Cecilia Algarín

Iron Deficiency Anemia in Infancy: Long-Lasting Effects on Auditory and Visual System Functioning

Evoked potentials provide noninvasive measures of nerve transmission and CNS functioning. Auditory brainstem responses (ABR) and visual evoked potentials (VEP) show dramatic changes in infancy, largely as a result of progressive myelination. Because iron is required for normal myelination, pathway transmission in these sensory systems might be affected by early iron deficiency. We previously reported evidence to that effect: infants with iron-deficiency anemia (IDA) had slower transmission through the auditory brainstem pathway, uncorrected by iron therapy. To determine long-term effects, ABR and/or VEP of healthy Chilean children who were treated for IDA or were nonanemic in infancy were compared at approximately 4 y of age. Absolute latencies for all ABR waves and interpeak latencies (except I-III interval) were significantly longer in former IDA children. Longer latency was also observed for the P100 wave on VEP. The magnitude of differences was large—about 1 SD. These findings, with differences in latencies but not amplitudes, further support the hypothesis that IDA in infancy alters myelination and provide evidence that effects on transmission through the auditory and visual systems can be long lasting. Subtle changes in sensory pathway transmission might be an underlying mechanism for the derailment of other developmental aspects in early IDA.

Sleep-wake states and their regulatory mechanisms throughout early human development.

The emergence of sleep states is one of the most significant aspects of development. Descriptions of both neonatal and late fetal behavior and studies on the organization of sleep have shown that fetus and newborns exhibit spontaneously discrete and cyclic patterns of active sleep (AS) and quiet sleep (QS). Human fetuses and neonates sleep most of their life, and AS is the prevailing state even during the first postnatal months. Several hypotheses to explain central nervous system development consider that AS is the expression of a basic activation program for the central nervous system that increases the functional competence of neurons, circuits, and complex patterns before the organism is called on to use them. Current results indicate the maturation of QS not only coincides with the formation of thalamocortical and intracortical patterns of innervation and periods of heightened synaptogenesis, since this sleep state is also associated with important processes in synaptic remodeling. In fact, several studies suggest that the information acquired during wakefulness is further processed during AS and QS. This article reviews the processes involved in the timing of both AS/QS and sleep/wake alternating patterns throughout early human development. A growing body of evidence indicates that the duration of unmodulated parental care and noncircadian environmental conditions may be detrimental for the establishment of these basic rhythmicities. As a consequence, alterations in parental/environmental entraining factors may well contribute to disturb sleep and feeding commonly experienced by preterm infants. Further knowledge on the early establishment of sleep-wake states regulatory mechanisms is needed to improve modalities for appropriate stimulation in the developing human being.

Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years.

OBJECTIVE To determine the long-term effects of iron deficiency on the neural correlates of recognition memory. STUDY DESIGN Non-anemic control participants (n=93) and 116 otherwise healthy formerly iron-deficient anemic Chilean children were selected from a larger longitudinal study. Participants were identified at 6, 12, or 18 months as iron-deficient anemic or non-anemic and subsequently received oral iron treatment. This follow-up was conducted when participants were 10 years old. Behavioral measures and event-related potentials from 28 scalp electrodes were measured during an new/old word recognition memory task. RESULTS The new/old effect of the FN400 amplitude, in which new words are associated with greater amplitude than old words, was present within the control group only. The control group also showed faster FN400 latency than the formerly iron-deficient anemic group and larger mean amplitude for the P300 component. CONCLUSIONS Although overall behavioral accuracy is comparable in groups, the results show that group differences in cognitive function have not been resolved 10 years after iron treatment. Long-lasting changes in myelination and energy metabolism, perhaps especially in the hippocampus, may account for these long-term effects on an important aspect of human cognitive development.

Twenty-four-hour motor activity in human infants with and without iron deficiency anemia

Iron deficiency anemia (IDA) is a very common nutritional problem that alters motor activity. The aim of this study was to compare 24-h motor activity in the home in healthy 6-month-old infants with and without IDA. Activity was assessed via actigraphs on the leg during 24 continuous hours in 17 Chilean infants with IDA and 18 with normal hemoglobin levels. All infants were given oral iron, and activity was reassessed at 12 and 18 months. The frequency of movement units per minute was determined for each waking/sleep state during the day and night, and the duration of each state was computed. At 6 months of age, there were no differences between anemic and nonanemic infants in time per state. However, infants with IDA showed an overall increase in motor activity compared to controls. These differences were no longer observed at 12 and 18 months of age. Increased activity during the period of IDA raises the issue of a shared underlying mechanism with restless legs syndrome, a sensorimotor dysfunction where iron deficiency increases the severity of the symptoms and iron supplementation ameliorates them. Due to previous findings of decreased motor activity in the laboratory at 12 months during the waking time surrounding an afternoon nap, we also compared those data to a nap in the home. Infants with IDA were less active in the laboratory than in the home. The home versus laboratory results suggest that contextual factors affect the motor activity of IDA infants to a larger extent than controls.

Iron-deficiency anemia in infancy and poorer cognitive inhibitory control at age 10 years.

The aim of this study was to assess the effects of iron‐deficiency anemia (IDA) in infancy on executive functioning at age 10 years, specifically inhibitory control on the Go/No‐Go task. We predicted that children who had IDA in infancy would show poorer inhibitory control.

Extracting Fuzzy Rules From Polysomnographic Recordings for Infant Sleep Classification

A neuro-fuzzy classifier (NFC) of sleep-wake states and stages has been developed for healthy infants of ages 6 mo and onward. The NFC takes five input patterns previously identified on 20-s epochs from polysomnographic recordings and assigns them to one out of five possible classes: Wakefulness, REM-Sleep, Non-REM Sleep Stage 1, Stage 2, and Stage 3-4. The definite criterion for a sleep state or stage to be established is duration of at least 1 min. The data set consisted of a total of 14 continuous recordings of naturally occurring naps (average duration: 143plusmn39 min), corresponding to a total of 6021 epochs. They were divided in a training, a validation and a test set with 7, 2, and 5 recordings, respectively. During supervised training, the system determined the fuzzy concepts associated to the inputs and the rules required for performing the classification, extracting knowledge from the training set, and pruning nonrelevant rules. Results on an independent test set achieved 83.9plusmn0.4% of expert agreement. The fuzzy rules obtained from the training examples without a priori information showed a high level of coincidence with the crisp rules stated by the experts, which are based on internationally accepted criteria. These results show that the NFC can be a valuable tool for implementing an automated sleep-wake classification system

Sleep in brain development.

With the discovery of rapid eye movement (REM) sleep, sleep was no longer considered a homogeneous state of passive rest for the brain. On the contrary, sleep, and especially REM sleep, appeared as an active condition of intense cerebral activity. The fact that we get large amounts of sleep in early life suggested that sleep may play a role in brain maturation. This idea has been investigated for many years through a large number of animal and human studies, but evidence remains fragmented. The hypothesis proposed was that REM sleep would provide an endogenous source of activation, possibly critical for structural maturation of the central nervous system. This proposal led to a series of experiments looking at the role of REM sleep in brain development. In particular, the influence of sleep in developing the visual system has been highlighted. More recently, non-REM (NREM) sleep state has become a major focus of attention. The current data underscore the importance of both REM sleep and NREM sleep states in normal synaptic development and lend support to their functional roles in brain maturation. Both sleep states appear to be important for neuronal development, but the corresponding contribution is likely to be different.

Automated Sleep-Spindle Detection in Healthy Children Polysomnograms

We present a new methodology to detect and characterize sleep spindles (SSs), based on the nonlinear algorithms, empirical-mode decomposition, and Hilbert-Huang transform, which provide adequate temporal and frequency resolutions in the electroencephalographic analysis. In addition, the application of fuzzy logic allows to emulate experts procedures. Additionally, we built a database of 56 all-night polysomnographic recordings from children for training and testing, which is among the largest annotated databases published on the subject. The database was split into training (27 recordings), validation (10 recordings), and testing (19 recordings) datasets. The SS events were marked by sleep experts using visual inspection, and these marks were used as golden standard. The overall SS detection performance on the testing dataset of continuous all-night sleep recordings was 88.2% sensitivity, 89.7% specificity, and 11.9% false-positive (FP) rate. Considering only non-REM sleep stage 2, the results showed 92.2% sensitivity, 90.1% specificity, and 8.9% FP rate. In general, our system presents enhanced results when compared with most systems found in the literature, thus improving SS detection precision significantly without the need of hypnogram information.

Iron Deficiency Anemia in Infancy Is Associated with Altered Temporal Organization of Sleep States in Childhood

The highest prevalence of iron deficiency anemia (IDA) in infancy coincides with a time of rapid changes in sleep organization. Since IDA in infancy is associated with long-lasting neurofunctional effects despite iron treatment, the normal development of sleep patterns might be affected. Night polysomnographic recordings were performed in 55 healthy 4-y-old children (former IDA = 27, nonanemic controls = 28). Both groups were followed from infancy and were similar in background characteristics. The duration of each waking episode was measured, as was the duration of each episode of nonrapid eye movement (NREM) sleep stages 1 (NREM1), 2 (NREM2), and 3–4 (SWS), and rapid eye movement (REM) sleep. The data were analyzed according to the successive thirds of the total sleep time (TST). Relative to controls, former IDA children showed: a) longer duration of REM sleep episodes in the first third and shorter in the last third; b) more REM sleep episodes in the first third and fewer in the second third; and c) shorter latency to the first REM sleep episode and shorter NREM stage 2 and SWS episodes within the first sleep cycle. The results show that early IDA is associated with long-lasting alterations in the temporal organization of sleep patterns.

Sleep alterations and iron deficiency anemia in infancy

Iron deficiency anemia (IDA) continues to be the most common single nutrient deficiency in the world. An estimated 20-25% of the worlds infants have IDA, with at least as many having iron deficiency without anemia. Infants are at particular risk due to rapid growth and limited dietary sources of iron. We found that infants with IDA showed different motor activity patterning in all sleep-waking states and several differences in sleep states organization. Sleep alterations were still apparent years after correction of anemia with iron treatment in the absence of subsequent IDA. We suggest that altered sleep patterns may represent an underlying mechanism that interferes with optimal brain functioning during sleep and wakefulness in former IDA children.