Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric HematologyOncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics

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dc.contributor.authorChandra, Jagdishen_US
dc.contributor.authorDewan, Poojaen_US
dc.contributor.authorKumar, Praveenen_US
dc.contributor.authorMahajan, Amitaen_US
dc.contributor.authorSingh, Preetien_US
dc.contributor.authorDhingra, Bhavnaen_US
dc.contributor.authorRadhakrishnan, Nitaen_US
dc.contributor.authorSharma, Ratnaen_US
dc.contributor.authorManglani, Mamtaen_US
dc.contributor.authorKumar, Rawat Ashoken_US
dc.contributor.authorGupta, Piyushen_US
dc.contributor.authorGomber, Sunilen_US
dc.contributor.authorBhat, Sunilen_US
dc.contributor.authorGaikwad, Paragen_US
dc.contributor.authorElizabeth, KEen_US
dc.contributor.authorBansal, Deepaken_US
dc.contributor.authorDubey, Anand Prakashen_US
dc.contributor.authorShah, Nitinen_US
dc.contributor.authorKini, Pranotien_US
dc.contributor.authorTrehan, Amitaen_US
dc.contributor.authorDatta, Kalpanaen_US
dc.contributor.authorBasavraja, GVen_US
dc.contributor.authorSaxena, Vineeten_US
dc.contributor.authorKumar, Remesh Ren_US
dc.date.accessioned2023-08-25T06:39:33Z
dc.date.available2023-08-25T06:39:33Z
dc.date.issued2022-10
dc.description.abstractJustification: Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. Objective: To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. Process: These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. Recommendations: We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.en_US
dc.identifier.affiliationsThe Departments of Pediatricsen_US
dc.identifier.affiliationsPGIMSR and ESIC Model Hospital, Basaidarapur, New Delhien_US
dc.identifier.affiliationsUCMS and GTB Hospital, Delhien_US
dc.identifier.affiliationsLady Hardinge Medical College and Associated Kalawati Saran Children’s Hospital, New Delhien_US
dc.identifier.affiliationsDepartment of Pediatric Hematology and Oncology, Indraprastha Apollo Hospital, Delhien_US
dc.identifier.affiliationsAIIMS, Bhopal, Madhya Pradeshen_US
dc.identifier.affiliationsPediatric Hematology Oncology, Post Graduate Institute of Child Health. NOIDA, Uttar Pradeshen_US
dc.identifier.affiliationsMCGM- Comprehensive Thalassemia Care, Pediatric Hematology-Oncology & BMT Centre, Mumbai, Maharashtraen_US
dc.identifier.affiliationsPAN Society, Indian Academy of Pediatrics (IAP)en_US
dc.identifier.affiliationsMazumdar Shaw Medical Center, Narayana Health City, Bangalore, Karnatakaen_US
dc.identifier.affiliationsNational Secretary – Nutrition Chapter of IAPen_US
dc.identifier.affiliationsSree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamilnaduen_US
dc.identifier.affiliationsHematology-Oncology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarhen_US
dc.identifier.affiliationsBJ Wadia Hospital for Children, Mumbai and PD Hinduja Hospital, Mumbaien_US
dc.identifier.affiliationsDepartment of Pediatrics Medical College, Kolkata, West Bengalen_US
dc.identifier.affiliationsHony. Secretary General 2020-2021, IAPen_US
dc.identifier.affiliationsHony. Secretary General 2022-2023, IAPen_US
dc.identifier.affiliationsPresident 2022, IAPen_US
dc.identifier.citationChandra Jagdish, Dewan Pooja, Kumar Praveen, Mahajan Amita, Singh Preeti, Dhingra Bhavna, Radhakrishnan Nita, Sharma Ratna, Manglani Mamta, Kumar Rawat Ashok, Gupta Piyush, Gomber Sunil, Bhat Sunil, Gaikwad Parag, Elizabeth KE, Bansal Deepak, Dubey Anand Prakash, Shah Nitin, Kini Pranoti, Trehan Amita, Datta Kalpana, Basavraja GV, Saxena Vineet, Kumar Remesh R. Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric HematologyOncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics. Indian Pediatrics. 2022 Oct; 59(10): 782-801en_US
dc.identifier.issn0079-6061
dc.identifier.issn0974-7559
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/225378
dc.languageenen_US
dc.publisherIndian Academy of Pediatricsen_US
dc.relation.issuenumber10en_US
dc.relation.volume59en_US
dc.source.urihttps://indianpediatrics.net/oct2022/782.pdfen_US
dc.subjectCobalaminen_US
dc.subjectDeficiencyen_US
dc.subjectFolic aciden_US
dc.subjectHemoglobinen_US
dc.subjectIronen_US
dc.subjectVitamin B12.en_US
dc.titleDiagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric HematologyOncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatricsen_US
dc.typeJournal Articleen_US
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