Iron deficiency anemia in infants and toddlers

Eun Young Joo; Keun Young Kim; Dong Hyun Kim; Ji-Eun Lee; Soon Ki Kim

doi:10.5045/br.2016.51.4.268

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Original Article

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Blood Res 2016; 51(4):

Published online December 23, 2016

https://doi.org/10.5045/br.2016.51.4.268

Iron deficiency anemia in infants and toddlers

Eun Young Joo, Keun Young Kim, Dong Hyun Kim, Ji-Eun Lee, and Soon Ki Kim^*

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Department of Pediatrics, Inha University College of Medicine, Incheon, Korea.

Correspondence to : Correspondence to Soon Ki Kim, M.D., Ph.D. Department of Pediatrics, Inha University School of Medicine, 27, Inhang-ro, Jung-gu, Incheon 22332, Korea. pedkim@inha.ac.kr

Received: July 29, 2016; Revised: October 20, 2016; Accepted: November 18, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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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.

Keywords Iron deficiency anemia, Infant, Child, Risk factors, Breastfeeding, Low birth weight

Article

Original Article

Blood Res 2016; 51(4): 268-273

Published online December 23, 2016 https://doi.org/10.5045/br.2016.51.4.268

Iron deficiency anemia in infants and toddlers

Eun Young Joo, Keun Young Kim, Dong Hyun Kim, Ji-Eun Lee, and Soon Ki Kim^*

Department of Pediatrics, Inha University College of Medicine, Incheon, Korea.

Correspondence to: Correspondence to Soon Ki Kim, M.D., Ph.D. Department of Pediatrics, Inha University School of Medicine, 27, Inhang-ro, Jung-gu, Incheon 22332, Korea. pedkim@inha.ac.kr

Received: July 29, 2016; Revised: October 20, 2016; Accepted: November 18, 2016

Abstract

Background

Methods

Results

Conclusion

Keywords: Iron deficiency anemia, Infant, Child, Risk factors, Breastfeeding, Low birth weight

Abstract

Fig 1.

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Figure 1.

Distribution of iron deficiency anemia in patients aged 6–23 months.

Blood Research 2016; 51: 268-273https://doi.org/10.5045/br.2016.51.4.268

Table 1 . Clinical characteristics of iron deficiency anemia in infants and young children aged <24 months (N=1,330)..

Abbreviations: M, male; F, female; SD, standard deviation; MCV, mean corpuscular volume; RDW, red cell distribution width; TS, transferrin saturation [iron/ total iron binding capacity×100]..

Table 2 . Chief complaints in infants and young children with iron deficiency anemia at the time of hospital visit..

^a)Respiratory symptoms: cough, rhinorrhea, and nasal obstruction. ^b)Gastrointestinal symptoms: vomiting, diarrhea, and abdominal pain. ^c)Symptoms of anemia: pallor, night irritability (≥2 arousals and/or cries), and pica. ^d)Miscellaneous: the presence of a neck mass, cellulitis, hernia, etc. ^e)Bleeding: epistaxis, melena, and hematuria..

Abbreviation: IDA, iron deficiency anemia..

Table 3 . The frequency of risk factors in iron deficiency anemia affected infants and young children aged 6 to 23 months (multiple answers)..

^a)Prolonged BMF: exclusive breast milk feeding till >6 months of age. ^b)LBW: birth weight <2.5 kg. ^c)Failure to thrive: undernutrition - weight <2nd percentile of age and gender corrected gestation weight, or weight <80% of the ideal weight for age. ^d)Gastrointestinal loss: chronic diarrhea and melena. ^e)Inappropriate milk intake: introduction of unmodified cow’s milk before 12 months of age, cow’s milk protein induced colitis, or the consumption of cow’s milk >700 mL/day..

Abbreviations: IDA, iron deficiency anemia; BMF, breast milk feeding; LBW, low birth weight..

Table 4 . Risk factors identified in a multiple regression analysis to be associated with iron deficiency anemia and severe iron deficiency anemia..

^a)Prolonged BMF: exclusive breast milk feeding till >6 months of age. ^b)Low birth weight: birth weight <2.5 kg. ^c)Failure to thrive: undernutrition - weight <2nd percentile of age and gender corrected gestation weight, or weight <80% of the ideal weight for age..

Abbreviations: BMF, breast milk feeding; OR, odds ratio; CI, confidence interval; M, male; F, female..