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TOXICOLOGY

Universal versus Selective Iron Supplementation for Infants and the Risk of Unintentional Poisoning in Young Children: A Comparative Study of Two Populations

Clinical Specialist, The Toxikon Consortium, Children's Memorial Hospital, Chicago, IL; Department of Pediatrics, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ToxiPedia Program, Divisions of Clinical Pharmacology and Toxicology and Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Michael S Wahl, MD

Director, Illinois Poison Control Center, Metropolitan Chicago Healthcare Council, Chicago, IL; Department of Emergency Medicine, Evanston Northwestern Healthcare

Yedidia Bentur, MD

Director, Israel Poison Information Center, Rambam Health Care Campus; Senior Lecturer of Toxicology; Faculty of Medicine, Technion Chairman, Israel Society of Toxicology, Haifa, Israel

Tal Schechter, MD

Clinical Specialist, Divisions of Hematology/Oncology and Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto

Ben Zion Garty, MD

Director, Department of Pediatrics, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University

Timothy B Erickson, MD FACEP FACMT

Professor of Emergency Medicine and Director, Division of Clinical Toxicology, University of Illinois Medical Center, Chicago

Gabby Chodick, PhD MHA

Biostatistitian, The Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University

Alfred Cahana, MD

Senior Staff Member, Israel Poison Information Center, Rambam Health Care Campus, Haifa

Bill J Mounstephen, MD

Director, Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto

Gideon Koren, MD FABMT FRCP MBBS

Professor, Divisions of Clinical Pharmacology and Toxicology and Emergency Medicine, The Hospital for Sick Children, University of Toronto

Steven E Aks, DO

Director, The Toxikon Consortium; Associate Professor of Emergency Medicine, Rush University, Stroger Cook County Hospital, Chicago, IL

Reprints: Dr. Koren, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, Canada, M5G1X8, fax 416/813-7562, gidiup_2000{at}yahoo.com

BACKGROUND: Iron continues to be a common cause of poisoning in young children, in part due to its widespread use and easy accessibility.

OBJECTIVE: To determine differences in the epidemiology and outcome of unintentional iron ingestion by young children in populations practicing selective (eg, US) versus universal (eg, Israel) iron supplementation to infants.

METHODS: All cases of unintentional iron ingestion in children younger than 7 years in a one year period were identified through the poison control center databases of 2 sites (Illinois and Israel). Parameters compared include patient sex and age; type, form, and dose of iron preparation; circumstances and clinical manifestations; management; and outcome.

RESULTS: A total of 602 children were identified: 459 in Illinois and 143 in Israel. The majority of Illinois children ingested multivitamin preparations (94%), whereas Israeli children ingested single-ingredient iron preparations (78%) (p < 0.001). Iron doses ingested were higher in Israel (median 14.5 vs 6.6 mg/kg; p < 0.001) but remained within the nontoxic range for most children. No deaths or severe poisonings were reported, and 93% of children in both groups were asymptomatic. The majority of ingestions in both locations were due to unintentional self-ingestion. However, parental miscalculation occurred more frequently in Israel (16%) than in Illinois (1%).

CONCLUSIONS: Universal iron supplementation to infants was not associated with a negative impact on the outcome of pediatric unintentional ingestions. Low-dose exposures were safely managed by on-site observation.

Key Words: iron supplementation, poisoning

Published Online, March 6, 2007. www.theannals.com, DOI 10.1345/aph.1H346