Prevención de la carencia de hierro en la lactancia, la infancia y la adolescencia

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Abstract

La carencia de hierro (CH) es frecuente en lactantes, niños y adolescentes de todo el mundo debido a sus elevadas necesidades de hierro durante el crecimiento, la precaria ingestión de hierro alimentario y la dieta con biodisponibilidad baja. El estado de hierro deficitario se asocia a consecuencias adversas para la salud durante toda la infancia. Las medidas preventivas deben iniciarse precozmente, y entre ellas destacan el aporte complementario de hierro en mujeres gestantes, el retraso en el pinzamiento del cordón umbilical en el parto y la alimentación exclusiva con leche materna durante 6 meses. El hierro tiene que incrementarse considerablemente después de los 4 a 6 primeros meses de vida y el contenido elevado en hierro de los alimentos complementarios es crucial. Aunque el enriquecimiento con hierro de las leches para lactantes y los cereales para lactantes, la adición de polvos de micronutrientes en alimentos complementarios de preparación casera o el suministro de gotas de hierro son las estrategias preventivas más eficaces en lactantes destetados, la introducción temprana de carne y el retraso en la introducción de leche de vaca son también importantes. Las estrategias preventivas en niños mayores implican abordajes alimentarios que aumenten el contenido y la biodisponibilidad del hierro en la alimentación, así como el consumo de alimentos enriquecidos con hierro. En zonas de CH extensa puede ser necesario el aporte complementario de hierro. Si el paludismo es frecuente sólo deben administrarse dosis elevadas de aportes complementarios en niños con CH confirmada. Todas las intervenciones para el control de la CH pediátrica deben integrarse en programas sanitarios nacionales y globales más extensos destinados a mujeres gestantes y niños, incluyendo la educación sanitaria, la prevención del paludismo y la desparasitación. Debe monitorizarse el impacto de las estrategias preventivas de la CH sobre el estado de hierro y la frecuencia de la CH midiendo periódicamente el estado de hierro en la población.

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Most cited references 55

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Breastfeeding and the use of human milk.

Lawrence Gartner, Jane I. Morton, Ruth Lawrence … (2005)

Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.

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Diagnosis and management of iron-deficiency anaemia.

Bruce Cook (2005)

Anaemia is typically the first clue to iron deficiency, but an isolated haemoglobin measurement has both low specificity and low sensitivity. The latter can be improved by including measures of iron-deficient erythropoiesis such as the transferrin iron saturation, mean corpuscular haemoglobin concentration, erythrocyte zinc protoporphyrin, percentage of hypochromic erythrocytes or reticulocyte haemoglobin concentration. However, the changes in these measurements with iron deficiency are indistinguishable from those seen in patients with the anaemia of chronic disease. The optimal diagnostic approach is to measure the serum ferritin as an index of iron stores and the serum transferrin receptor as a index of tissue iron deficiency. The treatment of iron deficiency should always be initiated with oral iron. When this fails because of large blood losses, iron malabsorption, or intolerance to oral iron, parenteral iron can be given using iron dextran, iron gluconate or iron sucrose.

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Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.

Shirin Hassan, Eileen K. Hutton (2007)

With few exceptions, the umbilical cord of every newborn is clamped and cut at birth, yet the optimal timing for this intervention remains controversial. To compare the potential benefits and harms of late vs early cord clamping in term infants. Search of 6 electronic databases (on November 15, 2006, starting from the beginning of each): the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Neonatal Group trials register, the Cochrane library, MEDLINE, EMBASE, and CINHAL; hand search of secondary references in relevant studies; and contact of investigators about relevant published research. Controlled trials comparing late vs early cord clamping following birth in infants born at 37 or more weeks' gestation. Two reviewers independently assessed eligibility and quality of trials and extracted data for outcomes of interest: infant hematologic status; iron status; and risk of adverse events such as jaundice, polycythemia, and respiratory distress. The meta-analysis included 15 controlled trials (1912 newborns). Late cord clamping was delayed for at least 2 minutes (n = 1001 newborns), while early clamping in most trials (n = 911 newborns) was performed immediately after birth. Benefits over ages 2 to 6 months associated with late cord clamping include improved hematologic status measured as hematocrit (weighted mean difference [WMD], 3.70%; 95% confidence interval [CI], 2.00%-5.40%); iron status as measured by ferritin concentration (WMD, 17.89; 95% CI, 16.58-19.21) and stored iron (WMD, 19.90; 95% CI, 7.67-32.13); and a clinically important reduction in the risk of anemia (relative risk (RR), 0.53; 95% CI, 0.40-0.70). Neonates with late clamping were at increased risk of experiencing asymptomatic polycythemia (7 studies [403 neonates]: RR, 3.82; 95% CI, 1.11-13.21; 2 high-quality studies only [281 infants]: RR, 3.91; 95% CI, 1.00-15.36). Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign.

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Journal

Journal ID (publisher-id): ANS

Journal ID (doi): 10.1159/issn.0252-8185

Title: Annales Nestlé (Ed. española)

Publisher: S. Karger AG

ISBN: 978-3-8055-9734-0

ISBN: 978-3-8055-9735-7

ISSN (Print): 0252-8185

ISSN (Electronic): 1661-4003

Publication date Subscription-year: 2010

Publication date (Print): March 2011

Publication date (Electronic): 24 March 2011

Volume: 68

Issue: 3

Pages: 121-132

Affiliations

Laboratorio de Nutrición Humana, Instituto de Alimentos, Nutrición y Salud, ETH Zürich, Zürich, Suiza

Author notes

*Maria Andersson, Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Schmelzbergstrasse 7, CH–8092 Zürich (Switzerland), Tel. +41 44 632 80 51, Fax +41 44 632 1470, E-Mail maria.andersson@ilw.agrl.ethz.ch

Article

Publisher ID: 324427 Other ID: Ann Nestlé [Esp] 2010;68:121–132

DOI: 10.1159/000324427

SO-VID: e170f56a-4c3a-4e7a-84b7-0ecebf237bae

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Prevención de la carencia de hierro en la lactancia, la infancia y la adolescencia

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Abstract

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Karger: Nutrition and Dietetics

Most cited references 55

Breastfeeding and the use of human milk.

Diagnosis and management of iron-deficiency anaemia.

Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.

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