'Taylor&Francis Acta Paediatr 93: 1391-1396. 2004 • # healthsciences The effects of iron deficiency on infants' developmental test performance M Akman', D Cebeci^ V Okur^ H Angin"*, O Abali^ and AC Akman^ Department of Family Medicine' and Department of Public Health^, Marmara University, School of Medicine; Department of Paediatrics^, Haseki Education and Research Hospital: Haseki Education and Research Hospital: Child and Adolescent Psychiatry Department of Istanbul Medicine Faculty^, Istanbul University; Department of Family Medicine^, Haydarpa^a Numune Education and Research Hospital, Istanbul, Turkey Akman M, Cebeci D, Okur V, Angin H, Abali O, Akman AC. The effects of iron deficiency on infants' deveiopmentai test performance. Acta Paediatr 2004; 93: 1391-1396. Stockholm. ISSN 0803-5252 Aim; To assess the effects of iron deficiency on developmental test scores in infants. Methods; This prospective, single-blind, controlled clinical intervention study was made on 108 children aged 6-30 mo who applied to our paediatric outpatient clinic. The cases were classified as control (« = 31, haemoglobin > 11 g/dl, serum ferritin > 12 Hg/1, MCV >70 fi), non-anaemic iron deficiency (NAID, n = 40, haemoglobin >11 g/dl, serum ferritin <12ng/l, MCV >70fl) and iron deficiency anaemia (IDA, n = 37, haemoglobin <11 g/dl, ferritin < 12 \xgl\, MCV <70 fl) due to their anaemia status. In each group, MCV, haemoglobin and ferritin levels were measured, and Denver Develop- mental Screening Test (DDST) and Bayley Scales of Infant Development (BSID-I) were admini- stered before and after a 3-mo follow-up. IDA and about half of the NAID subjects were treated with oral iron for 3 mo. Results; Subjects with iron deficiency showed significantly lower develop- mental test scores both with BSID-I and DDST-II compared to their iron-sufficient peers (p < 0.05). After 3 mo of iron treatment, lower mental developmental test scores were no longer observed among the IDA and NAID groups whose anaemia and iron deficiency were also corrected. No significant differences were found between control NAID and control IDA groups on DGTT-II results after treatment. The difference in motor and mental developmental scores did not appear to depend on environmental and family factors considered in the analyses. Conclusion; These findings support the conclusions that iron deficiency may cause lower mental and motor test scores in infants and these adverse effects can be improved by iron therapy. Key words: Anaemia, infant, iron deficiency, mental development, motor development Mehmet Akman, Ahmet Qelebi Mah, Dogancilar Cad. No; 127/3, Uskiidar-Istanbul, Turkey (Tel. +90 216 310 69 23, e-mail. makman4@hotmaiLcom) In spite of its long history and well-understood treat- show behaviours such as increased proximity to ment, iron deficiency remains the most common nutri- caregivers, increased weariness or hesitance, and tional deficiency worldwide (1,2). The relationship decreased activity, which could contribute to "func- between iron deficiency and developmental test scores tional isolation". The results indicate that iron defi- among infants has been the focus of interest for many ciency anaemia in infancy is associated with alterations investigators in recent decades. Since Oski et al. (3,4) in affect and activity, suggesting that functional isola- reported that iron-deficient anaemic infants had lower tion is a useful framework for understanding poorer mental developmental scores, and that these scores were developmental outcome in iron deficiency anaemia, the improved after short-term iron therapy, starting in the world's most common single nutrient deficiency (12). mid-1980s, placebo-controlled, randomized clinical Iron therapy has not yet been shown effective in trials have been conducted in this field of interest, completely correcting many of the observed distur- Generally, Bayley Scales of Infant Development were bances caused by iron deficiency. Although some used as a tool to assess the developmental status, except aspects of cognitive function seem to change with iron in a study by Aukett et al. (5), in which the Denver test therapy, lower developmental test scores have still been was used. noted after treatment. These lower scores have been Several recent studies have shown that infants with shown to persist after several months of iron therapy iron deficiency had lower scores on tests of mental and despite complete correction of nutritional and haema- motor development than their peers with better iron tological matters (8, 11). In contrast with these results, status (6-11). In 1998, Lozoff et al. tested the in a randomized blinded design, Idjradinata et al. hypothesis that infants with iron deficiency anaemia reported that after 4 mo of therapy 12-18-mo-old © 2004 Taylor & Francis. ISSN 0803-5253 DOI 10.1080/08035250410030946