Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial

Berglund, Staffan; Chmielewska, Anna; Starnberg, Josefine; Westrup, Björn; Hägglöf, Bruno; Norman, Mikael; Domellöf, Magnus

doi:10.1038/pr.2017.235

Cited by 36 publications

(55 citation statements)

References 34 publications

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“…Moreover, studies have reported elevated total, internalizing, and/or externalizing problem scores in children born PT compared with FT peers (2) and that higher levels of internalizing difficulties may be a particular and long-lasting characteristic in children born at lower GA in the 1990s−2000s (4,8,14,15,41). Recently, an increased risk of externalizing problems at 7 years of age in infants with marginally low birth weight (of which most were moderately/late preterm) has been described-a risk that may be minimized by preventing iron deficiency (42). We have no individual data of iron intake in the current study, but iron supplementation was generally recommended for infants born PT with birth weight <2,500 g. No effect of group on total problem score and no specific pattern regarding internalizing or externalizing problems in the PT group could be discerned in the present study.…”

Section: Discussionmentioning

confidence: 99%

Risk for Behavioral Problems Independent of Cognitive Functioning in Children Born at Low Gestational Ages

et al. 2020

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This study aimed to investigate cognitive and behavioral outcomes in relation to gestational age (GA) in school-aged children born preterm (PT). Results from the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV), and the Child Behavior Checklist (CBCL) were analyzed in 51 children (mean age: 7.8 years [range: 7.0-8.7]) born PT (mean GA: 31 weeks [range: 23-35]; birth weight, mean: 1,637 g [range: 404-2,962]) with the majority (96%) having no diagnosed cognitive, sensory, or motor impairments. The control group included 57 age-matched typically developing children (mean age: 7.9 years [range: 6.2-8.7]) born full-term (FT). Children born PT, extremely PT (GA < 28) in particular, showed significantly lower cognitive performance and higher behavioral problem scores compared with children born FT. GA was found to predict aspects of both cognitive functioning and behavioral problems within the PT group, with lower GA being related to both poorer cognitive outcomes and elevated affective and attention-deficit/hyperactivity problems. Global cognitive functioning did not independently predict aspects of behavioral outcomes. Findings demonstrate that, even in children born PT without severe perinatal and/or postnatal complications and receiving active perinatal care, a short gestation is an evident risk factor for long-term negative effects on mental health independent of cognitive functioning. Additional findings suggest that both reduced growth and lower parental educational level may contribute to increased risk for poorer cognitive and behavioral functioning in children born PT.

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Section: Discussionmentioning

confidence: 99%

Risk for Behavioral Problems Independent of Cognitive Functioning in Children Born at Low Gestational Ages

et al. 2020

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“…Clinical trials that assess traditional supplementation as a single-nutrient oral dose are limited and are primarily conducted in low-income countries with high levels of IDA. These supplementation studies found that daily, oral iron supplementation between 6 and 12 months reduced the risk of IDA in infancy [292][293][294][295][296][297] and improved psychomotor development scores in anemic babies at 12 months old [293]. However, there was no significant neurocognitive improvement reported in iron-replete babies at 9 months [294] [297].…”

Section: Ironmentioning

confidence: 99%

“…The research indicates the most significant benefits of iron supplementation are seen in high-risk groups [70,292] with infants who have, or are at high-risk for, IDA [293,296], or who live in areas where there is a high prevalence of iron deficiency [70]. All current research agrees the relationship between iron, general development, and neurocognitive development is not fully understood, and further research is needed [70,[292][293][294][295][296][297].…”

Section: Ironmentioning

confidence: 99%

Nutritional Gaps and Supplementation in the First 1000 Days

Korczak²,

et al. 2019

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Optimized nutrition during the first 1000 days (from conception through the 2nd birthday) is critical for healthy development and a healthy life for the newborn. Pregnancy and the postpartum period are accompanied by physiological changes, increased energy needs, and changing requirements in the nutrients critical for optimal growth and development. Infants and toddlers also experience physiological changes and have specific nutritional needs. Food and nutrition experts can provide women of childbearing age with adequate dietary advice to optimize nutrition, as well as guidance on selecting appropriate dietary supplements. Considering the approaching 2020–2025 Dietary Guidelines for Americans (DGA) will be making specific recommendations for children, it is important to provide accurate scientific information to support health influencers in the field of nutrition. The purpose of this review is to summarize the nutrition and supplementation literature for the first 1000 days; to highlight nutritional and knowledge gaps; and to educate nutrition influencers to provide thoughtful guidance to mothers and families. Optimal nutrition during pregnancy through early childhood is critical for supporting a healthy life. Nutrition influencers, such as dietitians, obstetricians/gynecologists, and other relevant health professionals, should continue guiding supplement and food intake and work closely with expectant families and nutrition gatekeepers.

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“…This MA did not identify any studies comparing iron supplementation to placebo for neurodevelopmental outcomes and one study was identified that showed no difference in neurodevelopment between high- and low-dose iron but a higher incidence of an abnormal neurological examination at 5 years of age with late-onset supplementation of iron ( Mills & Davies, 2012 ). Child behaviour but not intelligence scores were reported in one RCT as significantly better at seven-year follow-up of LBW infants supplemented with iron from birth compared with unsupplemented infants ( Berglund et al, 2018 ).…”

Section: Resultsmentioning

confidence: 99%

Antimicrobial and micronutrient interventions for the management of infants under 6 months of age identified with severe malnutrition: a literature review

Campion-Smith

Kerac

McGrath³

et al. 2020

PeerJ

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Background Infants under 6 months (U6M) contribute a significant proportion of the burden and mortality of severe malnutrition globally. Evidence of underlying aetiology in this population is sparse, but it is known that the group includes ex-preterm and low birthweight (LBW) infants. They represent a unique population given their dependence on breastmilk or a safe, secure alternative. Nutrition agencies and health providers struggle to make programming decisions on which interventions should be provided to this group based upon the 2013 WHO Guidelines for the ‘Management of Severe Acute Malnutrition in Infants and Young Children’ since there are no published interventional trial data focussed on this population. Interim guidance for this group might be informed by evidence of safety and efficacy in adjacent population groups. Methodology A narrative literature review was performed of systematic reviews, meta-analyses and randomised controlled trials of antimicrobial and micronutrient interventions (antibiotics, deworming, vitamin A, vitamin D, iron, zinc, folic acid and oral rehydration solution (ORS) for malnutrition) across the population groups of low birthweight/preterm infants, infants under 6 months, infants and children over 6 months with acute malnutrition or through supplementation to breastfeeding mothers. Outcomes of interest were safety and efficacy, in terms of mortality and morbidity. Results Ninety-four articles were identified for inclusion within this review. None of these studied interventions exclusively in severely malnourished infants U6M. 64% reported on the safety of studied interventions. Significant heterogeneity was identified in definitions of study populations, interventions provided, and outcomes studied. The evidence for efficacy and safety across population groups is reviewed and presented for the interventions listed. Conclusions The direct evidence base for medical interventions for severely malnourished infants U6M is sparse. Our review identifies a specific need for accurate micronutrient profiling and interventional studies of micronutrients and oral fluid management of diarrhoea amongst infants U6M meeting anthropometric criteria for severe malnutrition. Indirect evidence presented in this review may help shape interim policy and programming decisions as well as the future research agenda for the management of infants U6M identified as malnourished.

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Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial

Cited by 36 publications

References 34 publications

Risk for Behavioral Problems Independent of Cognitive Functioning in Children Born at Low Gestational Ages

Risk for Behavioral Problems Independent of Cognitive Functioning in Children Born at Low Gestational Ages

Nutritional Gaps and Supplementation in the First 1000 Days

Antimicrobial and micronutrient interventions for the management of infants under 6 months of age identified with severe malnutrition: a literature review

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