Time to Resolution of Severe Anemia in Young Children With Iron Deficiency

Iron deficiency anemia in children remains a pervasive problem. Prolonged iron deficiency anemia (IDA) is linked to adverse neurodevelopmental outcomes, but the duration of severe IDA (hemoglobin <7 g/dL) in children is poorly studied, particularly for racial/ethnic minority groups. We reviewed the electronic medical records of 92 children (1 to 5 y old) with IDA within a major metropolitan health care system. Duration of anemia, hemoglobin at diagnosis and nadir, age, sex, race/ethnicity, and the use of intravenous interventions were analyzed by Kaplan-Meier curves, Cox regression, and logistic regression. The majority of the included children were Asian (72.8%). Anemia resolution was documented in 68% of cases, and 47% of cases received intravenous intervention. Iron repletion was only confirmed in 37% of cases (n=34), leaving many children with unclear resolution at risk for recurrence. Caucasian children had anemia resolution faster than Black or Asian children, and the latter groups were also less likely to reach hemoglobin normalization. Children with intravenous interventions were more likely to have documented resolution than those with only oral treatment. Those receiving intravenous interventions were more likely to be followed through anemia resolution, although treatment standardization was lacking, and confirmation of iron storage repletion was rarely checked. Future studies should emphasize the importance of ensuring iron storage replacement and potentially utilize time-to-anemia resolution data to determine optimal hemoglobin values for intravenous iron as a first-line intervention.