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Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized
Staffan K Berglund1, Anna Chmielewska1, Josefine Starnberg1
1Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Insights
Iron supplementation for low-birth-weight infants may reduce behavioral problems. This study found supplemented children had fewer externalizing behaviors at school age, suggesting lasting benefits.
Area of Science:
- Pediatrics
- Neurodevelopment
- Nutritional Science
Background:
- Low-birth-weight (LBW) infants face increased risk of iron deficiency, linked to impaired neurodevelopment.
- Early iron deficiency can negatively impact cognitive and behavioral outcomes.
- Long-term effects of early iron supplementation on LBW infants require further investigation.
Purpose of the Study:
- To investigate the long-term effects of early iron supplementation on cognitive function and behavior in marginally LBW infants until school age.
- To determine if varying doses of iron supplements impact neurodevelopmental outcomes.
- To assess the efficacy of iron supplementation in preventing behavioral problems.
Main Methods:
- Randomized controlled trial involving 285 marginally LBW infants (2,000-2,500g).
- Infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months.
- Cognitive and behavioral assessments (WISC-IV, CBCL, FTF) were conducted at 7 years of age.
Main Results:
- No significant differences in cognitive scores (WISC-IV) or general behavior (FTF) were observed between groups.
- Significantly lower scores for externalizing problems (CBCL) were found in supplemented children compared to placebo (P=0.013).
- Supplemented groups showed a reduced risk ratio for total behavioral scores above clinical cutoffs (RR 0.31, P=0.054).
Conclusions:
- Iron supplementation in marginally LBW infants demonstrated long-lasting positive effects on reducing externalizing behaviors.
- Findings support previous observations at 3 years, indicating potential sustained benefits of iron supplementation on behavioral function.
- Early iron supplementation may be a viable strategy to mitigate behavioral issues in LBW populations.
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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