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A better screening test for infant iron deficiency?
If left untreated, iron deficiency may permanently impair cognitive development even before it progresses to anemia, so Children's Hospital Boston researchers hope a new study could lead to a screening approach that detects iron deficiency earlier and more accurately than current hemoglobin testing.
Led by Hematology/Oncology fellow Christina Ullrich, MD, and then-Associate Chief of General Pediatrics Hank Bernstein, DO, (now chief of General Academic Pediatrics at Dartmouth Medical School) the study compared a test called CHr with the standard hemoglobin test in 200 healthy babies aged 9 to 12 months. CHr correctly identified 83 percent of iron-deficient infants, while the currently used test identified just 26 percent.
Both tests measure hemoglobin, the iron-containing, oxygen-carrying molecule in red blood cells. However, the CHr test measures the hemoglobin content of reticulocytes, or immature red blood cells, while the current hemoglobin test is based on the entire red-blood-cell population. Because reticulocytes circulate for only one to two days, as compared with several months for mature red cells, their hemoglobin content is a more timely indicator of iron status.
"There is a real need for a simple and reliable test to detect iron deficiency before it can cause neurocognitive impairment," Ullrich says. "CHr may provide just that." The study appeared in the August 24/31 Journal of the American Medical Association.
Kids with lung injury needn't be placed on their bellies
Some data have suggested that children with acute respiratory distress syndrome (ARDS) have better lung oxygenation when they are placed prone, or on their bellies. But a study led by Martha Curley, RN, PhD, director of Nursing Research in the Medical/Surgical ICU, suggests that prone positioning does not improve clinical outcomes and needn't be used in children who find it uncomfortable.
Curley and colleagues enrolled 102 children with ARDS, 2 weeks to 18 years old, from seven pediatric ICUs around the country. The children were randomized to either prone positioning or supine positioning (on their backs). The prone group did have better oxygenation, but the trial was stopped ahead of schedule when analysis showed no difference between groups in the duration of mechanical ventilation. Nor were there differences in mortality, time to recover from lung injury, organ failure, cognitive impairment or overall functional health.
"Nurses want to give the best possible evidence-based care," says Curley. "We now know that these sick patients can be safely cared for in any position of comfort, prone or supine." The study appeared in the July 13 issue of the Journal of the American Medical Association.
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