Auditory brainstem response in full-term neonates born to mothers with iron deficiency anemia: relation to disease severity

Elalfy, Mohsen Saleh; El-Farrash, Rania A.; Taha, Hesham; Ismail, Eman Abdel Rahman; Mokhtar, Noha Ahmed

doi:10.1080/14767058.2018.1533940

Cited by 15 publications

(21 citation statements)

References 37 publications

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“…Of those assessing the impact of ID in pregnancy/in utero, two studies measured maternal ID, one measured maternal IDA, three measured ID in cord blood at delivery and one study measured ID in both maternal and cord blood. Cord blood ID was defined as either ferritin <75 μg/L [ 22 , 23 , 24 , 25 ] or zinc protopophyrin (ZPP) >188 μmol/mol [ 26 ]. There was no consistency in the definition of maternal ID, although all studies measured ferritin concentration with [ 27 , 28 ] or without [ 24 , 29 ] a measure of inflammation.…”

Section: Resultsmentioning

confidence: 99%

“…Behavioural assessment tools included the Bayley Scales of Infant and Toddler Development (BSID) [ 43 ], the Mullen Scales of Early Learning (MSEL) [ 44 ] and the Wechsler Pre-school and Primary Scale of Intelligence (WPPSI) [ 45 ]. Several studies (observational ( n = 8), supplementation ( n = 6)) used objective measures of brain structure or function, including assessments of visual or auditory physiological responses [ 23 , 24 , 25 , 36 , 40 , 46 , 47 ], structural magnetic resonance imaging (MRI) [ 29 ], eye-blink rates [ 48 ] and nerve conduction velocity [ 49 ]. Other methods of assessment included parent-reported behaviours, for example achieved motor milestones [ 50 ], language production [ 37 ] or problematic behaviours [ 37 , 51 ].…”

Section: Resultsmentioning

confidence: 99%

“…None of the observational studies provided a sample size calculation to justify the number of participants, and many had relatively small sample sizes, with n < 30 ID or IDA participants in the analysis ( Tables S3 and S4 ). Consideration of factors widely reported to be related to both developmental outcomes and ID, such as status of other micronutrients, measures of growth and socio-economic context was generally inadequate, and in many studies entirely absent from analysis, with only crude associations reported [ 25 , 29 , 32 , 34 , 37 , 42 , 53 ] ( Tables S1 and S2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Neurophysiological assessments were used in four studies [23][24][25]29]. All four studies reported positive associations between iron status and infant responses.…”

Section: Neurophysiological Developmentmentioning

confidence: 99%

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The Role of Iron in Brain Development: A Systematic Review

2020

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One-third of children falter in cognitive development by pre-school age. Iron plays an important role in many neurodevelopmental processes, and animal studies suggest that iron sufficiency in pregnancy and infancy is particularly important for neurodevelopment. However, it is not clear whether iron deficiency directly impacts developmental outcomes, and, if so, whether impact differs by timing of exposure or developmental domain. We searched four databases for studies on iron deficiency or iron supplementation in pregnancy, or at 0–6 months, 6–24 months, or 2–4 years of age. All studies included neurodevelopmental assessments in infants or children up to 4 years old. We then qualitatively synthesized the literature. There was no clear relationship between iron status and developmental outcomes across any of the time windows or domains included. We identified a large quantity of low-quality studies, significant heterogeneity in study design and a lack of research focused on pregnancy and early infancy. In summary, despite good mechanistic evidence for the role of iron in brain development, evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Neurophysiological assessments were used in four studies [23][24][25]29]. All four studies reported positive associations between iron status and infant responses.…”

Section: Neurophysiological Developmentmentioning

confidence: 99%

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The Role of Iron in Brain Development: A Systematic Review

2020

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“…Despite the critical role of iron in the developing brain, investigations into the neurological consequences of iron deficiency in newborn human infants have been limited, often constrained by inadequate sample sizes and short‐term neurological follow‐up. To date, abnormalities in the auditory neural pathway after birth were reported in term and pre‐term infants with cord ferritin concentrations <76 µg/l (Amin et al ; Amin et al ; Choudhury et al ; ElAlfy et al ), while reduced haemoglobin at birth, reflective of anaemia, the end‐stage of iron deficiency, was associated with altered neonatal temperament in the first week of life (Wachs et al ). Infants born to mothers with gestational and pre‐gestational diabetes with cord ferritin ≤34 µg/l, a threshold the authors calculated to reflect brain iron depletion, also had poorer recognition memory at ~ 15 days old (Siddappa et al ).…”

Section: Iron and The Developing Brainmentioning

confidence: 99%

The neonatal period: A missed opportunity for the prevention of iron deficiency and its associated neurological consequences?

McCarthy

Kiely

2019

Nutrition Bulletin

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Iron deficiency is the most common micronutrient deficiency worldwide. Iron is essential for the development of multiple organ systems, most especially the developing brain. Iron deficiency, particularly during sensitive periods of brain development, such as in early childhood, is associated with long‐lasting adverse consequences for cognition, motor function and behaviour. Little consideration has been given to iron deficiency in newborn infants and its potential health consequences. Fetal iron accretion is compromised by pregnancy complications such as pre‐term birth and gestational diabetes mellitus, and our work has identified an increased risk of low iron stores at birth from maternal lifestyle factors such as smoking and obesity. Early‐life events, including Caesarean section delivery, further add to the cumulative risk of neonatal iron deficiency, which can persist throughout infancy into early childhood. While investigations into the long‐term neurological consequences of neonatal iron deficiency are limited, there is evidence of poorer memory, motor function and language ability in children born iron deficient. Recently, we also identified significant behavioural consequences of neonatal deficiency persisting from 2 to 5 years of age, with effects particularly apparent in ‘high‐risk’ children born to obese or smoking mothers or delivered by Caesarean section. Interventions targeting the fetal/neonatal period could therefore represent a key opportunity for the prevention of iron deficiency and its associated long‐term health consequences. A dual approach is required, comprising public health strategies targeting prevention, to improve health in women of reproductive age, and the development of screening strategies for the early detection of iron deficiency in newborn infants.

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