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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Review Article

Effects of Daily Iron Supplementation in 2- to 5-Year-Old Children: Systematic Review and Meta-analysis

Jane Thompson, Beverley-Ann Biggs and Sant-Rayn Pasricha
Pediatrics April 2013, 131 (4) 739-753; DOI: https://doi.org/10.1542/peds.2012-2256
Jane Thompson
aSchool of Medicine, Faculty of Health Sciences, University of Adelaide, South Australia, Australia;
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Beverley-Ann Biggs
bDepartment of Medicine, University of Melbourne, and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia;
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Sant-Rayn Pasricha
bDepartment of Medicine, University of Melbourne, and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia;
cNossal Institute for Global Health; and
dThalassaemia Service, Monash Medical Centre, Victoria, Australia
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Abstract

BACKGROUND AND OBJECTIVES: Iron deficiency (ID) is the most common cause of anemia worldwide. The prevalence is highest among preschool-aged children. Iron is widely administered to children with or at risk for ID, but evidence of benefit among 2- to 5-year-old children has not been evaluated by systematic review. We summarize the evidence for the benefit and safety of daily iron supplementation with regard to hematologic, growth, and cognitive parameters in 2 to 5 year olds.

METHODS: Electronic databases, regional databases, thesis repositories, gray literature, and references of studies and previous reviews were searched. We included randomized controlled trials that compared daily oral iron supplementation with control in 2 to 5 year olds. A random-effects meta-analysis was used to synthesize predefined outcomes reported by at least 2 studies.

RESULTS: Of 9169 references, 15 studies met the inclusion criteria, none of which were at low risk of bias. Children receiving iron supplementation had a mean end point hemoglobin of 6.97 g/L (P < .00001; I2 = 82%) greater than controls, whereas mean end point ferritin was 11.64 µg/L (P < .0001; I2 = 48%) greater. No trials reported the effects of iron supplementation on ID or iron deficiency anemia, and only one reported on anemia. Limited evidence suggested that iron supplementation produced a small improvement in cognitive development but had no effect on physical growth.

CONCLUSIONS: In 2 to 5 year olds, daily iron supplementation increases hemoglobin and ferritin. There is a concerning lack of data on the effect of iron supplementation on clinically important outcomes including anemia, ID anemia, ID, and cognitive development. Additional interventional studies in this age group are needed.

  • iron
  • anemia
  • child
  • preschool
  • meta-analysis
  • systematic review
  • Abbreviations:
    CI —
    confidence interval
    Hb —
    hemoglobin
    ICC —
    intraclass correlation coefficients
    ID —
    iron deficiency
    IDA —
    iron deficiency anemia
    MD —
    mean difference
    SMD —
    standard mean difference
    WHO —
    World Health Organization
    • Accepted November 26, 2012.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 4
    1 Apr 2013
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    Effects of Daily Iron Supplementation in 2- to 5-Year-Old Children: Systematic Review and Meta-analysis
    Jane Thompson, Beverley-Ann Biggs, Sant-Rayn Pasricha
    Pediatrics Apr 2013, 131 (4) 739-753; DOI: 10.1542/peds.2012-2256

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    Effects of Daily Iron Supplementation in 2- to 5-Year-Old Children: Systematic Review and Meta-analysis
    Jane Thompson, Beverley-Ann Biggs, Sant-Rayn Pasricha
    Pediatrics Apr 2013, 131 (4) 739-753; DOI: 10.1542/peds.2012-2256
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