Pediatric Iron Deficiency, Anemia
Conditions
Keywords
iron deficiency, choline, anemia
Brief summary
BACKGROUND: Iron deficiency limits the neurodevelopmental potential of more than 200 million children each year. Iron therapy is typically started when iron deficiency anemia is first diagnosed after screening for anemia or detection of clinical symptoms of iron deficiency anemia at 12 months of age. But iron started at this time does not fully correct earlier iron-deficiency-mediated brain dysfunction, underscoring the need for low-cost, easily implementable adjunct therapies to iron to treat or prevent this dysfunction in high-risk populations. GAP Supplementation with the nutrient choline lessens damage to the hippocampus from early-life iron deficiency in pre-clinical models and improves hippocampus-mediated memory in children with Fetal Alcohol Spectrum Disorders. Choline has not been tested in children with iron deficiency anemia, despite strong pre-clinical and clinical evidence supporting a benefit to brain development. HYPOTHESIS: Infants with iron deficiency anemia who receive iron and nine months of daily choline supplements will have better scores on specific neurobehavioral tests of recognition memory than infants who receive iron and placebo. METHODS: This randomized, double-blinded, placebo-controlled clinical trial will randomize 300 6-month-old infants with iron deficiency anemia at Mulago Hospital, Kampala, Uganda, to iron plus choline or iron plus placebo to test the effect of choline on hippocampus-specific and global neurobehavioral outcomes after nine months. RESULTS: Pending IMPACT: If our hypothesis is correct, choline could be added immediately to standard-of-care treatment for iron deficiency anemia. This intervention could safely mitigate the brain dysfunction of early-life iron deficiency that is often undiagnosed until the hippocampal critical window is closing. This simple, low-cost nutrient could thus have life-long benefit for both individuals and the economic and social prosperity of entire regions.
Interventions
Daily supplementation for 9 months with 200 mg choline bitartrate
OTHERplacebo drug
Daily supplementation for 9 months with identical placebo
Sponsors
University of Minnesota
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Manufacturer of choline and placebo tablets will randomize the regimens and hold the randomization key
Intervention model description
Randomized, double-blinded, placebo-controlled trial of 9 months of daily choline supplementation of 300 6-month-old Ugandan infants with iron deficiency anemia
Eligibility
Sex/Gender
ALL
Age
5 Months to 7 Months
Healthy volunteers
No
Inclusion criteria
* Age 6 months +/- 28 days * Hb \< 11.0 g/dL * ZPP \> = 80 * T\<37.5°C * Malaria-negative based on Rapid Diagnostic Test (RDT) * Mother is HIV-negative.
Exclusion criteria
* Developmental disorder * Severe malnutrition (severe wasting or bipedal edema) * Known sickle cell disease * Neurologic disorder, brain injury, or other condition affecting brain development * Not currently breastfeeding * Birthweight \< 2000 g
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Elicited Imitation score | 9 months (1 month = 28 days) after enrollment | Elicited Imitation outcomes (number of items correctly recalled and number of steps recalled in the correct order for both immediate and delayed recall) at age 15 months, i.e., after nine months of daily supplementation with choline or placebo. |
| 1) Composite Score on the Mullen Scales of Early Learning; 2) Behavior Rating Scale (BRS) composite score; 3) Early Childhood Vigilance Test (ECVT, computerized test for attention). | 9 months (1 month = 28 days) after enrollment | 1\) Composite Score on the Mullen Scales of Early Learning; 2) Behavior Rating Scale (BRS) composite score; 3) Early Childhood Vigilance Test (ECVT, computerized test for attention). |
Countries
United States
Contacts
Primary ContactSarah Cusick
Outcome results
None listed