South African Paediatric Surgical Outcomes Study-2 (SAPSOS-2): a prospective multi-centre pre-post study evaluating haemoglobin response to oral iron for iron-deficiency anaemia in children undergoing elective noncardiac surgery.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42386436.
- Also identified by DOI 10.1016/j.bja.2026.06.001.
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Abstract
Preoperative anaemia in children is associated with increased morbidity, mortality, and blood transfusion exposure. This study aimed to evaluate a pragmatic preoperative anaemia pathway and the haemoglobin (Hb) response (ΔHb) to oral iron in children with iron-deficiency anaemia (IDA) undergoing elective noncardiac surgery in South Africa. This prospective pragmatic study with a pre-post design was conducted at two academic hospitals in South Africa from February 2023 to March 2025. Children aged >6 months to <16 yr were first screened using point-of-care capillary HemoCue®. Children with laboratory-confirmed IDA received oral iron and selective deworming. The primary outcome was ΔHb. Secondary outcomes included anaemia prevalence detected by point-of-care screening with HemoCue®, proportion of IDA among children with laboratory-confirmed anaemia, improvement or resolution of anaemia, and feasibility measures. On preoperative HemoCue® screening, 177/755 (23.4%; 95% confidence interval 20.4-26.6%) children had Hb concentrations below WHO age-specific thresholds. Among the 175 children who underwent confirmatory laboratory testing, 71/175 (40.6%) had anaemia. Of these, 39/71 (54.9%) had IDA, with 35/39 (89.7%) completing follow-up. Median ΔHb was 1.0 g dl<sup>-1</sup> (interquartile range 0.5-1.8; P=0.001). The WHO anaemia severity category (defined as mild, moderate or severe) improved in 23/35 (65.7%) children, and 17/35 (48.6%) were no longer anaemic. Adherence was high and side effects infrequent. This pragmatic preoperative anaemia-management pathway was feasible and produced a modest increase in Hb in children with IDA. These findings highlight the potential role of structured optimisation pathways and support further evaluation in resource-limited settings. ClinicalTrials.gov (NCT05681871).