Screening and routine supplementation for iron deficiency anemia: a systematic review.

Pediatrics. 2015 Apr;135(4):723-33.
McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C.

BACKGROUND AND OBJECTIVES:

Supplementation and screening for iron-deficiency anemia (IDA) in young children may improve growth and development outcomes. The goal of this study was to review the evidence regarding the benefits and harms of screening and routine supplementation for IDA for the US Preventive Services Task Force.

METHODS:

We searched Medline and Cochrane databases (1996-August 2014), as well as reference lists of relevant systematic reviews. We included trials and controlled observational studies regarding the effectiveness and harms of routine iron supplementation and screening in children ages 6 to 24 months conducted in developed countries. One author extracted data, which were checked for accuracy by a second author. Dual quality assessment was performed.

RESULTS:

No studies of iron supplementation in young children reported on the diagnosis of neurodevelopmental delay. Five of 6 trials sparsely reporting various growth outcomes found no clear benefit of supplementation. After 3 to 12 months, Bayley Scales of Infant Development scores were not significantly different in 2 trials. Ten trials assessing iron supplementation in children reported inconsistent findings for hematologic measures. Evidence regarding the harms of supplementation was limited but did not indicate significant differences. No studies assessed the benefits or harms of screening or the association between improvement in impaired iron status and clinical outcomes. Studies may have been underpowered, and control factors varied and could have confounded results.

CONCLUSIONS:

Although some evidence on supplementation for IDA in young children indicates improvements in hematologic values, evidence on clinical outcomes is lacking. No randomized controlled screening studies are available.

The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse
Cindy W. Christian, MD, FAAP, COMMITTEE ON CHILD ABUSE AND NEGLECT

PEDIATRICS Volume 135, number 5, May 2015

The American Academy of Pediatrics (AAP) has updated its child physical abuse guideline to include new information on the lasting effects of abuse and on how pediatricians can protect children. The guideline highlights risk factors for abuse and abusive injuries that are frequently overlooked.
Child physical abuse is an important cause of pediatric morbidity and abstract mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children

Systematic screening for active tuberculosis: principles and recommendations.

Systematic screening for active tuberculosis: principles and recommendations.

World Health Organization (WHO). Systematic screening for active tuberculosis: principles and recommendations. Geneva (Switzerland): World Health Organization (WHO); 2013. 133 p. [103 references] Major Recommendations The rating schemes for the quality of the evidence (high, moderate, low, very low) and the strength of the recommendations (strong, conditional) are defined at the end of the "Major Recommendations" field. Key Principles for Screening for Active Tuberculosis (TB) The following key principles should be considered when planning a TB screening initiative. Before screening is initiated, high-quality TB diagnosis, treatment, care, management and support for patients should be in place, and there should be the capacity to scale these up further to match the anticipated rise in case detection that may occur as a result of screening. In addition, a baseline analysis should be completed in order to demonstrate that the potential benefits of screening clearly outweigh the risks of doing harm, and that the required investments in screening are reasonable in relation to the expected benefits. Indiscriminate mass screening should be avoided. The prioritization of risk groups for screening should be based on assessments made for each risk group of the potential benefits and harms, the feasibility of the initiative, the acceptability of the approach, the number needed to screen, and the cost effectiveness of screening. The choice of algorithm for screening and diagnosis should be based on an assessment of the accuracy of the algorithm for each risk group considered, as well as the availability, feasibility and cost of the tests. TB screening should follow established ethical principles for screening for infectious diseases, observe human rights, and be designed to minimize the risk of discomfort, pain, stigma and discrimination. The TB screening approach should be developed and implemented in a way that optimizes synergies with the delivery of other health services and social services. A screening strategy should be monitored and reassessed continually to inform re-prioritization of risk groups, re-adaptation of screening approaches when necessary and discontinuation of screening at an appropriate time. See section 7 in the original guideline document for details on the key principles. Recommendations on Risk Groups to Be Screened for Active TB ....