Aggiornamento monografico
La carenza di ferro Parte II: Clinica, prevenzione e terapia
IRON DEFICIENCY. PART 2: CLINICAL MANIFESTATIONS, PREVENTION AND THERAPY
CALOGERO VULLO
Divisione Pediatrica, Arcispedale S. Anna, Ferrara
Giugno 1998 - pagg. 359 -374
Abstract
Part II of the review on iron deficiency (ID)
is devoted to clinical manifestations, prevention
and treatment. Pallor and fatigue
are increasingly rare as presenting signs
and symptoms of ID in industrialized countries.
More subtle conditions such as developmental
disorders and learning disabilities
may be caused by ID but many other
factors may be involved in their etiology. ID
may protect the child form infection, and,
conversely, iron overload can enhance the
virulence of pathogens such as Yersinia enterocolitica.
Serum iron may be low during
infections and chronic diseases even in absence
of true ID. Breath holding spells and
febrile convulsions have been recently related
to ID.
Iron fortification of cereals and follow-up
formula are widely used but thay does not
appear justified in Italy due to the low prevalence
of ID. Only preterm infants should
be supplemented with iron, with dosage depending
on their birth weight. Oral administration
of bivalent iron (2-3 mg/kg/day)
represent the first choice treatment of ID.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Moffat MEK, Longstaffe S, Besant J, et al:
Prevention of iron deficiency and psychomotor
decline in high-risk infants through use
of iron fortified infant formula: a randomized
clinical trial. J Pediatr 125, 527-534, 1994.
2. Aukett MA, Parkes YA, Scott PH, et al: Treatment with iron increases weight gain in psychomotor development. Arch Dis Child 76, 144-147, 1986.
3. Webb W, Oski EA: Iron deficiency anemia and scholastic achievement in young adolescents. J Pediatr 82, 827, 1973.
4. Oski FA, Honig AS: J Pediatr 92, 21-25, 1978.
5. Parks YA, Wharton BA: Iron deficiency and the brain. Acta Paediatr Scand Suppl 361, 71-77, 1989.
6. de Andraca I, Castillo M, Walter T: Psychomotor development and behavior in iron deficient anemic infants. Nutrition Reviews 55, 125- 131, 1997.
7. Pollit E: Iron deficiency and education deficiency. Nutrition Reviews 55, 133-140, 1997.
8. Herchberg S, Galan P: Biochemical effects of iron deprivation. Acta Paediatr Scand Suppl 361, 63- 70, 1989.
9. Weinberg ED: Iron and susceptibility to infectious disease. Science 184, 952-956, 1984.
10. Murray MJ, Murray AB, Murray MB, et al: Adverse effect of iron repletion on three course of certain infections. BMJ ii, 1113- 1115, 1978.
11. Higgs JM, Wells RS: Chronic mucocutaneous candidiasis: new approaches to treatment. Br J Dermatol 89, 179-90, 1973.
12. Modell B, Berdoukas V: The clinical approach to thalassaemia. Grune and Stratton ed, London 1984.
13. Di Palma A, Gamberini NM, Vullo C: Infezioni e Malattia di Cooley. Riv It Ped 12, 776, 1986.
14. Gallanr T, Freedman M, Vellend H, et al: Yersinia sepsis in patients with iron overload treated with deferoxamine. N Engl J Med 314, 1643, 1986.
15. Walter T, Olivares M, Pizarro F, et al: Iron, anemia and infection. Nutrition Reviews 55, 119-124, 1997.
16. Barry DMJ, Reeve AW: Increased incidence of gram-negative neonatal sepsis with intramuscular iron administration. Pediatrics 60, 908-912, 1977.
17. Cantwell RJ: Iron deficiency anemia of infancy. Some clinical principles illustrated by the clinical response of Maori infants to neonatal parenteral iron administration. Clin Pediatr ii, 443-449, 1972.
18. Oppenheimer SJ: Iron and infection: the clinical evidence. Acta Paediatr Scand Suppl 361, 62, 1989.
19. Bullen JJ, Rogers HJ, Leigh L: Iron binding protein in milk and resistance to Escherichia coli infections in infants. BMJ 1, 69, 1972.
20. Roberts AK, Chierici R, Sawatzki G, et al: Supplementation of an adapted formula with bovine lactoferrin: 1. Effect on infant flora. Acta Paediatr 81, 119-24, 1992.
21. Andelman MB, Sered BR: Utilization of dietary iron by term infants: a study of 12.048 infants from a low socioeconomic population. Arch Dis Child 111, 45-55, 1966.
22. Blumberg BS, Lustbader ED, Whitford PL: Changes in serum iron levels due to infection with hepatitis B virus. Proc Nat Acad Sci USA 78, 3222-4, 1981.
23. Lustbader ED, Hann HL, Blumberg BS: Serum ferritin as a predictor of host response to hepatitis B virus infection. Science 220, 423-5, 1983.
24. De Virgilis S, Cornacchia G, Sanna G, et al: Chronic liver disease in transfusion-dependent thalassemia: liver iron quantitation and distribution. Acta Haematologica 65, 32- 9, 1981.
25. van Thiel DH, Friedlander L, Fagiuoli S, et al: Response to interferon a therapy is influenced by the iron content of the liver. J Hepatol 20, 410-5, 1994.
26. Nelson WE, Behrman RE, Kliegman RM, et al: Nelson textbook of Pediatrics. WB Saunders Co. Philadelphia, 15° edit. 1996, pag 88.
27. Hannon DH: Breath-holding spells: waiting to jnhale, waiting for systole or waiting for iron therapy. J Pediatr 130, 510-2, 1997.
28. Daoud AS, Batihea A, Al Sheyyab M, et al: Effectiveness of iron therapy on breathholding spells. J Pediatr 130, 547-50, 1997.
29. Tan DA, Rash TC: Breath holding spells in a patient with transient erythroblastopenia of childhood. J Pediatr 130, 651-3, 1997.
30. Rweeves JD, Yip R, Kiley VA, et al: Iron deficiency in infants. The influence of mild antecedent infection. J Pediatr 105, 874, 1984.
31. Solonen JT, Myssonen K, Korpela H, et al: High iron stored levels are associated with excess risk of myocardial infarction in Eastern Finnish men. Circulation 86, 803-11, 1992.
32. Stevens RG, Jones DY, Micozzi MS, et al: Body iron stores and the risk of cancer. N Engl J Med 319, 1047-52, 1988.
2. Aukett MA, Parkes YA, Scott PH, et al: Treatment with iron increases weight gain in psychomotor development. Arch Dis Child 76, 144-147, 1986.
3. Webb W, Oski EA: Iron deficiency anemia and scholastic achievement in young adolescents. J Pediatr 82, 827, 1973.
4. Oski FA, Honig AS: J Pediatr 92, 21-25, 1978.
5. Parks YA, Wharton BA: Iron deficiency and the brain. Acta Paediatr Scand Suppl 361, 71-77, 1989.
6. de Andraca I, Castillo M, Walter T: Psychomotor development and behavior in iron deficient anemic infants. Nutrition Reviews 55, 125- 131, 1997.
7. Pollit E: Iron deficiency and education deficiency. Nutrition Reviews 55, 133-140, 1997.
8. Herchberg S, Galan P: Biochemical effects of iron deprivation. Acta Paediatr Scand Suppl 361, 63- 70, 1989.
9. Weinberg ED: Iron and susceptibility to infectious disease. Science 184, 952-956, 1984.
10. Murray MJ, Murray AB, Murray MB, et al: Adverse effect of iron repletion on three course of certain infections. BMJ ii, 1113- 1115, 1978.
11. Higgs JM, Wells RS: Chronic mucocutaneous candidiasis: new approaches to treatment. Br J Dermatol 89, 179-90, 1973.
12. Modell B, Berdoukas V: The clinical approach to thalassaemia. Grune and Stratton ed, London 1984.
13. Di Palma A, Gamberini NM, Vullo C: Infezioni e Malattia di Cooley. Riv It Ped 12, 776, 1986.
14. Gallanr T, Freedman M, Vellend H, et al: Yersinia sepsis in patients with iron overload treated with deferoxamine. N Engl J Med 314, 1643, 1986.
15. Walter T, Olivares M, Pizarro F, et al: Iron, anemia and infection. Nutrition Reviews 55, 119-124, 1997.
16. Barry DMJ, Reeve AW: Increased incidence of gram-negative neonatal sepsis with intramuscular iron administration. Pediatrics 60, 908-912, 1977.
17. Cantwell RJ: Iron deficiency anemia of infancy. Some clinical principles illustrated by the clinical response of Maori infants to neonatal parenteral iron administration. Clin Pediatr ii, 443-449, 1972.
18. Oppenheimer SJ: Iron and infection: the clinical evidence. Acta Paediatr Scand Suppl 361, 62, 1989.
19. Bullen JJ, Rogers HJ, Leigh L: Iron binding protein in milk and resistance to Escherichia coli infections in infants. BMJ 1, 69, 1972.
20. Roberts AK, Chierici R, Sawatzki G, et al: Supplementation of an adapted formula with bovine lactoferrin: 1. Effect on infant flora. Acta Paediatr 81, 119-24, 1992.
21. Andelman MB, Sered BR: Utilization of dietary iron by term infants: a study of 12.048 infants from a low socioeconomic population. Arch Dis Child 111, 45-55, 1966.
22. Blumberg BS, Lustbader ED, Whitford PL: Changes in serum iron levels due to infection with hepatitis B virus. Proc Nat Acad Sci USA 78, 3222-4, 1981.
23. Lustbader ED, Hann HL, Blumberg BS: Serum ferritin as a predictor of host response to hepatitis B virus infection. Science 220, 423-5, 1983.
24. De Virgilis S, Cornacchia G, Sanna G, et al: Chronic liver disease in transfusion-dependent thalassemia: liver iron quantitation and distribution. Acta Haematologica 65, 32- 9, 1981.
25. van Thiel DH, Friedlander L, Fagiuoli S, et al: Response to interferon a therapy is influenced by the iron content of the liver. J Hepatol 20, 410-5, 1994.
26. Nelson WE, Behrman RE, Kliegman RM, et al: Nelson textbook of Pediatrics. WB Saunders Co. Philadelphia, 15° edit. 1996, pag 88.
27. Hannon DH: Breath-holding spells: waiting to jnhale, waiting for systole or waiting for iron therapy. J Pediatr 130, 510-2, 1997.
28. Daoud AS, Batihea A, Al Sheyyab M, et al: Effectiveness of iron therapy on breathholding spells. J Pediatr 130, 547-50, 1997.
29. Tan DA, Rash TC: Breath holding spells in a patient with transient erythroblastopenia of childhood. J Pediatr 130, 651-3, 1997.
30. Rweeves JD, Yip R, Kiley VA, et al: Iron deficiency in infants. The influence of mild antecedent infection. J Pediatr 105, 874, 1984.
31. Solonen JT, Myssonen K, Korpela H, et al: High iron stored levels are associated with excess risk of myocardial infarction in Eastern Finnish men. Circulation 86, 803-11, 1992.
32. Stevens RG, Jones DY, Micozzi MS, et al: Body iron stores and the risk of cancer. N Engl J Med 319, 1047-52, 1988.