Department of Pediatrics, Faculty of Medicine.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Pediatrics. 2018 Dec;142(6). doi: 10.1542/peds.2018-2095.
The American Academy of Pediatrics recommends universal screening for anemia using hemoglobin at 12 months. However, hemoglobin lacks diagnostic accuracy for iron deficiency, and the optimal age for screening has not been determined. Our objective was to assess a screening strategy for iron deficiency using serum ferritin.
We conducted a cross-sectional study of children 1 to 3 years old attending a health supervision visit. We examined the relationship between child age and serum ferritin, age and hemoglobin, hemoglobin and serum ferritin, and the prevalence of elevated C-reactive protein (CRP).
Restricted cubic spline analysis ( = 1735) revealed a nonlinear relationship between age and serum ferritin ( < .0001). A linear spline model revealed that from 12 to 15 months, for each 1-month increase in age, serum ferritin levels decreased by 9% (95% confidence interval [CI]: 5 to 13). From 15 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each month increase in age, serum ferritin increased by 2% (95% CI: 1 to 2). For hemoglobin, from 12 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each 1-month increase in age, hemoglobin increased by 20% (95% CI: 9 to 32). Compared with the serum ferritin cutoff of <12 μg/L, the hemoglobin cutoff of <110 g/L had a sensitivity of 25% (95% CI: 19 to 32) and a specificity of 89% (95% CI: 87 to 91). Elevated CRP ≥10 mg/L occurred in 3.3% (95% CI: 2.5 to 4.2).
Screening for iron deficiency using serum ferritin at 15 or 18 months may be a promising strategy. For children at low risk for acute inflammation, concurrent measurement of CRP may not be necessary.
美国儿科学会建议在 12 个月时使用血红蛋白进行贫血的普遍筛查。然而，血红蛋白对铁缺乏的诊断准确性较低，并且尚未确定最佳的筛查年龄。我们的目的是评估使用血清铁蛋白进行铁缺乏筛查的策略。
我们对 1 至 3 岁接受健康监督就诊的儿童进行了横断面研究。我们检查了儿童年龄与血清铁蛋白、年龄与血红蛋白、血红蛋白与血清铁蛋白之间的关系，以及 C 反应蛋白（CRP）升高的患病率。
限制三次样条分析（ = 1735）显示年龄与血清铁蛋白之间呈非线性关系（<0.0001）。线性样条模型显示，从 12 至 15 个月，每增加 1 个月，血清铁蛋白水平下降 9%（95%置信区间：5 至 13）。从 15 至 24 个月，变化率无统计学意义。从 24 至 38 个月，每增加 1 个月，血清铁蛋白增加 2%（95%置信区间：1 至 2）。对于血红蛋白，从 12 至 24 个月，变化率无统计学意义。从 24 至 38 个月，每增加 1 个月，血红蛋白增加 20%（95%置信区间：9 至 32）。与血清铁蛋白截断值<12 μg/L 相比，血红蛋白截断值<110 g/L 的敏感性为 25%（95%置信区间：19 至 32），特异性为 89%（95%置信区间：87 至 91）。升高的 CRP≥10 mg/L 发生在 3.3%（95%置信区间：2.5 至 4.2）。
在 15 或 18 个月时使用血清铁蛋白筛查铁缺乏可能是一种很有前途的策略。对于急性炎症风险较低的儿童，同时测量 CRP 可能不是必需的。
