Журнал «Здоровье ребенка» 1 (60) 2015

Background. Iron deficiency (ID) and iron-deficiency anemia (IDA) continue to be of worldwide concern. Among children in the developing world, iron is the most common single-nutrient deficiency. In industrialized nations, despite a demonstrable decline in prevalence, IDA remains a common cause of anemia in young children. The World Health Organization (WHO) recommends exclusive breastfeeding for 6mo. However, iron deficiency is a concern for some exclusively breastfed (EBF) infants before 6 mo of age, especially in susceptible populations. ID during infancy has been linked to impaired psychomotor development and may compromise immune function. Combating ID during infancy is therefore a high priority, but it is challenging to identify feasible, effective, and safe intervention strategies for implementation during the first 6 mo. The introduction of complementary foods is not recommended before 6mo and, in any case, may not prevent ID.

Aim: To estimate of different methods of prevention of iron deficiency anemia in breast-fed infants.

Materials and methods. The study was approved by the Ethics Committee of the Luhansk State Medical University and all participants provided informed written consent after the study had been fully explained.

Studied of the questionnaires in 948 lactating mothers, to determined the hemoglobin level in their 948 infants, assessed of iron status (serum ferritin level, serum iron level and total iron binding capacity of serum) in 96 infants, the breast milk iron concentration (BMIC) in 88 lactating mothers. Efficiency of iron supplementation evaluated in 96 born full term infants. In 1^st group infants (n=31) received iron supplementation (1 mg/kg daily during 2 months) from 4 months of age; in 2^nd group (n=33) – without it; in 3^rd group (n=32) – breast milk infants from mothers consuming 60 mg iron daily. All infants take exclusive breastfeeding before 6 mo of age and take complementary foods.

Data processing and statistical analyses were performed using the software package STATISTICA 7.0. Shapiro-Wilk test was used to check for the normality of the data. Kruskal-Wallis and Mann-Whitney U test were used to calculate the difference between three ore two groups, non-normally distributed data. P value < 0.05 was considered significant.

Results. The prevalence of anemia in infants in region was 6 times higher than the official statistics (349.2/1000 vs. 52.9/1000). Iron status was higher in exclusively breast-fed infants before 6 mo old, but the incidence of anemia in 9 mo old infants was independent of the type of feeding.

Median of BMIC was 3.1 μmol/L (25%=1.6 μmol/L, 75%=5.5 μmol/L), only 23.9±4.5% samples of samples have normal iron level (5.4 to 16.1μmol/L); 24.1% of samples have critically low iron levels (<25%).

Lactating mothers who daily meat intake (according to the questionnaires), had BMIC no significant difference from the index of mothers who consumed meat products less often: Me=2.3μmol/L vs. 3.4μmol/L (p=0.72). The iron supplementation in the mother during lactation also did not affect the BMIC: the median of iron level in milk was 2.1μmol/L vs. 3.4μmol/L in mothers without it (p=0.16). Perhaps this was due to the recovery of its own iron stores due to losses during pregnancy and lactation.

Infants have significant highest hemoglobin level in 1^st group then in 2^nd and 3^rd groups (p=0.0001 and p=0.001 respectively). Median of serum iron was highest in 1^st group: 17.1μmol/L vs. 7.8μmol/L in 2^nd group (p=0.001) and 9.3μmol/L in 3^rd group (p=0.03). Serum iron levels in 2^nd and 3^rd group did not differ significantly (p=0.98). Median of total iron binding capacity of serum was higher in infants without iron supplementation (69.9μmol/L and 71.9μmol/L vs. 55.6μmol/L in infants from 1^st group (p=0.01). The serum ferritin level was 1.8 times higher in infants with iron supplementation (24.1±6.3μg/L vs. 13.6±4.9μg/L in 2^nd group and 14.7μg/L in 3^rd group respectively) (р=0.001). Rate of IDA was 3.2% in infants in 1^st group vs. 21.2% in infants without iron prophylaxis.

Conclusion. The breast milk iron concentration was independent from the mother's intake and iron supplementation during lactation. The best method of the iron prevention in breast-fed infants is daily iron supplementation of 1 mg/kg, starting at 4 months of age during 2 months and continued until appropriate iron-containing complementary foods.