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Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia

  • Review
  • Intervention

Authors

  • Susana Martins,

    1. Unidade de Ensaios Clínicos e Meta-análise, Centro Cochrane do Brasil, São Paulo, SP, Brazil
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  • Stuart Logan,

    Corresponding author
    1. Peninsula Medical School, Universities of Exeter & Plymouth, Institute of Health and Social Care Research, Exeter, UK
    • Stuart Logan, Institute of Health and Social Care Research, Peninsula Medical School, Universities of Exeter & Plymouth, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. stuart.logan@pms.ac.uk.

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  • Ruth E Gilbert

    1. Institute of Child Health, Centre for Paediatric Epidemiology and Biostatistics, London, UK
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Abstract

Background

Iron deficiency and iron deficiency anaemia (IDA) are common in young children. It has been suggested that the lack of iron may have important effects on children's psychomotor development and cognitive function.

Objectives

To determine the effects of iron therapy on psychomotor development and cognitive function in iron deficient children less than 3 years of age.

Search methods

The following databases were searched:
COCHRANE LIBRARY (2000 ISSUE 4)
MEDLINE (1966-August 2000)
EMBASE (1980-August 2000)
Latin American Database (LILACS)
PsycLIT Journal articles (1974-August 2000)
PsycLIT Chapters and Books (1987-August 2000)

The references of identified trials and of important review articles were scrutinised. Citation searches on trials from the primary search were performed within the Science Citation Index. Key authors were contacted.

Selection criteria

Studies were included if children less than 3 years of age with evidence of iron deficiency anaemia were randomly allocated to iron or iron and vitamin C versus a placebo or vitamin C alone and assessment of developmental status or cognitive function was carried out using standardised tests by observers blind to treatment allocation.

Data collection and analysis

Abstracts and titles of studies identified on searches of electronic databases were read to determine whether they might meet the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by two independent reviewers. Differences of opinion about suitability for inclusion were resolved by discussion. Data were analysed separately depending on whether participants had iron assessments were performed within one month of beginning iron therapy or later.

Main results

Five trials, including 180 children with IDA, examined the effects of iron therapy on measures of psychomotor development between 5 and 11 days of commencement of therapy. Data from four trials could be pooled. The pooled difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups was -3.2 (95%CI -7.24, 0.85) and in Bayley Scale MDI, 0.55 (95% CI -2.84, 1.75).

Two studies, including 160 randomised children with IDA, examined the effects of iron therapy on measures of psychomotor development more than 30 days after commencement of therapy. Aukett et al reported the mean number of skills gained after two months of iron therapy, using the Denver test. The intervention group gained 0.8 (95% CI -0.18, 1.78) more skills on average than the control group. Idjrandinata et al reported that the difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups after 4 months was 18.40 (95%CI 10.16, 26.64) and in Bayley Scale MDI, 18.80 (95% CI 10.19, 27.41).

Authors' conclusions

There is no convincing evidence that iron treatment of young children with IDA has an effect on psychomotor development discernable within 5-11 days. The effect of longer term treatment remains unclear but the data would be compatible with clinically significant benefit. There is urgent need for further randomised controlled trials with long term follow up.

摘要

背景

以鐵劑治療 (Iron therapy) 改進3歲以下缺鐵性貧血 (iron deficiency anaemia) 兒童的精神運動 (psychomotor) 發展和認知功能

鐵缺乏和缺鐵性貧血常見於年幼兒童。鐵缺乏可能對兒童的精神運動發展和認知功能產生重要影響。

目標

研究鐵劑治療對3歲以下鐵缺乏兒童精神運動發展和認知功能的療效

搜尋策略

搜尋以下資料庫:COCHRANE LIBRARY (2000 ISSUE 4) MEDLINE (1966August 2000) EMBASE (1980August 2000) Latin American Database (LILACS) PsycLIT Journal articles (1974August 2000) PsycLIT Chapters and Books (1987August 2000) 挑出的試驗文獻和重要文章都被仔細研讀。在Science Citation Index內檢索之前挑選出的試驗所引用的文獻。有聯繫主要作者。

選擇標準

符合以下條件的試驗會被納入:三歲以下有缺鐵性貧血的兒童,被隨機分配至鐵治療或鐵和維生素治療,對照安慰劑組或只有維生素C治療。發展狀態或認知功能的評估由不知兒童接受何種治療的觀察者以標準化的檢驗評估。

資料收集與分析

閱讀由電子資料庫找出的研究摘要和題目,以決定這些研究是否符合納入標準。由電子資料庫或其他方式得到之可能符合納入標準的文獻全文,由兩位獨立審閱者評估。若對是否適合納入有不同意見,則經由討論取得共識。依受試者是否在開始鐵劑治療一個月內或之後有鐵評估將資料分開分析。

主要結論

5個總共包含180位有缺鐵性貧血兒童的試驗,檢視鐵劑治療對治療5至11天後的精神運動發展之療效。四個試驗的資料可以合併。合併後的資料顯示鐵劑治療組和安慰劑組治療前後的貝萊量表精神運動發展指標 (Bayley Scale PDI) 差異為 −3.2 (95% 信賴區間 (CI) −7.24, 0.85) ,而貝萊量表心智發展指標 (Bayley Scale MDI) 差異為0.55 (95% CI −2.84, 1.75) 。2個共隨機分配160位缺鐵性貧血兒童的試驗,檢視鐵劑治療進行30天以後對精神運動發展指標的影響。Aukett及其他人得到鐵劑治療兩個月後用丹佛檢驗 (Denver test) 得到的平均技能得分。介入組比安慰劑組的技能得分平均高出 0.8 (95% CI −0.18, 1.78) 。Idjrandinata及其他人得到鐵劑治療和安慰劑兩組,在治療4個月後,治療前後貝萊量表精神運動發展指標差別為18.40 (95% CI 10.16, 26.64) 且貝萊量表心智發展指標差別為18.80 (95% CI 10.19, 27.41) 。

作者結論

沒有決定性證據證明鐵劑治療5 – 11天就可對缺鐵性貧血年輕兒童的精神運動發展有療效。長期療效仍不清楚但資料將與臨床顯著益處相容。急需進一步有長期追蹤的隨機對照試驗。

翻譯人

共識仍待確認。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

本次結論為並沒有明顯證據證明治療缺鐵性貧血年幼病童能增進他們的發展。年幼兒童缺鐵可能會影響體智能發展,因此缺鐵性貧血兒童應該接受治療。長久以來一直建議缺鐵性貧血兒童應該接受治療,因年幼兒童缺鐵可能會影響體智能發展。但這裡的證據並不認為口服鐵或注射鐵,於接受治療的6 – 11天內會改進兒童發展。兩個進行治療兩個月以上的試驗中,一個於發展有顯著益處但另一個則沒有。撰稿者不確定鐵劑治療是否有益於鐵缺乏的貧血兒童之發展。

Plain language summary

Iron therapy for improving psychomotor development and cognitive function in children under three with iron deficiency anaemia

It has been suggested that a lack of iron in young children affects their physical and intellectual development and therefore those who are anaemic for this reason should be treated. The evidence here does not suggest that iron given by mouth or by injection leads to improvement in children's development within 6-11 days of starting treatment. Of the two studies which treated children for two months or longer, one reported dramatic benefits for development, while the other did not. This leaves the reviewers unsure whether iron treatment is beneficial for development in iron-deficient, anaemic children.

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