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Meta-Analysis
. 2013 Jun 6;2013(6):CD001444.
doi: 10.1002/14651858.CD001444.pub2.

Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia

Bo Wang  1 , Siyan Zhan, Ting Gong, Liming Lee
Affiliations
Meta-Analysis

Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia

Bo Wang et al. Cochrane Database Syst Rev. .

Abstract

Background: Iron deficiency and iron deficiency anaemia (IDA) are common in young children. It has been suggested that the lack of iron may have deleterious effects on children's psychomotor development and cognitive function. To evaluate the benefits of iron therapy on psychomotor development and cognitive function in children with IDA, a Cochrane review was carried out in 2001. This is an update of that review.

Objectives: To determine the effects of iron therapy on psychomotor development and cognitive function in iron deficient anaemic children less than three years of age.

Search methods: We searched the following databases in April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (ICTRP). We also searched the reference lists of review articles and reports, and ran citation searches in the Science Citation Index for relevant studies identified by the primary search. We also contacted key authors.

Selection criteria: Studies were included if children less than three years of age with evidence of IDA were randomly allocated to iron or iron plus vitamin C versus a placebo or vitamin C alone, and assessment of developmental status or cognitive function was carried out using standardised tests by observers blind to treatment allocation.

Data collection and analysis: Two review authors independently screened titles and abstracts retrieved from the searches and assessed full-text copies of all potentially relevant studies against the inclusion criteria. The same review authors independently extracted data and assessed the risk of bias of the eligible studies. Data were analysed separately depending on whether assessments were performed within one month of beginning iron therapy or after one month.

Main results: We identified one eligible study in the update search that had not been included in the original review. In total, we included eight trials.Six trials, including 225 children with IDA, examined the effects of iron therapy on measures of psychomotor development and cognitive function within 30 days of commencement of therapy. We could pool data from five trials. The pooled difference in pre- to post-treatment change in Bayley Scale Psychomotor Development Index (PDI) between iron and placebo groups was -1.25 (95% confidence interval (CI) -4.56 to 2.06, P value = 0.65; I(2) = 33% for heterogeneity, random-effects meta-analysis; low quality evidence) and in Bayley Scale Mental Development Index (MDI) was 1.04 (95% CI -1.30 to 3.39, P value = 0.79; I(2) = 31% for heterogeneity, random-effects meta-analysis; low quality evidence).Two studies, including 160 randomised children with IDA, examined the effects of iron therapy on measures of psychomotor development and cognitive function more than 30 days after commencement of therapy. One of the studies reported the mean number of skills gained after two months of iron therapy using the Denver Developmental Screening Test. The intervention group gained 0.8 (95% CI -0.18 to 1.78, P value = 0.11, moderate quality of evidence) more skills on average than the control group. The other study reported that the difference in pre- to post-treatment change in Bayley Scale PDI between iron-treated and placebo groups after four months was 18.40 (95% CI 10.16 to 26.64, P value < 0.0001; moderate quality evidence) and in Bayley Scale MDI was 18.80 (95% CI 10.17 to 27.43, P value < 0.0001; moderate quality evidence).

Authors' conclusions: There is no convincing evidence that iron treatment of young children with IDA has an effect on psychomotor development or cognitive function within 30 days after commencement of therapy. The effect of longer-term treatment remains unclear. There is an urgent need for further large randomised controlled trials with long-term follow-up.

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Conflict of interest statement

Bo Wang ‐ none known. Si‐Yan Zhan ‐ none known. Ting Gong ‐ none known. Liming Lee ‐ none known.

Figures

1
1
Selection of eligible studies: a flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
4
4
Forest plot of comparison: 1 iron treatment versus placebo in children with iron deficiency anaemia (IDA), outcome: 1.1 Tests of psychomotor development performed 5 to 30 days after study entry: change in Bayley Scale Psychomotor Development Index (PDI)
5
5
Forest plot of comparison: 1 iron treatment versus placebo in children with iron deficiency anaemia (IDA), outcome: 1.2 Tests of mental development performed 5 to 30 days after study entry: change in Bayley Scale Mental Development Index (MDI)
6
6
Funnel plot of comparison: 1 iron treatment versus placebo in children with iron deficiency anaemia (IDA), outcome: 1.1 Tests of psychomotor development performed 5 to 30 days after study entry: change in Bayley Scale Psychomotor Development Index (PDI)
7
7
Funnel plot of comparison: 1 iron treatment versus placebo in children with iron deficiency anaemia (IDA), outcome: 1.2 Tests of mental development performed 5 to 30 days after study entry: change in Bayley Scale Mental Development Index (MDI)
1.1
1.1. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 1 Tests of psychomotor development performed 5‐30 days after study entry: change in Bayley Scale Psychomotor Development Index (PDI).
1.2
1.2. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 2 Tests of mental development performed 5‐30 days after study entry: change in Bayley Scale Mental Development Index (MDI).
1.3
1.3. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 3 Tests of psychomotor development performed 5‐30 days after study entry: post treatment Bayley Scale PDI.
1.4
1.4. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 4 Tests of mental development performed 5‐30 days after study entry: post treatment Bayley Scale MDI.
1.5
1.5. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 5 Tests of psychomotor development performed more than 30 days after study entry: change in Bayley Scale PDI.
1.6
1.6. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 6 Tests of mental development performed more than 30 days after study entry: change in Bayley Scale MDI.
1.7
1.7. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 7 Tests of psychomotor development and mental development performed more than 30 days after study entry: change in Denver Developmental Screening Test scores.
1.8
1.8. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 8 Tests of psychomotor development performed more than 30 days after study entry: post treatment Bayley Scale PDI.
1.9
1.9. Analysis
Comparison 1 Iron treatment versus placebo in children with iron deficiency anaemia, Outcome 9 Tests of mental development performed more than 30 days after study entry: post treatment Bayley Scale MDI.
See this image and copyright information in PMC

Update of

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