Infants with vitamin B12 deficiency-related neurological dysfunction and the effect of maternal nutrition

Aim: Studies linked vitamin B12 deficiency in infancy are most commonly in patients with hematological and dermatological complaints rather than infant with neurodevelopmental retardation. In our study we aimed to evaluate the data of infants who presented with various neurological complaints and determined neurodevelopmental retardation due to vitamin B12 deficiency and also effects of maternal diet on the infants.Material and Methods: Infants who were admitted with various neurological complaints due to vitamin B12 deficiency between the dates of September 2016 and March 2018 were included in this study. Patients were retrospectively analyzed according to age, growth and development, clinical and laboratory findings (neurological, hematologic), continuation of breastfeeding, age at onset of complemantary food. During the pregnancy and lactation, the amount of feeding with animal foods, intake of vitamin supplements, duration of breastfeeding and vitamin B12 levels were examined.Results: The most common complaints were fatigue, pallor, no eye contact, apathy, vomiting, constipation, diarrhea, refusal to feed, retardation to growth and development, undeveloped or lost of ability (ability to tonic neck reflex, ability to sit supported and unsupported ability to sit). In the neurological examination of infants; iIn 13 infants, there was hypotonia, undeveloped ability to tonic neck reflex and ability to sit (supported and unsupported). Fifteen, in 15 infants just undeveloped ability to sit (supported and unsupported) and also in 6 infants had swallowing disorders.Conclusion: Vitamin B12 routinely to all pregnant women like folic acid and iron supplementation. In addition, developmental stages of infants should be evaluated and vitamin supplements should be given to infants when necessary.

PDF

___

1. World Health Organization, United Nations Children’s Fund. Global strategy for infant and young child feeding. 2003, Geneva, pp.30.
2. Lücke T, Korenke GC, Poggenburg I, et al. Maternal vitamin B12 deficiency: cause for neurological symptoms in infancy. Z Geburtshilfe Neonatol. 2007;211:157-61.
3. Kliegman RM, Stanton BF, St Geme JW, Nelson Textbook of Pediatrics. 20 ed. Megaloblastic Anemias/ Vitamin B12 (Cobalamin) Deficiency. Philadelphia: Elsevier 2016;2321-2.
4. Kliegman RM, Stanton BF, St Geme JW, Schor NF, Nelson Textbook of Pediatrics. 20 ed. Vitamin B Complex Deficiencies and Excess. Vol. 1. 2016, Philadelphia: Elsevier. 328-329.
5. Hay G, Clausen T, Whitelaw A, et al. Maternal Folate and Cobalamin Status Predicts Vitamin Status in Newborns and 6-Month-Old Infants-3. The Journal of nutrition. J Nutr 2010;140: 557-64.
6. Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab 2015. 66:22-33.
7. Dror DK, LH Allen. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev 2008; 66:250-5.
8. Allen L, J King, B Lönnerdal, Nutrient regulation during pregnancy, lactation, and infant growth. Springer Science & Business Media. 2013; 352
9. Casella EB, Valente M, de Navarro JM, Vitamin B12 deficiency in infancy as a cause of developmental regression. Brain Dev 2005;27:592-4.
10. Watkins D, VM Whitehead, DS Rosenblatt, Megaloblastic anemia. Nathan and Oski’s Hematology of Infancy and Childhood, Saunders Elsevier, Philadelphia 2008;467-520.
11. Graham SM, Arvela OM, Wise GA. Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants. J Pediatr 1992;121:710-4.
12. Health Quality Ontario. Vitamin B12 and cognitive function: an evidence-based analysis. Ont Health Technol Assess Ser 2013;13:1-45.
13. Biancheri R1, Cerone R, Schiaffino MC, et al. Cobalamin (Cbl) C/D deficiency: clinical, neurophysiological and neuroradiologic findings in 14 cases. Neuropediatrics 200;32:14-22.
14. Murphy SP, Allen LH, Nutritional importance of animal source foods. J Nutr 2003;133:3932-5.
15. Neumann CG1, Bwibo NO, Murphy SP, et al. Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings. J Nutr 2003;133:3941-9.
16. Baatenburg de Jong R, Bekhof J, Roorda R, et al. Severe nutritional vitamin deficiency in a breast-fed infant of a vegan mother. Eur J Pediatr 2005;164:259-60.
17. Louwman MW, van Dusseldorp M, van de Vijver FJ, et al. Signs of impaired cognitive function in adolescents with marginal cobalamin status. Am J Clin Nutr 2000;72:762-9.
18. Chalouhi C, Faesch S, Anthoine-Milhomme MC, et al. Neurological consequences of vitamin B12 deficiency and its treatment. Pediatr Emerg Care 2008;24:538-41.
19. Phillips DA, JP Shonkoff, From neurons to neighborhoods: The science of early childhood development. National Academies Press (US) 2000.