Iron Requirements of Infants and Toddlers

Abstract

Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group because their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of ID anemia (IDA) include low birth weight, high cow's-milk intake, low intake of iron-rich complementary foods, low socioeconomic status, and immigrant status. The aim of this position paper was to review the field and provide recommendations regarding iron requirements in infants and toddlers, including those of moderately or marginally low birth weight. There is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting. Delayed cord clamping reduces the risk of ID. There is insufficient evidence to support general iron supplementation of healthy European infants and toddlers of normal birth weight. Formula-fed infants up to 6 months of age should receive iron-fortified infant formula, with an iron content of 4 to 8 mg/L (0.6-1.2 mg(-1) · kg(-1) · day(-1)). Marginally low-birth-weight infants (2000-2500 g) should receive iron supplements of 1-2 mg(-1) · kg(-1) · day(-1). Follow-on formulas should be iron-fortified; however, there is not enough evidence to determine the optimal iron concentration in follow-on formula. From the age of 6 months, all infants and toddlers should receive iron-rich (complementary) foods, including meat products and/or iron-fortified foods. Unmodified cow's milk should not be fed as the main milk drink to infants before the age of 12 months and intake should be limited to <500 mL/day in toddlers. It is important to ensure that this dietary advice reaches high-risk groups such as socioeconomically disadvantaged families and immigrant families.

Zinc protoporphyrin/heme ratio as parameter of iron status in moderately preterm infants: natural course and associations in the first 4 months

“…High growth velocity has been reported as a risk factor for ID and IDA, 1,23 because an increase in weight and subsequently expanding blood volume increases the requirement of iron for erythropoiesis. 12,21 We found lower ZnPP/H levels in the infants of mothers with pregnancy-induced hypertension.…”

“…2,6,7 Providing iron supplementation in each preterm infant, regardless of its iron status, might cause iron overload in infants with sufficient iron stores, which is associated with an increased risk of infection and impaired growth. 1,8 To be able to individualize iron supplementation in moderately preterm infants, it is important to differentiate infants at risk for ID and those who are not and might be harmed by iron overload.…”

“…However, the natural course of ZnPP/H in the first months of life and the association of ZnPP/H with the development of ID and IDA is not known in these infants. Therefore, we addressed the following questions in a cohort of Dutch moderately preterm infants screened for ID and IDA, who did not receive an erythrocyte transfusion or iron supplementation: (1) What is the natural course of ZnPP/H in the first 4 months of life? (2) Are ZnPP/H levels higher in moderately preterm infants with ID or IDA at 4 months of age compared with those who are not iron deficient?…”

Prophylaxis of Iron Deficiency Anemia in Infants and Todllers: A Multidisciplinary Approach (Literature Review)

“…Yrant vaisiaus eritrocitams, atsipalaidavusi geležis kaupiama retikuloendotelinėje sistemoje -vyksta geležies persiskirstymas kūdikio organizme (1 lentelė). Geležies atsargos vidutiniškai padidėja iki 120 mg [15].…”

“…Prasidėjus aktyviai eritrocitų gamybai, Hgb sintezei naudojamos geležies atsargos, kurių sveikam normalaus gimimo svorio išnešiotam naujagimiui pakanka iki 4-6 gyvenimo mėnesiams (kol padvigubėja gimimo svoris). Šiuo periodu su maistu gaunamas geležies kiekis turi kompensuoti tik kasdien netenkamos geležies kiekį -apie 0,02 mg/kg/d [15].…”