Delayed iron does not alter cognition or behavior among children with severe malaria and iron deficiency.
Anemia, Iron-Deficiency
/ complications
Attention
Behavior
Child Behavior Disorders
/ physiopathology
Child, Preschool
Cognition
Drug Administration Schedule
Emotions
Female
Follow-Up Studies
Heme
/ analysis
Humans
Infant
Iron
/ therapeutic use
Iron Deficiencies
Malaria, Cerebral
/ complications
Male
Memory
Protoporphyrins
/ blood
Uganda
/ epidemiology
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
28
10
2019
accepted:
03
05
2020
pubmed:
14
5
2020
medline:
24
8
2021
entrez:
14
5
2020
Statut:
ppublish
Résumé
Malaria and iron deficiency (ID) in childhood are both associated with cognitive and behavioral dysfunction. The current standard of care for children with malaria and ID is concurrent antimalarial and iron therapy. Delaying iron therapy until inflammation subsides could increase iron absorption but also impair cognition. In this study, Ugandan children 18 months to 5 years old with cerebral malaria (CM, n = 79), severe malarial anemia (SMA, n = 77), or community children (CC, n = 83) were enrolled and tested for ID. Children with ID were randomized to immediate vs. 28-day delayed iron therapy. Cognitive and neurobehavioral outcomes were assessed at baseline and 6 and 12 months (primary endpoint) after enrollment. All children with CM or SMA and 35 CC had ID (zinc protoporphyrin concentration ≥80 μmol/mol heme). No significant differences were seen at 12-month follow-up in overall cognitive ability, attention, associative memory, or behavioral outcomes between immediate and delayed iron treatment (mean difference (standard error of mean) ranged from -0.2 (0.39) to 0.98 (0.5), all P ≥ 0.06). Children with CM or SMA and ID who received immediate vs. delayed iron therapy had similar cognitive and neurobehavioral outcomes at 12-month follow-up. The optimal time to provide iron therapy in children with severe malaria is not known. The present study shows that delay of iron treatment to 28 days after the malaria episode, does not lead to worse cognitive or behavioral outcomes at 12-month follow-up. The study contributes new data to the ongoing discussion of how best to treat ID in children with severe malaria.
Sections du résumé
BACKGROUND
Malaria and iron deficiency (ID) in childhood are both associated with cognitive and behavioral dysfunction. The current standard of care for children with malaria and ID is concurrent antimalarial and iron therapy. Delaying iron therapy until inflammation subsides could increase iron absorption but also impair cognition.
METHODS
In this study, Ugandan children 18 months to 5 years old with cerebral malaria (CM, n = 79), severe malarial anemia (SMA, n = 77), or community children (CC, n = 83) were enrolled and tested for ID. Children with ID were randomized to immediate vs. 28-day delayed iron therapy. Cognitive and neurobehavioral outcomes were assessed at baseline and 6 and 12 months (primary endpoint) after enrollment.
RESULTS
All children with CM or SMA and 35 CC had ID (zinc protoporphyrin concentration ≥80 μmol/mol heme). No significant differences were seen at 12-month follow-up in overall cognitive ability, attention, associative memory, or behavioral outcomes between immediate and delayed iron treatment (mean difference (standard error of mean) ranged from -0.2 (0.39) to 0.98 (0.5), all P ≥ 0.06).
CONCLUSIONS
Children with CM or SMA and ID who received immediate vs. delayed iron therapy had similar cognitive and neurobehavioral outcomes at 12-month follow-up.
IMPACT
The optimal time to provide iron therapy in children with severe malaria is not known. The present study shows that delay of iron treatment to 28 days after the malaria episode, does not lead to worse cognitive or behavioral outcomes at 12-month follow-up. The study contributes new data to the ongoing discussion of how best to treat ID in children with severe malaria.
Identifiants
pubmed: 32403115
doi: 10.1038/s41390-020-0957-8
pii: 10.1038/s41390-020-0957-8
pmc: PMC7483848
mid: NIHMS1592253
doi:
Substances chimiques
Protoporphyrins
0
zinc protoporphyrin
15442-64-5
Heme
42VZT0U6YR
Iron
E1UOL152H7
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
429-437Subventions
Organisme : NINDS NIH HHS
ID : D43 NS078280
Pays : United States
Organisme : FIC NIH HHS
ID : D43 TW010928
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS055349
Pays : United States
Organisme : NICHD NIH HHS
ID : U01 HD064698
Pays : United States
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