Infants in the Second Year of Life Are Still at Significant Risk for Developing Iron Deficiency Anemia (IDA) and Should Be Treated with Prophylactic Iron Supplements.
Authors: Nir Yifat , Limoni Yehuda , Gordon Michal , Moser Asher 
Published: October 2019

Abstract
Abstract 4533

Background
Identifying and treating iron deficiency anemia (IDA) is recommended by the American Academy of Pediatrics, the CDC and a U.S. Preventive Services Task Force to prevent various long-term squeals such as delayed mental and psychomotor development.
As the prevalence of IDA and Thalassemia is high in Israel, the ministry of health has instituted that all infants of 4-12 months of age be supplemented with an iron preparation at 3 mg/kg/day. Iron deficient infants are treated with 6mg/kg/day iron, and rechecked at 3 months.

Aim of Study
To determine the prevalence of IDA in infants in the second year of life

Methods
Study population consists of 1818 toddlers between 12 to 24 months, from eight clinics in the southern (Negev) district of Israel; four clinics of the Bedouin sector (1167 toddlers) and four of the Jewish sector (651 toddlers) Samples were collected during 2006 and 2007 from otherwise healthy individuals, as recommended by the ministry of health. Toddlers were eligible unless previously known to be suffering from a congenital anemia disorder. Anemia was defined as MCV < 70. Iron deficiency was defined by an increment in MCV at a repeat test within 6 months or a ferritin level below norm.

Results
Of the 968 males and 850 females (Mean age 16.9±3.4 months), 505 (27.8%) toddlers were found to be anemic. The prevalence of anemia was significantly higher amongst Bedouin toddlers, (37.5% vs. 10.3% in Jews, p=0.001), and Male gender (30.5% vs. 24.7% in females, p=0.006), highly significant for Jewish males (14.6% vs. 5.5% in Jewish females p<0.001). Anemic toddlers were significantly older than the non-anemic toddlers (17.3±3.4 months vs. 16.7±3.4, respectively, p=0.001).
One hundred thirteen (22.3%) anemic infants had a follow-up test (average time 4.4 months), 81 of them had an improvement in MCV and 5 had a low ferritin level. The group of toddlers with IDA was determined at 76.1% of the anemic children. We found no significant difference in the execution of a follow-up test between sectors and genders. However, toddlers that underwent a second test were significantly younger, by an average of 3 months (p<0.001, 95% [CI]: 2.27-3.45 months).
No differences in demographics gender, age or blood indices were found between the groups of infants who repeated the test and those without further data. Of the total sample population 20.1% were defined as IDA. Multivariate analysis of the anemia model revealed a significantly higher risk for developing IDA in the second year of life for Bedouin toddlers (27%) compared to Jewish toddlers (7.4%; OR: 3.7; 95% CI: 2.482-5.468), and for male toddlers compared to female.

Conclusions
A cost-effective screening program to prevent and treat IDA and other anemias in a high-risk population is cost effective and easily executed. Physicians need to be aware of IDA in order to implement an effective screen.
With an overall prevalence of more than 1 in 5 infants suffering from IDA, and the very low probability of iron overload, our results clearly support the need to continue iron supplementation in the second year of life.

Disclosures:
No relevant conflicts of interest to declare.