Inflammation and micronutrient deficiency as major risk factors for anemia in children with intestinal failure.

BACKGROUND: Most data on anemia in children with intestinal failure (IF) have been obtained from studies in which the data were collected at a single point in time. We aimed to identify the frequency of anemia and factors associated with hemoglobin levels in children with IF during their course of home parenteral nutrition.

METHODS: This prospective cohort study included patients with IF followed up at a pediatric intestinal rehabilitation center. Outcome variables were hemoglobin levels and prevalence of anemia during the follow-up period. The exposure variables were age, duration of parenteral nutrition, chronic disease, and serum concentrations of C-reactive protein, iron, copper, selenium, vitamins A, D, B12, and folic acid.

RESULTS: Twenty-five children with a median time receiving parenteral nutrition of 40.7 months were included. A median (IQR) of 40.7 (25.2; 58) hemoglobin measurements were performed per patient. Mean (SD) hemoglobin was 10.7 (1.8) g/dL at baseline and 11.6 (0.9) g/dL in the last observation (paired t-test, p=0.07); 32% of patients had mean hemoglobin values below the lower limit for age. In a multivariable predictive model, having C-reactive > 1 mg/dL was associated with a decrease of 0.57g/dL in hemoglobin (95% confidence interval [CI], -0.90; -0.24, p=0.01), and an increase of 1 mg/mL in serum vitamin A concentration represented an increase of 0.93 g/dL in hemoglobin level (95% CI, 0.24; 1.61, p=0.008).

CONCLUSION: Anemia affects almost one-third of children with IF and its frequency decreases during the follow-up period. Hemoglobin levels are associated with inflammatory response and serum micronutrient concentrations. This article is protected by copyright. All rights reserved.