1. THE INFLUENCE OF FEEDING PRACTICE
ON IRON TREATMENT
FOR ANEMIA IN INFANTS
Wiyarni Pambudi
Department of Child Health
Sumber Waras Hospital
Medical School, Tarumanagara University
Jakarta – Indonesia

2. INTRODUCTION
Infants aged between 6 and 12 months are the high risk
groups of iron deficiency anemia (IDA)
The consequences of IDA : abnormalities of immune
function, increased risk of infection, poor growth and
neurocognitive impairment (Canfield, 2003)
Prevention and early treatment of IDA are essential 
benefit of iron treatment was well determined (Baker, 2010)
The influence of feeding practices during iron
treatment on clinical and laboratory parameters are
inconclusive
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3. OBJECTIVE
To compare the influence of feeding practice
on clinical and laboratory evaluation
of iron treatment for IDA,
between exclusive, partial, or non breastfed infants
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4. METHODS
Design
: Prospective cohort study
Period
: April 2010 - March 2011
Location
: 2 private hospitals in West Jakarta
Participan
: Convinience sampling of IDA infants
Statistical analysis : Chi-square test
Student’s t-test
p<0.05 ~ statistically significant
(SPSS ver 16.0)
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5. methods
Eligibility criteria :
Full term infant
Age : 2-5 mo
Hb <11 g/dL
Hct <33%
MCV <70 fL
RDW >14,5%
Therapeutic trial of iron
3 mg/kg/day po 1 month
Hb <11 g/dL
Ferritin <10 g/L
SI <30 g/dL
TIBC >480 g/dL
Transferin <8%
Confirmed diagnosis of
Iron Defiency Anemia
M1
Increase of
Hb 1 g/dL or Hct 3%
M3
Follow up
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Therapeutic course of iron
3 mg/kg/day po 3 months
M6
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6. RESULTS & DISCUSSION
Table 1.Characteristic of sample (n=36)
Exclusive
Partial
Non
breastfeeding breastfeeding breastfeeding
n=11
n=13
n=12
Maternal age (y)
28,2±4,5
28,5±3,1
26,8±5,3
Maternal BMI (kg/m²)
20,7±2,8
20,9±5,8
20,4±2,6
Maternal Hb (g/dL)
11,6±3,7
11,8±2,9
11,5±1,7
Gestational age (weeks)
39,7±2,1
39,9±1,5
40,1±1,9
Infant’s birth weight (g)
2.965±2.76
2.837±3.17
2.918±3.73
Duration of exclusive
6±0,1
3,8±1,5
1,1±0,7
breastfeeding (mo)*
Start on complementary
6±0,2
6±0,1
6±0,3
food (mo)
*p < 0.05
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7. results & discussion
Table 2.Hematologic evaluation at diagnostik of IDA
Hemoglobin (g/dL)
Hematocrit (%)
MCV (fl)
Serum ferritin (g/L)
CRP (mg/L)
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Exclusive
Partial
Non
breastfeeding breastfeeding breastfeeding
n=11
n=13
n=12
9,2±0,3
9,5±0,1
9,4±0,2
31,2±2,7
30,8±4,3
30,1±6,2
79,9±5,4
77,6±3,1
78,3±4,6
8,2±0,8
8,3±0,4
8,4±0,3
1,4±0,2
1,3±0,5
1,3±0,4
*p < 0.05
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8. results & discussion
Figure 1. Hemoglobin improvement during iron treatment among groups
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9. results & discussion
Figure 2. Growth velocity during iron treatment among groups
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10. results & discussion
Figure 3. Occurence of infection during iron treatment among groups
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11. results & discussion
Breastfeeding has often been maligned for being a
contributing factor to iron deficiency during infancy
(Pizzaro, 1991)
This study  exclusive breastfeeding infants achieved
higher hemoglobin level at 3 and 6 month evaluation of
iron treatment (p<0,01)
The protective effect of breastfeeding was attributed
to the high bioavailablility of breastmilk iron (49%) due
in part to vitamin C and lactose in human milk, which
enhances iron absorbtion (Friel, 2007)
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12. results & discussion
At the end of study, weight and length gain was better
and morbidity risk was lower in exclusive breasfeeding
infant compared to partial breastfeeding group and
non breastfeeding infants (p<0,01)
Breastmilk contains lactoferrin, which binds to extra
iron that your baby doesn't use, keeping it from
feeding harmful intestinal bacteria (Dewey, 2002)
Iron fortification may increase the susceptibility of
infection by overwhelm the lactoferrin so that the
bacteria thrive, often resulting in diarrhea and even
microscopic bleeding (Gera, 2002)
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13. CONCLUSION
The pattern of feeding practice did have an influence on
clinical and laboratory evaluation of iron treatment
These findings highlight the need to support
breastfeeding throughout management of iron
deficiency anemia in infants
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