The effects of iron supplementation in infancy on prevention of iron deficiency and psychomotor development

The effects of iron supplementation in infancy on prevention of iron deficiency and psychomotor developmentIn Turkey, as well as in other developing nations, iron deficiency anemia (IDA) affects a significant number of children. In some studies from Turkey, anemia prevalence was found to range between 48-75%. The aim of the present study was to investigate risk factors for anemia in infants, evaluate the iron status of full term babies at 12 months of age, the effects of iron supplementation on prevention of ID- IDA and infant developmental test performance. Four hundred healthy term infants who were born between June and December 2005 and regularly followed up at Gazi University Hospital well baby clinics until 12 months of age, were considered for enrollment in the study. Of these infants, 213 (53.3 %) were boys and 187 (46.7%) were girls. Iron supplementation in a dose of 1mg/kg/day was given to all of these patients. Participant families were asked to complete a questionnaire with items on socioeconomic and demographic factors, information on feeding practices, and adherence to the use of iron supplementation. Complete physical examination was perfomed, anthropometric measures were obtained and routine immunizations were applied. Iron status of the infants was determined by complete blood count and ferritin. Those infants having 2 or more of the following abnormal measures were considered to have IDA: hemoglobin level <10,5 g/dl, serum ferritin ?15 ng/ml, MCV<70 fl, RDW>14,5, Htc<%33. Infants only with serum ferritin ?15 ng/ml were considered to be the non-anemic iron deficient group. All data were analysed using the statistical package SPSS for Windows 11,5. Categorical variables were analysed by chi-square (?2 ) test. In the analysis of other continuous variables, student?s t-test was used. The Bayley Scales of Infant Development (BSID) II was administered by a tester unaware of the child?s hematological status. The Kolmogrow-Smirnov test was used to analyse outcomes of BSID II. The infants included in the study had a mean Hb value of 12.1 ±1.1 (6.1-15) and a mean ferritin value of 26.3±32.7 (1-480). The prevalence of IDA was 7% and that of ID was 36.8% in the study group. This study indicates that the main determinants of anemia in infants are increased number of deliveries, low adherence to iron supplementation, male gender, low family income and low education status of the care-giver. The most important dietary factor was early introduction of cows? milk, a factor which had a clear negative influence on iron status at 12 months of age. Iron deficiency in infancy was associated with lower scores on BSID ?II. The prevalence of IDA is high in infants and young children in our country and since it negatively influences the psychomotor development, measures to prevent ID such as exclusive breast-feeding in the first 6 months, avoiding cows? milk before 1 year of life, starting iron supplementation at 4-6 months of age in breast-fed infants, and using iron -fortified formula when not breastfeeding together with continuing iron supplementation until 24 months of age and screening for iron deficiency at 9 to 12 months of age should be advised.Keywords: Iron deficiency, iron supplementation, Bayley Scales of Infant Development II