Iron Laboratory Studies in Pediatric Patients With Heart Failure from Dilated Cardiomyopathy

Higgins, David M.; Otero, Jessica; Kirk, Christa Jefferis; Pak, Jennifer; Jorgensen, Neal W.; Kemna, Mariska; Albers, E.; Hong, Borah J.; Friedland‐Little, Joshua M.; Law, Yuk M.

doi:10.1016/j.amjcard.2017.08.023

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…Iron deficiency is associated with a higher risk of hospitalization, worse echocardiographic features, ventricular assist device (VAD) implantation, heart transplant, and death. 45,46 In children with unrepaired cyanotic heart disease, Mukherjee et al found that iron deficient patients had significantly more cyanotic spells. 43 Otsuka et al found that in postoperative infant and pediatric patients who were treated with iron supplementation preoperatively, these patients received a significantly reduced volume of red blood cell transfusion.…”

Section: Ironmentioning

confidence: 99%

“…In cyanotic heart disease, hemoglobin and mean corpuscular volume levels may not decline because of the polycythemia resulting from chronic hypoxia, making iron deficiency difficult to interpret on a complete blood count. Iron deficiency is associated with a higher risk of hospitalization, worse echocardiographic features, ventricular assist device (VAD) implantation, heart transplant, and death 45,46 …”

Section: Nutrition Assessmentmentioning

confidence: 99%

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Nutrition for critically ill children with congenital heart disease

Kerstein,

Klepper,

Finnan

et al. 2023

Nut in Clin Prac

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Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter‐based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision‐making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.

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Section: Ironmentioning

confidence: 99%

Section: Nutrition Assessmentmentioning

confidence: 99%

Nutrition for critically ill children with congenital heart disease

Kerstein,

Klepper,

Finnan

et al. 2023

Nut in Clin Prac

View full text Add to dashboard Cite

show abstract

“…57 Such patients often fail to respond to oral iron but may become transfusion independent with intravenous iron therapy. 58 ID is increasingly becoming recognized in patients with heart failure [59][60][61][62]…”

Section: Concomitant Inflammationmentioning

confidence: 99%

“…Such patients often fail to respond to oral iron but may become transfusion independent with intravenous iron therapy . ID is increasingly becoming recognized in patients with heart failure resulting from a combination of poorer nutritional status, failure to thrive, and decreased intestinal iron absorption. Treatment of ID with intravenous iron in adult heart failure patients has demonstrated clinical improvement, including reduction of all‐cause mortality and cardiovascular hospital readmission .…”

Section: Consultations To the Pediatric Hematology–oncology Specialistmentioning

confidence: 99%

How I approach iron deficiency with and without anemia

Powers

O’Brien

2018

Pediatric Blood & Cancer

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Iron deficiency anemia remains a common referral to the pediatric hematology–oncology subspecialist. Improved understanding of iron homeostasis, including the effects of the regulatory hormone hepcidin, recent adult and pediatric clinical trial data, as well as the availability of safer formulations of intravenous iron, have resulted in additional considerations when making treatment recommendations in such patients. Young children and adolescent females remain the most commonly affected groups, but children with complex medical or chronic inflammatory conditions including comorbid gastrointestinal disorders also require special consideration.

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“…[1][2][3][4][5] Over 50% of children with heart failure are iron deficient, and iron deficiency is associated with increased hospitalisation burden and worse echocardiographic features in this population. 6,7 In both children and adults with heart failure, iron deficiency is also independently associated with higher risk of ventricular assist device implantation, heart transplant, or death [6][7][8] , regardless of the presence of anaemia.…”

mentioning

confidence: 99%

Poor efficacy of oral iron replacement therapy in pediatric patients with heart failure

et al. 2021

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Introduction: Iron deficiency is associated with worse outcomes in children and adults with systolic heart failure. While oral iron replacement has been shown to be ineffective in adults with heart failure, its efficacy in children with heart failure is unknown. We hypothesised that oral iron would be ineffective in replenishing iron stores in ≥50% of children with heart failure. Methods: We performed a single-centre retrospective cohort study of patients aged ≤21 years with systolic heart failure and iron deficiency who received oral iron between 01/2013 and 04/2019. Iron deficiency was defined as ≥2 of the following: serum iron <50 mcg/dL, serum ferritin <20 ng/mL, transferrin >300 ng/mL, transferrin saturation <15%. Iron studies and haematologic indices pre- and post-iron therapy were compared using paired-samples Wilcoxon test. Results: Fifty-one children with systolic heart failure and iron deficiency (median age 11 years, 49% female) met inclusion criteria. Heart failure aetiologies included cardiomyopathy (51%), congenital heart disease (37%), and history of heart transplantation with graft dysfunction (12%). Median dose of oral iron therapy was 2.9 mg/kg/day of elemental iron, prescribed for a median duration of 96 days. Follow-up iron testing was available for 20 patients, of whom 55% (11/20) remained iron deficient despite oral iron therapy. Conclusions: This is the first report on the efficacy of oral iron therapy in children with heart failure. Over half of the children with heart failure did not respond to oral iron and remained iron deficient.

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Iron Laboratory Studies in Pediatric Patients With Heart Failure from Dilated Cardiomyopathy

Cited by 12 publications

References 24 publications

Nutrition for critically ill children with congenital heart disease

Nutrition for critically ill children with congenital heart disease

How I approach iron deficiency with and without anemia

Poor efficacy of oral iron replacement therapy in pediatric patients with heart failure

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