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Original Article
Abstract
Background Iron deficiency (ID) is a commonly found nutritional Keywords: iron deficiency; infant neurological
disorder and a persistent problem, especially in Indonesia. Iron development; Bayley Infant Neurodevelopmental
deficiency during the critical period in childhood brain develop-
ment is estimated to cause irreversible damage that hinders infant
N
development.
Objective To determine the relationship between infant iron status utrition has an important role for achieving
and neurological development. optimal growth and development in
Methods We conducted a cross-sectional study at the Growth and
childhood.1 Iron deficiency is a common
Development Outpatient Clinic, Prof. Dr. R. D. Kandou Hospital,
Manado, from March to May 2015. By consecutive sampling, we nutritional disorder and one of the
obtained 44 healthy infants aged 7 to 10 months who fulfilled the main causes of nutritional anemia, especially in
inclusion criteria. Infants with a history of perinatal complications, Indonesia.2 Ringoringo reported that the incidence
such as head trauma, hypoglycemia, respiratory distress syndrome,
infection, or malaria were excluded Subjects’ serum hemoglobin and
of iron deficiency (ID) in infants aged 0-12 months
ferritin were examined for iron status. Infants’ risk of neurological was 7.6%.3 In ID cases, not only tissue delivery of
impairment was assessed by the Bayley Infant Neurodevelopmental oxygen is compromised, but proliferation, growth,
Screener (BINS). Results were analyzed by descriptive analysis for differentiation, myelinogenesis, immune function,
the characteristics and Spearman’s rank correlation coefficient
analysis for the relationship between iron status and neurological
energy metabolism, absorption, and biotransformation
development. are also affected, leading to abnormal growth and
Results From 14 infants with ID, 8 infants had a high risk of devel- behaviour.4 So far, there has been no consensus
opmental impairment. Of the 30 non-ID subjects, 4 infants had a
high risk of developmental impairment. Of the 30 non-ID infants,
16 infants had a low risk of impaired development, while 2 infants
with ID had low risk of developmental impairment. Spearman’s rho
revealed that infant iron deficiency was significantly associated with
high risk of neurological impairment. (r=-0.547; P<0.0001).
Conclusion Lower serum ferritin levels (iron deficiency) is From the Department of Child Health, Sam Ratulangi University Medical
significantly associated with greater risk of impaired neuro- School/Prof. Dr. R. D. Kandou Hospital, Manado, North Sulawesi,
logical development in infants aged 7-10 months. [Paediatr Indonesia.
Indones. 2017;57:291-4 ; doi: http://dx.doi.org/10.14238/
pi57.6.2017.291-4 ]. Reprint requests to: Buntat, MD, Department of Child Health, Sam
Ratulangi University Medical School/Prof. Dr. R. D. Kandou Hospital,
Jalan Raya Tanawangko, Manado 95115, North Sulawesi, Indonesia. Telp.
+62-431-865883; Email: lighty_snow86@yahoo.com.sg.
reported incidence of ID in Indonesian infants aged developmental evaluations of four conceptual areas
0-6 months, because no gold standard cut-off point of ability, i.e., basic neurological function, receptive
for ferritin levels are available for the determination of function, expressive function, and cognitive processes.
ID deficiency in such infants. Currently, in Manado, Results of the BINS examination were categorized
particularly in Prof. Dr. RD Kandou Hospital, there as high, moderate, or low risk.7 History-taking and
is limited data on the prevalence of ID and the physical examinations were performed to assess for
relationship between iron status and neurological infection and inflammation, weight (kg), and length
development in infants younger than 12 months. (cm). Based on Z-score, nutritional status was classified
The aim of this study was to assess for a potential as well-nourished (weight-for-length index -2SD to
relationship between infant iron status and impaired 2SD). Venous blood specimens (5 mL) were drawn
neurological development. by laboratory staff and tested for serum hemoglobin
(Hb) and ferritin levels. The Hb level was measured
with cyanmethemoglobin assay and serum ferritin
Methods level was measured with immunochemiluminiscence
(ICMA).
This cross-sectional study was performed from Descriptive data analysis was used for the
March to May 2015 and included all consecutive subjects’ characteristics and correlative data analysis
healthy infants aged 7 – 10 months at the Growth with Spearman’s rho was used to assess for a possible
and Development Outpatient Clinic, Prof. Dr. R. D. association between infant iron status and neurological
Kandou Hospital, Manado. We estimated a required development. This study was approved by the Ethics
sample size of 32 subjects, based on α=0.05 and Committee of Sam Ratulangi University Medical
power=80%. The inclusion criteria were infants School, Manado.
who registered as patients at our hospital (either at
the clinic or by birth), with clear childbirth medical
records, good nutritional status, born full term with Results
birth weight ≥ 2,500 grams, Apgar score ≥ eight at the
5th minute, and with parental consent. The exclusion Initially, 50 children were eligible for this study.
criteria were history of perinatal complications, However, six children were excluded due to parental
including head trauma, hypoglycemia, respiratory refusal to have infants’ blood drawn, leaving a total
distress syndrome, infection, or malaria. of 44 subjects.
Iron deficiency was defined as serum ferritin < 12 The prevalence of ID in our subjects was 32%.
µg/mL,5 with or without anemia. Anemia was defined These subjects comprised of eight males and six
as hemoglobin level < 11 g/dL.6 Infant neurological females. The highest prevalence was found in the
development status was assessed by BINS. This 10-month age group (8/14) (Table 1).
examination is a combination of neurological and
Of the 14 infants with ID, 8 infants had high risk risk of impaired neurological development. Other
and two infants had low risk of impaired neurlogical studies have reported a similar relationship between
development. Of 30 non-iron deficient infants 4 iron deficiency and neurological development in
infants had high risk and 16 infants had low risk infants.14-17
(Table 2). The relationship between infant iron A limitation of our study was that we did not
status and neurological development was analyzed assess other factors that may have affected iron status
by Spearman’s rho, revealing a moderate significant and neurological development, such as upbringing,
inverse association (r=-0.547; P<0.0001). genetics, quality of food, and maternal iron status.
Iron status
Deficient 2 4 8 14
Non-deficient 16 10 4 30