SOCIETAL PAPERCMEEvaluation and Management of Iron Deficiency inChildren Undergoing Intestinal Rehabilitation-APosition Paper From the NASPGHAN IntestinalRehabilitation Special Interest Group'Saurabh Talathi,MD,MPH,tShweta Namjoshi,MD,MPH,Vikram Raghu,MD,MS,sDanielle Wendel,MD,IStephanie B Oliveira,MD,Kerry Reed,RN,MS,CPNP-PC,Dianna Yanchis,RD,and "Ethan A.Mezoff,MDABSTRACTIron deficiency (ID)is the most common nutritional deficiency affecting chil-What Is Knowndren undergoing intestinal rehabilitation(IR).Patients may be asymptomatic orpresent with nonspecific symptoms including fatigue,imitability,and dizziness.Iron deficiency (ID)is the most common nutritionalThe diagnosis of ID in this population can be complicatted by the coexistencedeficiency in children undergoing intestinal rehabili-of systemic inflammation or other nutritional deficiencies which may mimictation (IR).ID.Many routinely available laboratory tests lack specificity and no consenThe diagnosis of ID can be difficult due to othersus on screening is available.Success in oral and enteral treatment is impededcoexisting nutritional deficiencies and/or other con-by poor tolerance of iron formulations in a population already challenged withditions that mimic ID.intolerance.Newer parenteral iron formulations exhibit excellent safety pro-The unique needs of children undergoing IR may requirefiles,but their role in repletion in this populationremains unclear.The ollowingmodification of the approach to iron supplementationreport,compiled by a multidisciplinary group of providers caring for childrenand treatment of iron deficiency anemia(IDA).undergoing IR and representing the North American Society for Pediatric Gas-troenterology,Hepatology,and Nutrition Special Interest Group for IntestinalWhat Is NewRehabilitation,seeks to address these challenges.After discussing iron physiol-ogy and population-specific pathophysiology,we make recommendations onChildren undergoing IR should be routinely screenediron intake,iron status assessment,and evaluation for alternative causes of ane-mia.We then provide recommendations on iron supplementation and treatmentfor iron deficiency prior to the onset of anemia.Parenteral iron is recommended in children under-of ID anemia specific to this nutritionally vulnerable population.going IR with IDA or in those with iron deficiencyKey Words:anemia,intestinal failure,intestinal rehabilitation program,without anemia and poor enteral tolerance.iron deficiency,malnutrition,micronutrient deficiency,nutrition,Multicenter collaboration is required to optimizenutritional deficiencies,parenteral nutritionscreening and management strategies.(JPGN2023;76:672-683)with intestinal failure (IF)and short bowel syndrome (SBS)(1,2).The documented prevalence of ID in this population ranges fromron deficiency (ID)is common in general pediatrics and in chil-20%to 87%;Table 1 summarizes the estimated burden (3-8).Lowdren undergoing intestinal rehabilitation(IR),specifically thoseseru
