - 26.4) Reticulocyte count (%) Baseline (n=60), Week 12 (n=45) 1.4 (0.3 - 3.9) 0.9 (0.4 - 1.8) Reticulocyte hemoglobin equivalent (pg) Baseline (n=41), Week 12 (n=40) 17.2 (10.6 - 28.4) 29.5 (15.9 - 34.3) Serum iron (mcg/dL) 20 (9 - 349) 51 (15 - 394) Serum ferritin (ng/mL) 2.5 (0.5 - 49.2) 11 (2.4 - 46) Total iron binding capacity (mg/dL) 513 (236 - 636) 394 (287 - 560) Disclosures Powers: Gensavis Pharmaceuticals, LLC: Research Funding. Mccavit:Gensavis Pharmaceuticals, LLC: Research Funding; Pfizer: Speakers Bureau; Novartis: Speakers Bureau. Adix:Gensavis Pharmaceuticals, LLC: Research Funding. Buchanan:Gensavis Pharmaceuticals, LLC: Research Funding.

Background: Iron deficiency, even without a diagnosis of anemia, can be neurodevelopmentally dangerous in pediatric populations. Oral iron supplementation has been the treatment of choice but is associated with poor adherence for several reasons including metallic taste of the tablets, gastric irritation, severe constipation, and daily dosing for several weeks. Intravenous iron has been safely used in adult populations for iron supplementation, but has less commonly been used in pediatric populations. It is hypothesized that pediatric patients with iron deficiency anemia (IDA) who receive intravenous iron infusions will show normalization of hematologic parameters. Methods: EMR of patients aged 1-21 who received at least one intravenous iron infusion at Cooper University Hospital between 2016 and January 2019 were reviewed for retrospective data collection. Pre-infusion lab values including Hgb, MCV, RBCs and RDW were compared to post-infusion values to determine if values normalized after intravenous iron infusion. Patient demographics including ethnicity, cause of IDA, prior oral iron treatments, and adverse effects of oral and IV iron were analyzed. Results: There were 33 subjects in this study. The average age of the subjects was 12.8 (+/- 5.1) years of age and 79% were female. The most prevalent indication for IV iron was menorrhagia (55%), while GI issues were 18% and insufficient diet accounted for 27%. The mean baseline HGB was 8.3 (+/- 1.7) while the mean final HGB increased to 11.5 (+/- 1.4) (p<0.001). The mean baseline MCV was 69.2 (+/- 9.3) and the mean last MCV was 76.1 (+/- 6.8) (p<0.001). The mean baseline RBC was 4.2 (+/- 0.82) and the mean last RBC was 4.9 (+/- 0.6) (p<0.001). Conclusion: IV iron sucrose infusions administered to pediatric outpatients were safe and effective in children and adolescents with IDA. Adherence to intravenous iron did not significantly improve. Hematologic parameters improved with infusions. Further analysis of patient demographics and characteristics of diagnosis needs to be performed to elucidate benefits of this therapy. As a single institution study, the results are limited to a regional patient population and their specific demographics. Disclosures No relevant conflicts of interest to declare.

Ménétrier disease (MD) is characterized by enlarged gastric folds with associated protein losing gastropathy. In children it is a rare and self-limited cause of protein losing gastropathy. We report a case of a 2-year-old male who presented with prolonged, refractory emesis and peripheral edema. Workup revealed severe hypoalbuminemia, hypoproteinemia, iron deficiency anemia, and high stool alpha-1 antitrypsin. Hepatic protein synthesis was normal with no urinary protein loss. Endoscopy showed antrum sparing, severe erosive gastritis in body and fundus, characteristic of MD. Histologic examination displayed inflammation with eosinophilia, foveolar hyperplasia, atrophic oxyntic epithelium, and rare CMV inclusions. Patient received antiviral therapy, intravenous albumin, diuretic and was discharged on high protein diet. Follow-up revealed clinical recovery, with endoscopy and histology showing normal gastric mucosa throughout the stomach. It is important to remain vigilant of this condition in pediatric population and to include it in the differential diagnosis in cases of protein losing gastroenteropathy.

Ménétrier disease (MD) is characterized by enlarged gastric folds with associated protein losing gastropathy. In children it is a rare and self-limited cause of protein losing gastropathy. We report a case of a 2-year-old male who presented with prolonged, refractory emesis and peripheral edema. Workup revealed severe hypoalbuminemia, hypoproteinemia, iron deficiency anemia, and high stool alpha-1 antitrypsin. Hepatic protein synthesis was normal with no urinary protein loss. Endoscopy showed antrum sparing, severe erosive gastritis in body and fundus, characteristic of MD. Histologic examination displayed inflammation with eosinophilia, foveolar hyperplasia, atrophic oxyntic epithelium, and rare CMV inclusions. Patient received antiviral therapy, intravenous albumin, diuretic and was discharged on high protein diet. Follow-up revealed clinical recovery, with endoscopy and histology showing normal gastric mucosa throughout the stomach. It is important to remain vigilant of this condition in pediatric population and to include it in the differential diagnosis in cases of protein losing gastroenteropathy.

ABSTRACT Background: Iron deficiency anemia is a global health problem that affects children, women and the elderly, and it is also a common comorbidity under a variety of medical conditions. This study aimed to determine the role of health workers in the practice of adolescent girls with iron deficiency anemia. Subjects and Method: This was a scoping review conducted was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selection; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The search included PubMed, ProQuest, Wiley, Science Direct. The inclusion criteria were English-language and full-text articles published between 2008 and 2019. The data were selected by the PRISMA flow chart. Results: Seven articles were selected from 316 articles, 25 duplicated articles and 284 excluded articles. Several important points were obtained, namely doctor diagnose and provide therapy, haematologist analyzing blood sample results, nutritionist educate nutrition of female adolescent, nurses provide care and recording adolescent health status, and laboratory staff taking blood for analysis. Conclusion: All health workers play an equally important in reducing iron deficiency Keywords: Collaboration, Inter-professional Health, Role, Iron Deficiency Anemia. Correspondence: Irma Nurma Linda. Universitas ‘Aisyiyah Yogyakarta, Indonesia. Jl. Ringroad Barat No.63, Mlangi Nogotirto, Gamping, Area Sawah, Nogotirto, Gamping, Sleman district, Yogyakarta 55592. Email: irmanurmalinda@gmail.com. Mobile: 081233223694. DOI: https://doi.org/10.26911/the7thicph.03.41