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Long-term developmental outcome of infants with iron deficiency
B Lozoff1, E Jimenez, A W Wolf
1Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106.
Insights
Infants with iron-deficiency anemia may experience lasting developmental disadvantages. Early iron treatment is crucial for cognitive and motor skills in children, impacting long-term outcomes.
Area of Science:
- Pediatric Health
- Developmental Psychology
- Nutritional Science
Background:
- Iron-deficiency anemia in infancy is linked to impaired cognitive and motor development.
- Long-term developmental consequences of infant iron deficiency remain largely unknown.
Purpose of the Study:
- To assess the long-term psychoeducational outcomes of children with a history of iron-deficiency anemia in infancy.
- To determine if early iron deficiency impacts cognitive and motor functioning at school entry.
Main Methods:
- Follow-up study of 163 Costa Rican children with documented infant iron status.
- Comprehensive clinical, nutritional, and psychoeducational assessments at age five.
- Utilized standardized tests including Wechsler, Woodcock-Johnson, Beery VMI, Draw-a-Man, and Bruininks-Oseretsky.
Main Results:
- Children with moderate-to-severe infant iron-deficiency anemia (hemoglobin ≤ 100 g/L) showed lower mental and motor scores at age five.
- These deficits persisted even after controlling for socioeconomic and other background factors.
- Significant differences observed in adjusted Woodcock-Johnson and Beery VMI scores.
Conclusions:
- Infant iron-deficiency anemia poses a risk for enduring developmental disadvantages.
- Children with a history of iron deficiency anemia may face long-term challenges in cognitive and motor skills compared to peers.
- Highlights the importance of addressing iron status in early childhood for optimal development.
Background:
Iron-deficiency anemia has been associated with lowered scores on tests of mental and motor development in infancy. However, the long-term developmental outcome of infants with iron deficiency is unknown, because developmental tests in infancy do not predict later intellectual functioning.
Methods:
This study is a follow-up evaluation of a group of Costa Rican children whose iron status and treatment were documented in infancy. Eighty-five percent (163) of the 191 children in the original group underwent comprehensive clinical, nutritional, and psychoeducational assessments at five years of age. The developmental test battery consisted of the Wechsler Preschool and Primary Scale of Intelligence, the Spanish version of the Woodcock-Johnson Psycho-Educational Battery, the Beery Developmental Test of Visual-Motor Integration, the Goodenough-Harris Draw-a-Man Test, and the Bruininks-Oseretsky Test of Motor Proficiency.
Results:
All the children had excellent hematologic status and growth at five years of age. However, children who had moderately severe iron-deficiency anemia as infants, with hemoglobin levels less than or equal to 100 g per liter, had lower scores on tests of mental and motor functioning at school entry than the rest of the children. Although these children also came from less socioeconomically advantaged homes, their test scores remained significantly lower than those of the other children after we controlled for a comprehensive set of background factors. For example, the mean (+/- SD) adjusted Woodcock-Johnson preschool cluster score for the children who had moderate anemia in infancy (n = 30) was 448.6 +/- 9.7, as compared with 452.9 +/- 9.2 for the rest of the children (n = 133) (P less than 0.01); the adjusted visual-motor integration score was 5.9 +/- 2.1, as compared with 6.7 +/- 2.3 (P less than 0.05).
Conclusions:
Children who have iron-deficiency anemia in infancy are at risk for long-lasting developmental disadvantage as compared with their peers with better iron status.