Prevalence of anemia in exclusively breastfed full term babies between 3-6 months of age
Keywords:Anemia, Exclusive breast feeding, Fullterm baby, Prevalence
Background: WHO recommends exclusive breast feeding for 6 months without examination for anemia. However there are concerns about the feasibility and safety of this recommendation. Cochrane review studies especially in developing countries, suggest that exclusive breastfeeding up to 6 months without iron supplementation may compromise the hematologic status of children leading to IDA and its consequences. So the question arises; does absolute breast feeding protect infants from anemia during first 6 months of life? The present study was conducted to estimate the prevalence of anemia in exclusively breastfed babies between 3-6 months of age.
Methods: This was a retrospective study conducted between January 2019 and December 2019 at Shivajyoti Institute of Child Health-Haveri, in exclusively breastfed infants aged between 3-6 months who attended OPD and underwent complete blood count examination. Hemoglobin levels were collected and anemia was defined and classified as per WHO criteria for 6-24 months old children.
Results: Out of 81 infants 52 were males and 29 were females. Age wise, 26 babies were 3 months, 34 were 4 months and 21 were 5 months old. A total of 71 children had anemia; 49 mild, 20 moderate and 2 severe. The prevalence of anemia was 87.6% and it was highest (92.3%) at 3 months of age.
Conclusions: Exclusively breastfed infants between 3-6 months are at increased risk of anemia. Therefore infants after 3 months, should be evaluated for anemia and iron deficiency which is the commonest cause of anemia. Such infants should be supplemented with oral iron in addition to exclusive breast feeding for 6 months, to prevent adverse effects of IDA on infants’ growth and development.
WHOVitamins and minerals- Available at: https://www.who.int/nutrition/publications/vitamins_minerals/en/. Accessed on 10 November 2020.
WHO. The global prevalence of anemia in 2011. World Health Organization. Geneva: Switzerland; 2015.
WHO/Worldwide prevalence of anaemia 1993-2005. http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf. Accessed 10 Nov 2020
Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, et al. Determinants of anemia among young children in rural India. Pediatrics. 2010;126(1):e140-9.
Bharati S, Pal M, Bharati P. Prevalence of anaemia among 6-to 59-month-old children in India: the latest picture through the NFHS-4. J Biosoc Sci. 2020;52(1):97-107.
Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126(5):1040-50.
United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition (ASC/SCN) International Food Policy Research Institute (IFPRI). Fourth Report of the World Nutrition Situation. Geneva, Switzerland; 2000.
Huang Y, Wang L, Huo J, Wu Q, Wang W, Chang S, et al. Prevalence and causes of anaemia in children aged 6-23 months in rural Qinghai, China: findings from a cross-sectional study. BMJ Open. 2019;9(9):e031021.
Joo EY, Kim KY, Kim DH, Lee JE, Kim SK. Iron deficiency anemia in infants and toddlers. Blood Res. 2016;51(4):268-73.
Wang M. Iron deficiency and other types of anemia in infants and children. Am Fam Phys. 2016;93(4):270-8.
De Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S. The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia. J Nutr. 2002;132(8):2215-21.
Domellöf M, Dewey KG, Lönnerdal B, Cohen RJ, Hernell O. The diagnostic criteria for iron deficiency in infants should be reevaluated. J Nutr. 2002;132(12):3680‐6.
Domellöf M, Cohen RJ, Dewey KG, Hernell O, Rivera LL, Lönnerdal B. Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age. J Pediatr. 2001;138(5):679-87.
Dhanasekaran R, Sumitha A, Suguna. Impact of maternal anaemia on cord blood haemoglobin. Int J Contemp Pediatr 2019;6:1235-8.
Dallman PR, Siimes M, Stekel A. Iron deficiency in infancy and childhood. Am J Clin Nutr. 1980;33(1):86-118.
Yip R. Age related changes in iron metabolism. In: Brock JH, Halliday JW, Pippard MJ, Powell LW, eds. Iron Metabolism in Health and Disease. Academic Press, London, UK: WB Saunders; 1994:427-448.
Dewey KG, Chaparro CM. Session 4: Mineral metabolism and body composition iron status of breast-fed infants. Proc Nutr Soc. 2007;66(3):412-22.
Moraleda C, Rabinovich NR, Menéndez C. Are infants less than 6 months of age a neglected group for anemia prevention in low-income countries? Am J Trop Med Hygiene. 2018;98(3):647-9.
Irwin JJ, Kirchner JT. Anemia in children. Am Fam Phys. 2001;64(8):1379-86.
Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012;2012(8):CD003517.
World Health Organization. The Optimal Duration of Exclusive Breastfeeding: Report of an Expert Consultation. Geneva; 2001. Available at: https://www.who.int/nutrition/publications/optimal_duration_of_exc_bfeeding_report_eng.pdf. Accessed on 12 January 2021.
Dube K, Schwartz J, Mueller MJ, Kalhoff H, Kersting M. Iron intake and iron status in breastfed infants during the first year of life. Clin Nutr. 2010;29:773-8.
Friel JK, Aziz K, Andrews WL, Harding S, Courage ML, Adams RJ. A double-masked, randomized control trial of iron supplementation in early infancy in healthy term breast-fed infants. J Pediatr. 2003;143:582-6.
Marques RF, Taddei JA, Lopez FA, Braga JA. Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age. Revista da Associação Médica Brasileira. 2014;60(1):18-22.
Sills R. Iron deficiency anemia. In: Kingman RM, Staton BF, St Game III JW, Schruz. Nelson textbook of Pediatrics 20th edn. Elsevier: Philadelphia; 2016:455.
Hemachitra J, Monish A. Risk of infant anemia in 3-6 months old babies and its association with maternal anemia. Int J Contemp Pediatr. 2018;5(3):938.
Peirano PD, Algarin CR, Chamorro R, Reyes S, Garrido MI, Duran S, et al. Sleep and neurofunctions throughout child development: lasting effects of early iron deficiency. Pediatr Gastroenterol Nutr. 2009;48(1):S8-15.
Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135(2):267-72.
Black MM, Quigg AM, Hurley KM, Pepper MR. Iron deficiency and iron-deficiency anemia in the first two years of life: strategies to prevent loss of developmental potential. Nutr Rev. 2011;69(1):S64-70.
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011. Available at: https://apps.who.int/iris/handle/10665/85839. Accessed on 12 January 2021.
Kotecha PV. Nutritional anemia in young children with focus on Asia and India. Indian J Community Med. 2011;36(1):8-16.
Lutter CK. Iron deficiency in young children in low-income countries and new approaches for its prevention. J Nutr. 2008;138:2523-8.
Marol RN, Marol RR, Marol RR. Prevalence of anemia in children with acute lower respiratory tract infection: a case control study in children between 6 months to 23 months. Int J Contemp Pediatr. 2020;7:1573-7.
Sahu T, Sahani NC, Patnaik L. Childhood anemia- a study in tribal area of Mohana block in Orissa. Indian J Community Med. 2007;32(1):43-5.
Strauss MB. Anemia of infancy from maternal iron deficiency in pregnancy. J Clin Invest. 1933;12(2):345-53.
Colomer J, Colomer C, Gutierrez D, Jubert A, Nolasco A, Donat J, et al. (1990) Anaemia during pregnancy as a risk factor for infant iron deficiency: report from the Valencia Infant Anaemia Cohort (VIAC) study. Paediatr Perinat Epidemiol. 1990;4:196-204.
Prashant D. Prevalence of anemia among pregnant women attending antenatal clinics in rural field practice area of Jawaharlal Nehru Medical College, Belagavi, Karnataka, India. Int J Community Med Public Health. 2017;4(2):537.
Seema BN. Prevalence of anemia among pregnant women in rural Koppal: a study from teaching hospital, Koppal, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(9):3792-5.
Mangla M, Singla D. Prevalence of anaemia among pregnant women in rural India: a longitudinal observational study. Int J Reprod Contracept Obstet Gynecol. 2016 Dec 15;5(10):3500-5.
Chaparro CM, Neufeld LM, Alavez GT, Cedillo REL, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomized controlled trial. Lancet. 2006;367:1997-2004.
Van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ. 2006;333:954-8.
Hutton EK, Hassan ES. Late versus early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007;297(11):1241-52.
Andersson O, Hellström-Westas L, Andersson D, Domellöf M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343:d7157.
Census Data 2001- Census of India. Available at: https://censusindia.gov.in/2011-common/census_data_2001.html. Accessed on 10 November 2020.