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Screening for Iron Deficiency in Early Childhood Using Serum Ferritin in the Primary Care Setting
Hannah Oatley1, Cornelia M Borkhoff2,3,4, Shiyi Chen4
1Department of Pediatrics, Faculty of Medicine.
Insights
Universal anemia screening at 12 months using hemoglobin has limitations. Serum ferritin screening for iron deficiency at 15 or 18 months shows promise for improved diagnostic accuracy in young children.
Area of Science:
- Pediatric Health
- Nutritional Science
- Diagnostic Accuracy
Background:
- The American Academy of Pediatrics recommends universal anemia screening at 12 months using hemoglobin.
- Hemoglobin lacks diagnostic accuracy for identifying iron deficiency.
- The optimal age for iron deficiency screening remains undetermined.
Purpose of the Study:
- To evaluate serum ferritin as a screening tool for iron deficiency in children.
- To assess the relationship between child age, serum ferritin, and hemoglobin levels.
- To determine the prevalence of elevated C-reactive protein (CRP) in the study population.
Main Methods:
- A cross-sectional study involving 1735 children aged 1 to 3 years.
- Analysis of serum ferritin and hemoglobin levels in relation to child age.
- Examination of the correlation between hemoglobin and serum ferritin.
- Assessment of C-reactive protein (CRP) levels to identify inflammation.
Main Results:
- Serum ferritin showed a nonlinear relationship with age, decreasing from 12-15 months and increasing from 24-38 months.
- Hemoglobin levels did not significantly change from 12-24 months but increased from 24-38 months.
- Hemoglobin cutoff (<110 g/L) had lower sensitivity (25%) compared to serum ferritin cutoff (<12 μg/L) for detecting iron deficiency.
Conclusions:
- Screening for iron deficiency using serum ferritin at 15 or 18 months is a potentially effective strategy.
- Concurrent CRP measurement may not be essential for children at low risk of inflammation.
- Serum ferritin offers a more accurate screening approach for iron deficiency in young children.
Objectives:
The American Academy of Pediatrics recommends universal screening for anemia using hemoglobin at 12 months. However, hemoglobin lacks diagnostic accuracy for iron deficiency, and the optimal age for screening has not been determined. Our objective was to assess a screening strategy for iron deficiency using serum ferritin.
Methods:
We conducted a cross-sectional study of children 1 to 3 years old attending a health supervision visit. We examined the relationship between child age and serum ferritin, age and hemoglobin, hemoglobin and serum ferritin, and the prevalence of elevated C-reactive protein (CRP).
Results:
Restricted cubic spline analysis (n = 1735) revealed a nonlinear relationship between age and serum ferritin (P < .0001). A linear spline model revealed that from 12 to 15 months, for each 1-month increase in age, serum ferritin levels decreased by 9% (95% confidence interval [CI]: 5 to 13). From 15 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each month increase in age, serum ferritin increased by 2% (95% CI: 1 to 2). For hemoglobin, from 12 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each 1-month increase in age, hemoglobin increased by 20% (95% CI: 9 to 32). Compared with the serum ferritin cutoff of <12 μg/L, the hemoglobin cutoff of <110 g/L had a sensitivity of 25% (95% CI: 19 to 32) and a specificity of 89% (95% CI: 87 to 91). Elevated CRP ≥10 mg/L occurred in 3.3% (95% CI: 2.5 to 4.2).
Conclusions:
Screening for iron deficiency using serum ferritin at 15 or 18 months may be a promising strategy. For children at low risk for acute inflammation, concurrent measurement of CRP may not be necessary.
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