Feeding pracice & iron treatment in infants
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Transcript of Feeding pracice & iron treatment in infants
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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