Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
Prevention of Iron Deficiency Enemia in Infants
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Iron fortified formula (if not breast feeding) | Use of fortified formula lowers rates of iron deficiency anemia (IDA). Studies measuring clinical outcomes have not been conducted. | Randomized controlled trial <10> (I); quasi-randomized trial <12> (II-1) | There is fair evidence to recommend fortified formula for non-breast-fed infants. (B) |
| Iron fortified cereal | Lower IDA rates, for infants consuming iron fortified cereal compared to placebo, after the age of 4-6 months. Studies measuring clinical outcomes have not been conducted. | Randomized controlled trial <10,11> (I) | There is fair evidence to recommend iron fortified cereal for infants beginning at 4-6 months of age. (B) |
| Breast-feeding | Decrease in iron deficiency in breast-fed infants compared to infants fed cows milk (but not as low as the prevalence in those fed iron fortified formula). | Quasi-randomized study <12> (II-1) | There is fair evidence to recommend breast-feeding in newborn infants to lower the risk of iron deficiency anemia* (B); however, infants breast-fed beyond 6 months of age benefit from iron fortified cereal to prevent the development of IDA. |
| Decreased IDA in breast-fed infants; breast-feeding has been recommended on other grounds as well.* | Cohort analytic study <3> (II-3) | ||
| Iron supplementation | Two trials have demonstrated the benefit of iron oral supplements in infants. In North American the use of iron fortified formula and cereal is more widely used and may be more feasible. | Randomized controlled trials <13,14> (I) | There is fair evidence to recommend iron supplementation in infancy but iron fortified formula and cereal may be more feasible in most settings. (B) |
| Routine hemoglobin measurement at 6-12 months | Conflicting evidence from randomized controlled trials evaluating clinical outcomes. Three studies showed no benefit from therapy; one recent study demonstrated improvement in both cognitive and motor development. | Randomized controlled trials <15-19> (I) | Conflicting and insufficient evidence to recommend the inclusion or the exclusion of routine hemoglobin determination in normal-risk infants (C); on the basis a higher prevalence in certain risk groups** and a greater likelihood of inability to consume iron fortified products, there is fair evidence to recommend a routine hemoglobin measurement for high-risk infants. (B) |
* There is good evidence to recommend breast feeding for other reasons (A recommendation for preventing infection; see Chapter 22).
** High-risk infants include: infants of families of low socioeconomic status, Chinese or aboriginal ethnic origin, low birth weight (<2,500 grams) or fed only whole cow's milk during the first year of life.
Link to Full Text of this review
Link to Structured Abstract of this review
Link to Selected References list of this review
Reprinted in modified format by the Canadian
Task Force on Preventive Health Care
with permission.
Original Copyright
© 1994 Minister of Supply and Services Canada.
For any technical issues please contact: webmaster@ctfphc.org
Last modified March 27, 1998.
