Enteral Iron Supplementation in Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVES Iron is needed for growth and development of infants globally, but preterm and low birth weight (LBW) infants are at risk for severe iron deficiencies. To assess the effect of enteral iron supplementation on mortality, morbidity, growth, and neurodevelopment outcomes in preterm or LBW infants fed human milk. Secondary objectives were to assess the effect on biomarkers and dose and timing. METHODS Data sources include PubMed, Embase and Cochrane Library databases to March 16, 2021. Study Selection includes controlled or quasi experimental study designs. Two reviewers independently extracted data. RESULTS Eight trials (eleven reports; 1093 participants, 7 countries) were included. No trials reported mortality. At latest follow-up, there was little effect on infection (very low certainty evidence, 4 studies, 401 participants, relative risk [RR] 0.98, 95% confidence interval [95% CI] 0.56 to 1.73, I2 = 0.00%) and necrotising enterocolitis (3 studies, 375 participants, RR 1.47, 95% CI 0.68 to 3.20, I2 = 0.00%). There was an increase in linear growth (length) (moderate certainty evidence, 3 studies, 384 participants, mean difference 0.69 cm, 95% CI 0.01 to 1.37, I2 = 0%) but little effect on weight, head circumference, or cognitive development. There was an improvement in anemia (moderate certainty evidence, 2 studies, 381 participants, RR 0.25, 95% CI 0.10 to 0.62, I2 = 0.00%) but no effect on serum ferritin. Limitations include heterogeneity in the included studies. CONCLUSIONS There are important benefits for human milk-fed preterm and LBW infants from enteral iron supplementation. However, more randomized control trials are required to improve the certainty of evidence.publishedVersio

Strategic implications of changing rule of halves in hypertension: A cross-sectional observational study

Context: The burden of non-communicable diseases will sooner overwhelm the health system of the country and could curtail future economic development. Hypertension causes highest cardiovascular morbidities. To attain target Blood Pressure (BP), different strategies are required, which are area specific. The validity of rule of halves of hypertension in various settings needs to be studied for developing strategies for that particular geographical area. To utilize the resources in more efficient way, strategies need to differ in rural-urban and underserved- well-served areas. Aims: The present study aims at exploring whether the rule of halves holds good in the city of Mumbai as the findings of such research may have implications on strategies to control hypertension in communities. Hence, the objectives of this study are to ascertain the proportion of persons with hypertension with respect to the status of diagnosis, treatment, adequate treatment, and validate it with existing rule of halves. Setting and Design: Study was conducted in the urban field practice area of a teaching hospital and medical college of Mumbai that comprises 42 chawl (housing structures); study design- cross-sectional observational study. Materials and Methods: This observational cross-sectional study was conducted over a period of 18 months in the field practice area of a teaching hospital and medical college of Mumbai with a total population of 43,069. Sample size was 667. After ethical clearance, participants were interviewed using pretested semi-structured interview schedule that included socio-demographic factors, risk factor evaluation, clinical examination, and anthropometry. Subjects with diagnosed hypertension were questioned thoroughly about hypertension adherence. Statistical Analysis: Descriptive statistics was applied on quantitative data. Results: A total of 667 people from five chawls of age more than 35 years were included into the study. The mean age of study subjects was 50.84 ± 11.47 years. Out of total 667 respondents, 20.3% respondents were normotensive, 50.3% respondents were pre-hypertensive, 25.3% respondents were in stage 1 hypertension, and 4% respondents were in stage 2 hypertension. In contrary to the classical rule of halves, the present study shows only 31% of the diagnosed hypertensives are adequately treated. Conclusions: The strategies in the national programs are from the traditional understanding of rule of halves and emphasize increasing awareness and treatment. Family physician should actively involve in regular screening, treatment, and adherence of hypertension treatment. As a part of primary care, community participation is required for effectively achieving the target BP goal of the population