Interventions to Treat Pediatric Iron Deficiency Anemia: A Systematic Review and Meta-Analysis

To perform comparative effectiveness and safety of interventions used to treat pediatric iron deficiency anemia (IDA), and to examine risk of bias and study sources of heterogeneity across the studies.

We searched major medical databases from inception to June 26, 2023. Eligibility criteria were children 6 months to 18 years with IDA receiving one of 3 interventions (oral iron, intravenous [IV] iron, red blood cell [RBC] transfusion). Hemoglobin change-from-baseline and incidence of adverse events were our primary outcomes. Data were synthesized quantitatively and narratively. When possible, random-effects meta-analysis was used to pool estimates. We used an indirect method to compare pooled estimates. Heterogeneity was examined using forest plots and the I² statistic.

Of 2811 nonduplicate articles retrieved, 47 observational studies (4010 patients) were included. The pooled mean hemoglobin change-from-baseline favored IV iron compared with oral iron (26.66 g/L vs 22.08 g/L, difference = 4.58 g/L, 95% CI: -2.77, 11.93). There were limited data on RBC transfusion. The pooled incidence of adverse events was 7.30% (IV iron), 8.41% (oral iron), and 12.02% (RBC transfusion). Risk of bias was low or moderate for most studies. Sources of heterogeneity identified included severity of IDA, age, adherence to WHO definition of IDA and follow-up time.

Both oral and IV iron are effective in treating IDA. Our findings suggest that IV iron may be more effective in increasing hemoglobin, within a shorter period of time, with a favorable safety profile and could be considered more often in pediatric practice. Further research comparing these 2 treatments directly is warranted.