Vitamin B₁₂ deficiency in infants secondary to maternal causes

Abstract

A nine-month-old female infant presented with a two-day history of vomiting, diarrhea and decreased urine output, along with a three-month history of lethargy and reduced tone. Her early development had been normal, but regression of skills had begun three months before presentation, with a loss of gross motor skills progressing to a loss of head control. The child had been exclusively breastfed until solids were slowly introduced over the last month. Her family was of South-East Asian ethnic origin, and her mother was a strict life-long vegan who took prenatal vitamins during pregnancy.On examination, the baby was sleepy and pale. Her weight was 6.65 kg (< 3rd percentile), height was 69 cm (25th percentile) and head circumference was 41 cm (< 3rd percentile). The liver edge was 3 cm below the costal margin. The splenic tip was palpable. Her axial and peripheral muscle tone was decreased, with frog-like posture of both legs. No antigravity power was exhibited. Reflexes were 3+ in her lower extremities and 2+ in her upper extremities. She was able to fix visually but did not follow.Laboratory investigations showed a hemo- /L. The blood smear showed pancytopenia with severe leukoerythroblastic change, dysplastic red blood cells and rare hypersegmented neutrophils; it appeared severely megaloblastic overall (Figure 1). The albumin level was 18 (range 34-42) g/L. Vitamin B 12 level was less than 37 (range 133-695) pmol/L (lower reporting limit), and the folate level was 14 (range 7-36) nmol/L. A bone marrow biopsy showed morphological changes consistent with megaloblastic anemia. Magnetic resonance imaging (MRI) of the patient's brain showed generalized atrophy. Metabolic and biochemical investigations, including acylcarnitine profile, plasma amino acid and urine organic acids, showed abnormalities consistent with dietary protein deficiency.Because the infant had been mostly breastfed with limited solid intake, we examined the mother. Her complete blood count was normal, but her vitamin B 12 level was low at 63 (adult reference range 133-695, deficient < 107) pmol/L. Review of the mother's prenatal blood work indicated a normal hemoglobin level, with a normal mean corpuscular volume.The infant's anemia was managed initially with a slow transfusion of packed red blood cells. Intramuscular injections of vitamin B 12 (1000 µg) were given daily for seven days, then weekly for the next month, along with oral iron supplementation. Nasogastric feeding with formula was initiated because of poor suck, and breastfeeding was maintained for comfort. The mother was started on oral B 12 supplementation.Five months later, the infant was consuming solid baby food and infant formula, and her growth parameters had improved. Her muscle tone and neurologic status had also improved. The complete blood count and B 12 levels were normal. • Infant B 12 sufficiency is related to maternal levels via neonatal stores at birth and the amount in breast milk. Cases Vitamin• Vitamin B 12 deficiency in infants, although rare, is important to recogn...

Correlation between maternal and childhood VitB12, folic acid and ferritin levels

“…This highlights the importance of ensuring that women have excellent nutritional status prior to conception hence the emphasis should be shifted from antenatal care to pre-pregnancy health especially in developing countries where there are multiple pregnancies in young age and limited access to standard health care 4,21…”

Vitamin B12-deficient child of a vegan mother

“…Vitamin B12 (cobalamin) is essential for folate metabolism and DNA synthesis, acting as a cofactor for key enzymatic reactions (Roumeliotis et al, 2012).…”

Anyai és újszülöttkori B12-vitamin-hiány felismerése kiterjesztett újszülöttkori szűréssel

“…Ezek közé tartozik az újszülöttek B 12 -vitamin-hiányának azonosítása is. Az újszülöttkori szűrőprogramok elterjedése világszerte ráirányította a figyelmet a B 12 -vitamin-hiányra, és az ezekből származó adatok azt mutatják, hogy előfordulása jóval gyakoribb a fejlett országokban is, mint ahogy azt korábban feltételezték [3,4].…”

“…Az újszülött-és csecsemőkori B 12 -vitamin-hiány az esetek döntő többségében kizárólagos anyatejes táplálás mellett, anyai B 12 -hiány következtében lép fel, amelynek hátterében legtöbbször táplálkozással történő elégtelen EREDETI KÖZLEMÉNY bevitel vagy anaemia perniciosa áll. A diétás hiány általában vegetáriánus vagy vegán étrend következménye, de rossz szociális körülmények miatti alultápláltság is okozhatja [4,6,8]. Azokban az országokban, ahol tradicionálisan nagyobb a vegetáriánusok aránya és/vagy a szociális körülmények is rosszabbak, a B 12 -vitamin-hiány előfordulása jóval gyakoribb a nyugat-európai országokhoz vagy az Egyesült Államokhoz viszonyítva, ami az anyai és csecsemőkori B 12 -hiány magasabb prevalenciáját is eredményezi [9,10].…”

“…A B 12 -hiányos anya újszülöttjében a raktározott vitamin mennyisége kevés, és mivel az anyatej B 12 -vitamin-tartalma is alacsonyabb, a kizárólagos anyatejes táplálás nem biztosítja a megfelelő utánpótlást. Emiatt a hiány mértéke idővel egyre fokozódik, és néhány hónap után klinikai tünetek alakulhatnak ki [4] [4,6,12]. B 12 -vitamin-pótlással a neurológiai tünetek általában heteken belül javulnak, ugyanakkor a hiányállapot mértékétől és időtartamától függően a neurológiai károsodások lehetnek irreverzibilisek, tartós idegrendszeri tüneteket és szomatomentális elmaradást eredményezve [13,14].…”