THE INFLUENCE OF FEEDING PRACTICE

ON IRON TREATMENT FOR ANEMIA IN INFANTS

Wiyarni Pambudi 

Department of Child HealthSumber Waras Hospital

Medical School, Tarumanagara UniversityJakarta – Indonesia

INTRODUCTIONInfants aged between 6 and 12 months are the high risk groups of iron deficiency anemia (IDA)The consequences of IDA : abnormalities of immune function, increased risk of infection, poor growth and neurocognitive impairment (Canfield, 2003)

Prevention and early treatment of IDA are essential benefit of iron treatment was well determined (Baker, 2010)

The influence of feeding practices during iron treatment on clinical and laboratory parameters are inconclusive

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OBJECTIVE

To compare the influence of feeding practiceon clinical and laboratory evaluation

of iron treatment for IDA, between exclusive, partial, or non breastfed

infants

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METHODS

Design : Prospective cohort studyPeriod : April 2010 - March 2011Location : 2 private hospitals in West JakartaParticipan : Convinience sampling of IDA infants Statistical analysis : Chi-square test

Student’s t-testp<0.05 ~ statistically significant (SPSS ver 16.0)

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Hb <11 g/dL

Hct <33%MCV <70

fLRDW

>14,5%Hb <11 g/dLFerritin <10

g/LSI <30 g/dLTIBC >480

g/dLTransferin

<8%

Therapeutic trial of iron

3 mg/kg/day po 1 monthIncrease of

Hb 1 g/dL or Hct 3% Confirmed

diagnosis ofIron Defiency

AnemiaTherapeutic course of iron 3 mg/kg/day

po 3 months

Full term infant

Age : 2-5 mo

Eligibility criteria :

M1

M3

M6Follow

up

methods

RESULTS & DISCUSSION

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Table 1.Characteristic of sample (n=36)

Exclusive breastfee

dingn=11

Partial breastfee

dingn=13

Non breastfee

dingn=12

Maternal age (y) 28,2±4,5 28,5±3,1 26,8±5,3

Maternal BMI (kg/m²)

20,7±2,8 20,9±5,8 20,4±2,6

Maternal Hb (g/dL) 11,6±3,7 11,8±2,9 11,5±1,7

Gestational age (weeks)

39,7±2,1 39,9±1,5 40,1±1,9

Infant’s birth weight (g)

2.965±2.76 2.837±3.17 2.918±3.73

Duration of exclusive breastfeeding (mo)*

6±0,1 3,8±1,5 1,1±0,7

Start on complementary food (mo)

6±0,2 6±0,1 6±0,3

*p < 0.05

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Table 2.Hematologic evaluation at diagnostik of IDA

Exclusive breastfee

dingn=11

Partial breastfee

dingn=13

Non breastfee

dingn=12

Hemoglobin (g/dL) 9,2±0,3 9,5±0,1 9,4±0,2Hematocrit (%) 31,2±2,7 30,8±4,3 30,1±6,2MCV (fl) 79,9±5,4 77,6±3,1 78,3±4,6Serum ferritin (g/L) 8,2±0,8 8,3±0,4 8,4±0,3CRP (mg/L) 1,4±0,2 1,3±0,5 1,3±0,4*p < 0.05

results & discussion

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Figure 1. Hemoglobin improvement during iron treatment among groups

results & discussion

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Figure 2. Growth velocity during iron treatment among groups

results & discussion

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Figure 3. Occurence of infection during iron treatment among groups

results & discussion

Breastfeeding has often been maligned for being a contributing factor to iron deficiency during infancy (Pizzaro, 1991)

This study exclusive breastfeeding infants achieved higher hemoglobin level at 3 and 6 month evaluation of iron treatment (p<0,01)The protective effect of breastfeeding was attributed to the high bioavailablility of breastmilk iron (49%) due in part to vitamin C and lactose in human milk, which enhances iron absorbtion (Friel, 2007)

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results & discussion

At the end of study, weight and length gain was better and morbidity risk was lower in exclusive breasfeeding infant compared to partial breastfeeding group and non breastfeeding infants (p<0,01)Breastmilk contains lactoferrin, which binds to extra iron that your baby doesn't use, keeping it from feeding harmful intestinal bacteria (Dewey, 2002)

Iron fortification may increase the susceptibility of infection by overwhelm the lactoferrin so that the bacteria thrive, often resulting in diarrhea and even microscopic bleeding (Gera, 2002)

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results & discussion

CONCLUSION

The pattern of feeding practice did have an influence on clinical and laboratory evaluation

of iron treatment

These findings highlight the need to support breastfeeding throughout management of iron

deficiency anemia in infants

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