Abstract:
ABSTRACT
Background: Iron plays an essential role in many important biochemical processes. As with
all nutrients, the requirement for iron is greater during periods of rapid growth and
differentiation such as in the late fetal and neonatal period. Poor iron homeostasis during this
period can result in disordered development. Inadequate tissue iron levels can lead to reduced
erythropoiesis and poor oxygen carrying capacity. The nervous system, which develops
rapidly during the late fetal and early neonatal period, seems to be particularly susceptible to
iron deficiency.
Objective: To assess neurodevelopment of low birth weight infants in relation to their iron
status.
Methodology
Hospital based descriptive cross-sectional study of 270 infants who were born premature/low
birth weight aged less than 12 months, attending the high-risk children clinic, whose mothers
consented. Infants were recruited on Mondays and Fridays during their clinic visit using
convenient sampling technique. Infants with known congenital anomalies, born with birth
asphyxia, meningitis and jaundice and those who were acutely ill during the clinic visit were
excluded from the study. Bayley Mental Developmental Scoring was done on all infants
recruited in the study, along with a thorough history, physical examination and laboratory tests
including serum ferritin and complete blood count. Cognitive, motor and language
development scores were considered normal with score of ≥85 and poor with score of <85.
Iron deficiency were considered if serum ferritin was <12µ/dl.
Results
Of the 270 infants, 124 (45.9%) were male and 146 (54.1%) were female providing a male to
female ratio of 0.8:1.
The prevalence of poor cognitive, motor and language development were 90%, 88.2% and
59.2% respectively. Poor cognitive, language and motor development were noted with
vii
increasing age with p=0.0001 in all categories. Language and motor development were more
poorly developed in females than males with p=0.05 and p= 0.006 respectively.
Infants with iron deficiency and poor cognitive percentile score were 37% compared with 18%
of iron deficient infants with normal cognitive percentile scores (p=0.007). More infants with
poor language percentile scores (35%) were observed in iron deficient infants than iron
sufficient infants (p=0.04). Motor development percentile score was not significantly affected
among the iron deficient infants
Infants with a history of not receiving iron supplementation had poor cognitive, language and
motor development with p=0.006, 0.001, and 0.0001 respectively.
The prevalence of iron deficiency was 34.1%. The iron status of the baby was significantly
associated with the gestational age (p=0.0004), the birth weight (p=0.0013) and the nutrition
status of the infant (p=0.013).
Whereas maternal age, gestation age and maternal education were not significantly associated
with poor neurodevelopment outcomes, birth weight, nutritional status and iron
supplementation status were significantly associated with neurodevelopment. Infants born
with very low birth weight of 0.8-1.49kg were significantly associated with poor cognitive
development. However, wasting was a positive predictor of poor motor development and not
predictive of the status of cognitive and language development.
Conclusion and Recommendations
Neurodevelopment was poor among infants born with low birth weight and was more
pronounced among iron deficient infants. Neurodevelopment was significantly associated with
birth weight, iron deficiency and wasting. Therefore the study recommends early
neurodevelopment assessment done on all preterm/low birth weight infants to identify
neurologically challenged infants and to direct them for further stimulation and
supplementation, in order to improve neurodevelopment.
viii
The study also recommends an improvement in iron supplementation program through
universal iron supplementation in the right doses and appropriate duration to all low birth
weight infants as well as exploring for other causes of poor neurodevelopment and intervening
as needed.