Assistant Professor Texas Children's Hospital Baylor College of Medicine, Texas Children's Hospital Houston, Texas, United States
Background: Iron deficiency (ID) is the most common pediatric nutritional deficiency in the USA and is associated with neurodevelopmental delay, anemia, and failure to thrive. Infants with congenital heart disease (CHD) may be at high risk for ID due to early feeding difficulties, increased iron demand due to cyanosis, and heart failure. There are no studies on the burden of ID and its hematologic and neurodevelopmental associations in infants with CHD.
Objective: To assess the prevalence and predictors of ID in early childhood in children with CHD and association with neurodevelopmental outcomes.
Design/Methods: We conducted a single center retrospective cohort study including all infants with CHD undergoing cardiopulmonary bypass (CPB) surgery from 01/2013 to 11/2019 who had serum iron studies available in the first 2years of life. ID was defined as presence of ≥2 of the following 4 criteria: iron <50 mcg/dL, ferritin <20 ng/mL, transferrin >300 ng/mL, and transferrin saturation <15%. Demographic and clinical parameters were analyzed. Neurodevelopmental testing reviewed (if available) included Bayley Scales of Infant Development (BSID-III) at 18months (n=19), Gesell’s Motor Developmental Test at 12months (n=39), and Capute Cognitive Adaptive Test (CAT) and Clinical Linguistic & Auditory Milestone Scale (CLAMS) testing at 12months (n=38). Significant neurodevelopmental delay was defined as developmental quotient <70.
Results: Overall 137 patients met inclusion criteria – 59% (81) male, 50% (68) with single ventricle CHD. Median age at time of iron studies was 6.4months (IQR 3.3-10.6months). ID was present in 47% (64) patients. Only 32% (20/63) of the iron deficient patients were anemic, and 10% (6/63) had microcytosis. ID was more common in the single ventricle cohort, present in 62% (42/69) versus in 31% (22/68) of patients in the biventricular cohort (p=0.002). There was no association of ID with demographic or birth characteristics, or age at earliest CPB surgery. We did not find an association of ID with significant neurodevelopmental delay (BSID-III: cognitive, p=0.628; language, p=0.582; motor, p=1.000; Gesell’s motor test: p=1.000; Capute: CLAMS, p=0.408; CAT, p=1.000). Conclusion(s): Early childhood ID is present in 47% of infants with CHD undergoing CPB surgery, with the higher prevalence in the single ventricle cohort. Anemia and microcytosis have poor sensitivity to detect ID. Larger studies are needed to understand the potential association of ID with neurodevelopmental outcomes in this population.
Authors/Institutions: Kriti Puri, Texas Children's Hospital, Houston, Texas, United States; Jacquelyn M. Powers, Texas Children's Hospital, Houston, Texas, United States; Chetna K. Pande, Texas Children's Hospital, Houston, Texas, United States; Faridis Serrano-Forty, Texas Children's Hospital, Houston, Texas, United States; Lisa M. Noll, Baylor College of Medicine, Houston, Texas, United States; Sonia Monteiro, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, United States; Lara Shekerdemian, Texas Children's Hospital, Houston, Texas, United States; Justin Elhoff, Texas Children's Hospital, Houston, Texas, United States