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Table 2 Summary of existing recommendations

From: Screening of iron deficiency anaemia in early childhood

Source Ref Date General recommendations for anaemia by iron deficiency screening
WHO [3] 2001 For countries with adequate resource conditions, screening with haemoglobin or haematocrit and additional tests (serum ferritin or transferrin saturation) is recommended.
USPSTF [7] 2015 ‘The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in children ages 6 to 24 months.’ (I statement)
‘This recommendation applies to children ages 6 to 24 months living in the United States who are asymptomatic for iron deficiency anemia. It does not apply to children younger than age 6 months or older than 24 months, children who are severely malnourished, children who were born prematurely or with low birth weight, or children who have symptoms of iron deficiency anemia.’
PrevInfad [1] 2011 • Universal screening: it is recommended NOT to screen IDA
(Low quality of the evidence, strong recommendation)
• Screening in high-risk groups: IDA screening is recommended in all preterm infants under 1500 g of weight.
‘The benefits of routine screening, once the prophylaxis for IDA in asymptomatic premature children under 1500 g or less than 32 weeks is over, is greater than the potential damage.’
There is no evidence to recommend a second screening among children with risk factors who had a normal first screening.
(Low quality evidence, weak recommendation)
CDC [10] 1998 • Universal screening: “In populations of infants and preschool children at high risk for iron-deficiency anemia (e.g., children from low-income families, children eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children, migrant children, or recently arrived refugee children), screen all children for anemia between ages 9 and 12 months, 6 months later, and annually from ages 2 to 5 years.”
• Selective screening: “In populations of infants and preschool children not at high risk for iron-deficiency anemia, screen only those children who have known risk factors for the condition:
° Consider anemia screening before age 6 months for preterm infants and low-birth weight infants who are not fed iron-fortified infant formula.
° Annually assess children aged 2–5 years for risk factors for iron-deficiency anemia (e.g., a low-iron diet, limited access to food because of poverty or neglect, or special health-care needs). Screen these children if they have any of these risk factors.
° At ages 9–12 months and 6 months later (at ages 15–18 months), assess infants and young children for risk factors for anemia […].”
UK NSC [11] 2017 • “A systematic population screening programme for iron deficiency anaemia in children under 5 is not recommended.”
AAP [13] 2010 • Universal screening: recommended at approximately 1 year of age with determination of haemoglobin concentration and an assessment of risk factors associated with ID or IDA.
• Selective screening: recommended at any age in children who are at increased risk for ID or IDA.
• If haemoglobin < 11 g/dL or if high risk of dietary ID, additional screening tests for evaluating ID/IDA with serum ferritin and C-reactive protein, or reticulocyte haemoglobin.
• If mild anaemia (haemoglobin between 10 and 11 g/dL), close monitoring and document a 1 g/dL increase in plasma Hb concentration after 1 month of appropriate iron-replacement therapy.
  1. Abbreviations: AAP: American Academy of Pediatrics; CDC: Centers for Disease Control and Prevention; ID: iron deficiency; IDA: iron deficiency anaemia; NICE: National Institute for Health and Care Excellence; PrevInfad: PrevInfad workgroup from the Spanish Association of Primary Care Pediatrics; UK NSC: UK National Screening Committee; USPSTF: US Preventive Services Task Force; WHO: World Health Organization