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Background Iron-deficiency anemia (IDA) is associated with alterations in infant behavior and development that may not be corrected with iron therapy. Objective To determine if a home-based intervention to foster child development improves behavior and development of infants with IDA. Methods Infants with IDA and nonanemic infants aged 6 and 12 months were treated with oral iron and randomly assigned to a year of surveillance or intervention. Infants in the surveillance group were visited weekly, and information on iron intake, feeding, and health were recorded. Infants in the intervention were visited weekly, and the home visits included an hour-long program to foster child development by providing support to the mother-infant relationship. The number of infants enrolled was 128 (66 who received intervention) and 149 (70 intervention) at 6 and 12 months, respectively. Psychologists who were unaware of iron status and intervention assignment assessed infants' cognitive, motor, and social-emotional development (Bayley Scales) at the beginning, midpoint, and end of the year; 116 6-month-olds and 134 12-month-olds had at least 2 assessments. Hierarchical linear modeling was used to analyze change over time. Results Infants with IDA, regardless of enrollment age, were rated as less positive in social-emotional behavior at baseline. There were significant interactions between iron status and intervention associated with change in cognitive performance and positive social-emotional behavior. Infants with IDA who received intervention had developmental trajectories comparable to those of nonanemic infants in the intervention and surveillance groups, but these infants did not catch up in social-emotional behavior. Infants with IDA who received surveillance showed less increase in cognitive scores and had declines in positive social-emotional ratings. Conclusions Home-based intervention to foster child development improved cognitive and social-emotional scores in infants with IDA, but social-emotional differences remained between infants with IDA and those without IDA.

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CASE REPORTPropionic aeidaemia: two cases in Chile E. Raimann, V. Cornejo, C. G. Perates and M. Colombo Case 1 F.D.S., male, birth weight 2980g. At the second day of life he presented hypoglycaemia and 24 h later developed metabolic acidosis. At the 6th day of life he had vomiting, hypotonia and hyperreflexia that progressed to seizures and coma. Blood analyses showed metabolic acidosis and hyperammonaemia. The diagnosis of propionic acidaemia was confirmed by the study of organic acids in urine by gas chromatography, which showed large increases in the excretion of lactic, 3-hydroxypropionic, and methylcitric acids and in propiony!glycine, with a slight increase in 3-hydroxyisovaleric acid. A low protein, hypercaloric diet (1 g protein/kg per day, 200cal/kg per day) was started at the 10th day of life. Although severely undernourished, with treatment he recovered weight and height. At 5 months he had a psychomotor development of 3 months. One month later he had a bronchopneumonia and a severe metabolic imbalance and died. Case 2 J.G.F., 9-year-old boy. This boy developed normally until the age of 3 months, when he started vomiting, became severely hypotonic and started to present psychomotor delay. The diagnosis of propionic acidaemia was made at 16 months of age using gas chromatography (large increases in 3-hydroxypropionic, 3-hydroxyisovaleric and methylcitric acids and in propionylglycine). The treatment (a low protein, hypercaloric diet) was started at the age of diagnosis with 1 g protein/kg/day and 150 cal/kg per day. His physical development is normal and he has a borderline intelligence quotient.