Zinc Protoporphyrin and Iron Deficiency Screening Trends and Therapeutic Response in an Urban Pediatric Center Zinc Protoporphyrin and Iron Deficiency Screening

Magge H, Sprinz P, Adams WG, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Iron deficiency is the most common micronutrient deficiency among children worldwide, with iron-deficiency anemia associated with long-term adverse neurodevelopmental effects.

Objective

To understand the role of zinc protoporphyrin (ZPP) in iron deficiency screening in a low-income pediatric population, as well as to describe the prevalence and trends of abnormal ZPP and the response to iron therapy.

Design

Retrospective longitudinal study of data from electronic medical records collected from January 1, 2002, through December 31, 2010.

Setting

Boston Medical Center primary care center.

Participants

A total of 2612 children with baseline routine screening results for complete blood cell count, lead, and ZPP drawn between ages 8 and 18 months and at follow-up were included. Children with sickle cell disease or lead toxicity were excluded.

Intervention

Documented iron prescription.

Main Outcome Measure

Reduction of baseline abnormal ZPP at follow-up.

Results

Of 2612 children, 48% had an abnormal ZPP level at baseline. Among those with abnormal ZPP (n = 1254), 18% were prescribed iron. Iron prescription was significantly associated with ZPP reduction (odds ratio, 1.5; 95% CI, 1.1 to 2.0) and greater mean change in ZPP (mean difference, −4.4; 95% CI, −7.2 to −1.5). In multivariate analysis, the effect of iron prescription on the reduction of abnormal ZPP was modified by hemoglobin level. Iron prescription was significantly associated with ZPP reduction among those with anemia (odds ratio, 2.4; 95% CI, 1.1 to 5.0). Iron was rarely prescribed in children without anemia; a substantial, but not statistically significant, trend to improvement in those prescribed iron with low-normal hemoglobin was found.

Conclusions and Relevance

Abnormal ZPP was common in this low-income population. Iron prescription was significantly associated with a larger reduction of ZPP. Our data suggest that ZPP may be appropriate for iron deficiency screening; further investigation is warranted to explore the role of ZPP among nonanemic children.

Zinc Protoporphyrin to Prevent Iron Deficiency Zinc Protoporphyrin to Prevent Iron Deficiency

Baker RD. — Mon, 01 Apr 2013 00:00:00 GMT

In this issue of JAMA Pediatrics, Magge et al report on zinc protoporphyrin (ZPP) used as a screening test for iron deficiency (ID) and ID anemia (IDA) in a large group of infants and toddlers. The authors touch on 2 issues that make this study important to all of us: first, the suspected involvement of ID and IDA in neurodevelopment and second, how best to screen for and treat ID and IDA. The authors point out that, while the prevalence of ID and IDA has decreased substantially, infants and toddlers remain at risk. The chances of ID and IDA have decreased; however, with the recognition that ID and IDA may have long-term neurodevelopmental consequences, the results of ID or IDA may be more damaging than previously realized. An accurate, simple, easy to interpret screening test for ID and IDA is needed. The authors suggest that ZPP may be that simple test.

AMA Publishing Group: Anemias Topic Collection

Zinc Protoporphyrin and Iron Deficiency Screening Trends and Therapeutic Response in an Urban Pediatric Center Zinc Protoporphyrin and Iron Deficiency Screening

Zinc Protoporphyrin to Prevent Iron Deficiency Zinc Protoporphyrin to Prevent Iron Deficiency