Iron deficiency anemia is common in young children, usually because of poor dietary intake. Dr. Jonathan L. Maguire and colleagues bring to our attention the relationship between this and ischemic stroke (Pediatrics 2007;120[5]:1053-7). The study was case-controlled, comparing 15 ascertained cases from the stroke registry of the Hospital for Sick Children in Toronto with 143 controls from the general population. The ischemic stroke patients were previously healthy children aged 12-38 months, a time with a high prevalence of iron deficiency. Subjects were excluded if there was a known cause such as sickle cell disease, trauma, meningitis or any type of coagulopathy. Iron deficiency was defined as serum ferritin level < 12 µg/L, hemoglobin < 110 g/L, mean corpuscular volume < 73 fL and thrombocytosis as > 450 platelets x 109/L. With controls and subjects evenly matched for age and sex, a significant association was noted between iron deficiency anemia and ischemic stroke, with an odds ratio of 12. Even after controlling for thrombocytosis, the authors found a 10-fold increased risk of ischemic stroke in otherwise healthy children who are iron-deficient. The pearl: pay attention to nutritional issues in toddlers and young children.

Pediatric surgeons recommend orchiopexy at 9-15 months of age because of the risk of testicular cancer. Despite these recommendations, a significant number of boys in Sweden are operated on at a much later age, 5% at adolescence. Pettersson A et al (NEJM 2007;356[18]:1835-41) identified a cohort of 16,983 men with a diagnosis of cryptorchidism treated by surgery. These were then followed for an average of 12 years from age 15 years, or from the age at surgery plus 1. The risk of developing testicular cancer increased with age at surgery. Those operated after age 13 (puberty) faced twice the risk. The pearl: this paper supports current recommendations of early intervention.