Should infants be screened for anaemia? A prospective study investigating the relation between haemoglobin at 8, 12, and 18 months and development at18 months

Aims - To investigate the relation between haemoglobin in children followed longitudinally from 8 to 18 months, and developmental outcome at 18 months . Methods - The Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) i s a longitudinal survey of a geographically defined population of children born in 1991-92. In a randomly selected subsample, blood samples were assay ed for Db at 8, 12, and 18 months; a developmental assessment was carried o ut at is months on 1141 children using the Griffiths Scales of Mental Devel opment. Results - There was a strong quadratic association between Hb at 8 months a nd performance on the locomotor subscale at 18 months. Average scores incre ased with increasing Hb up to 95 g/l; there was little additional developme ntal benefit in Hb levels beyond 95 gm. Infants with Hb < 95 g/l at 8 month s of age scored on average 6 points lower on the locomotor subscale than in fants with Hb greater than or equal to 95 g/l; infants with Hb < 90 g/l at 8 months scored 12 points lower on the locomotor subscale than children wit h Hb greater than or equal to 90 g/l. Conclusions - Low Hb concentrations (less than or equal to 95 g/l) in 8 mon th old children are associated with impaired motor development at 18 months . This cut off point corresponds to the 5th centile of Hb at 8 months. The results indicate that if there is an adverse effect of low Hb on developmen tal outcome, screening may be more effective at 8 months or earlier, rather than after this age. We propose to examine the importance of infant anaemi a in relation to more accurate and detailed long term outcomes as the child ren get older.