Optimal iron dosing regimen in pediatric patients with iron deficiency anemia: An observational retrospective cohort study

Background: Iron deficiency anemia (IDA) is the most common nutritional disorder globally, significantly affecting pediatric populations in both developing and developed countries. In Qatar, IDA remains a prevalent health concern among children and adolescents, necessitating optimization of treatment strategies. In addition, there is no specific protocol for pediatric IDA treatment in Qatar, hence the variation in practice. The main objective of this study is to compare the effectiveness of low-dose (2–4 mg/kg/day) versus high-dose (4.1–6 mg/kg/day) elemental iron therapy in achieving anemia resolution among children diagnosed with IDA. Methods: This observational retrospective cohort study was conducted at a secondary-level hospital in Qatar, and included children aged 1 month to 14 years diagnosed with IDA between January and June 2022. Eligible patients were categorized into low-dose, high-dose, or subtherapeutic iron treatment groups based on prescribed elemental iron dosage. The primary outcome was anemia resolution, defined as normalization of hemoglobin levels post-treatment. The study was approved by the hospital’s ethical review board. Results: Out of 159 identified patients, 84 had complete follow-up data and were included in the final analysis: 47 received low-dose iron, 25 received high-dose iron, and 12 received subtherapeutic doses. Baseline characteristics were comparable across groups. Logistic regression analysis revealed that the low-dose group was 2.82 times more likely to achieve anemia resolution compared to the high-dose group, though this result did not reach statistical significance (95% CI, 0.99–8.05). A similar trend was observed after excluding patients with baseline hemoglobin <7 g/dL. The mean duration of treatment in the study cohort was about 2 months. Conclusion: While not statistically significant as per logistic regression analysis, findings suggest that lower doses of elemental iron may be more effective than higher doses in achieving anemia resolution in pediatric patients with IDA, potentially due to improved absorption and adherence. Further prospective studies are warranted to validate these observations and guide optimal dosing strategies.