Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
Pediatrics. 2015 Apr;135(4):723-33. doi: 10.1542/peds.2014-3979.
Supplementation and screening for iron-deficiency anemia (IDA) in young children may improve growth and development outcomes. The goal of this study was to review the evidence regarding the benefits and harms of screening and routine supplementation for IDA for the US Preventive Services Task Force.
We searched Medline and Cochrane databases (1996-August 2014), as well as reference lists of relevant systematic reviews. We included trials and controlled observational studies regarding the effectiveness and harms of routine iron supplementation and screening in children ages 6 to 24 months conducted in developed countries. One author extracted data, which were checked for accuracy by a second author. Dual quality assessment was performed.
No studies of iron supplementation in young children reported on the diagnosis of neurodevelopmental delay. Five of 6 trials sparsely reporting various growth outcomes found no clear benefit of supplementation. After 3 to 12 months, Bayley Scales of Infant Development scores were not significantly different in 2 trials. Ten trials assessing iron supplementation in children reported inconsistent findings for hematologic measures. Evidence regarding the harms of supplementation was limited but did not indicate significant differences. No studies assessed the benefits or harms of screening or the association between improvement in impaired iron status and clinical outcomes. Studies may have been underpowered, and control factors varied and could have confounded results.
Although some evidence on supplementation for IDA in young children indicates improvements in hematologic values, evidence on clinical outcomes is lacking. No randomized controlled screening studies are available.
补充和筛查缺铁性贫血（IDA）可能会改善幼儿的生长和发育结果。本研究的目的是为美国预防服务工作组审查有关筛查和常规补充 IDA 的获益和危害的证据。
我们搜索了 Medline 和 Cochrane 数据库（1996 年-2014 年 8 月）以及相关系统评价的参考文献列表。我们纳入了在发达国家开展的、针对 6 至 24 月龄儿童常规补铁和筛查有效性和危害的试验和对照观察性研究。一位作者提取数据，另一位作者检查数据准确性。进行了双重质量评估。
没有研究报告缺铁性贫血在幼儿中的神经发育迟缓的诊断。5 项关于各种生长结局的稀疏报告补充剂的试验均未发现补充的明显益处。在 2 项试验中，经过 3 至 12 个月后，贝利婴幼儿发育量表评分无显著差异。10 项评估儿童补铁的试验对血液学指标的评估结果不一致。关于补充剂危害的证据有限，但并未表明存在显著差异。没有研究评估筛查的获益或危害，也没有研究改善铁状态受损与临床结局之间的关联。这些研究可能存在效力不足的情况，而且对照因素不同，可能会混淆结果。
虽然一些关于缺铁性贫血幼儿补铁的证据表明可以改善血液学指标，但缺乏临床结局的证据。没有随机对照筛查研究。
