Home intervention improves cognitive and social-emotional scores in iron-deficient anemic infants

Abstract

Background: Iron-deficiency anemia (IDA) is associated with alterations in infant behavior and development that may not be corrected with iron therapy.

Objective: To determine if a home-based intervention to foster child development improves behavior and development of infants with IDA.

Methods: Infants with IDA and nonanemic infants aged 6 and 12 months were treated with oral iron and randomly assigned to a year of surveillance or intervention. Infants in the surveillance group were visited weekly, and information on iron intake, feeding, and health were recorded. Infants in the intervention were visited weekly, and the home visits included an hour-long program to foster child development by providing support to the mother-infant relationship. The number of infants enrolled was 128 (66 who received intervention) and 149 (70 intervention) at 6 and 12 months, respectively. Psychologists who were unaware of iron status and intervention assignment assessed infants' cognitive, motor, and social-emotional development (Bayley Scales) at the beginning, midpoint, and end of the year; 116 6-month-olds and 134 12-month-olds had at least 2 assessments. Hierarchical linear modeling was used to analyze change over time.

Results: Infants with IDA, regardless of enrollment age, were rated as less positive in social-emotional behavior at baseline. There were significant interactions between iron status and intervention associated with change in cognitive performance and positive social-emotional behavior. Infants with IDA who received intervention had developmental trajectories comparable to those of nonanemic infants in the intervention and surveillance groups, but these infants did not catch up in social-emotional behavior. Infants with IDA who received surveillance showed less increase in cognitive scores and had declines in positive social-emotional ratings.

Conclusions: Home-based intervention to foster child development improved cognitive and social-emotional scores in infants with IDA, but social-emotional differences remained between infants with IDA and those without IDA.

Trial registration: ClinicalTrials.gov NCT00998998.

Figure 1

Flowchart of subject participation for the 6-month cohort. ^a Corresponds to Table 1 and intention-to-treat (baseline) analyses; ^b corresponds to change-over-time analyses; n values for the second evaluation are those in Fig 3 and Table 4.

Figure 2

Flowchart of subject participation for the 12-month cohort. NA indicates nonanemic. ^a Corresponds to Table 2 and intention-to-treat (baseline) analyses; ^b corresponds to change-over-time analyses; n values for the second evaluation are those in Fig 4 and Table 4.

Figure 3

Change over time in raw mental development scores in the 6-month cohort. All groups had comparable scores at baseline. The groups showed similar rates of increase in raw mental scores over time, except for infants with DA randomly assigned to surveillance, who showed a lower rate of change (3-way interaction: intervention group according to iron status according to monthly change in score; P = .03). Table 4 gives the HLM parameters NA indicates nonanemic.

Figure 4

Change over time in raw mental development scores in the 12-month cohort. All groups had comparable scores at baseline. The groups showed similar rates of increase in raw mental scores over time, except for infants with DA randomly assigned to surveillance, who showed a lower rate of change (3-way interaction: intervention group according to iron status according to monthly change in score; P = .04). Table 4 gives the HLM parameters NA indicates nonanemic.

Figure 5

Change over time in positive social-emotiona scores in the 6-month cohort. Infants with IDA had lower positive social-emotional scores at baseline (factor scores expressed in SD units) The groups showed similar rates of increase in scores over time, except for infants with IDA randomly assigned to surveillance, who showed a decline in scores overtime (3-way interaction intervention group according to iron status according to monthly change in score; P = .002) Table 4 gives the HLM parameters. NA indicates nonanemic.

Figure 6

Change over time in positive social-emotional scores in the 12-month cohort. Infants with IDA had lower positive social-emotional scores at baseline (factor scores expressed in SD units) The groups showed similar rates of increase in scores over time, except for infants with IDA randomly assigned to surveillance, who showed a decline in scores overtime (3-way interaction ntervention group according to iron status according to monthly change in score; P = .01) Table 4 gives the HLM parameters. NA indicates nonanemic.