May solid food refusal and other non-specifi neurological symptoms be an early symptoms of Vitamin B12 defiiency in complementary feeding period?

Aim: In this study, we showed an early symptoms of VB12 defiiency in infancy complementary feeding period (CFP) withouthematologic fidings. Vitamin B-12 (VB12) defiiency can result in severe neurological degeneration within the fist year of life. Inliterature, symptoms of VB12 defiiency in infant were described with hematologic fidings which were like a pernicious anemia.Material and Methods: A 104 of 1,848 mother-infant pairs admitted for well-child visits between January 2018 and December 2018were included in the study. All babies were diagnosed with vitamin B12 defiiency. All baby-mother pairs were monitored during theCFP were included in the study. Overall, 83 mother who met the inclusion criteria and who agreed to participate in the study and theirbabies, were included in the study.Results: The cause of follow-up of these children was refusal to breastfeed and irritability in 21 infants (25.3%). There were 19infants (22.9%) with solid food refusal, 16 infants (19.2%) with sleeping problems, and 16 infants (19.2%) with failure to thrive. Inthe remaining 11 infants (13.2%), there were mild hypotonia, microcephalia, vomiting, and growth retardation. The mean age for thedevelopment of these symptoms was 5.5 ± 1.7 months, while the mean age of being diagnosed with VB12 defiiency was 6.4±1.2months.Conclusions: In this study, symptoms of VB12 defiiency without any hematological symptoms and not caused by other organiccauses, and arising during the period of transition to complementary feeding, were demonstrated. Physician must be aware of earlyfidings of VB12 defiiency before severe neurological fidings and hematological sypmtoms.

PDF

___

1. Lichtheim H. Zur Kenntniss der perciosen Anamie. Munchen Med Wchnschr 1986;34:301.
2. Dror DK, Allen LH. Effect of vitamin B12 defiiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev 2008;66:250-5.
3. Theisen-Toupal J, Horowitz G, Breu A. Low yield of outpatient serum folate testing: eleven years of experience. JAMA Intern Med 2014;174:1696-7.
4. Stabler SP. Clinical practice. Vitamin B12 defiiency. N Engl J Med 2013;368:149-60.
5. Green R. Vitamin B12 defiiency from the perspective of a practicing hematologist. Blood 2017;129:2603-11.
6. Schrier SL. Clinical manifestations and diagnosis of vitamin B12 and folate defiiency. https:// w w w. u p t o d a t e . c o m / c o n t e n t s / c a u s e s - a n d pathophysiology-of-vitamin-b12-and-folate defiiencies (last updated: Aug 27, 2018)
7. Michaud JL, Lemieux B, Ogier H et al. Nutritionalvitamin B12 defiiency: two cases detected by routine newborn urinary screening. Eur J Pediatr 1992;151:218-20.
8. Dror DK, Allen LH. Dairy product intake in children and adolescents in developedcountries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev 2014;72:68-81.
9. Katar S, Ozbek MN, Yaramis A, et al. Nutritional Megaloblastic Anemia in Young Turkish Children is Associated With Vitamin B-12 Defiiency and Psychomotor Retardation J Pediatr Hematol Oncol 2006; 28:559-62.
10. Wright JD, Bialostosky K, Gunter EW et al. Blood folate and vitamin B12: United States, 1988-94. Vital Health 1998;243:1-78.
11. Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 defiiency in children and adolescents. J Pediatr 2001;138:10-7.
12. Snow CF. Laboratory diagnosis ofvitamin B12 and folate defiiency: a guide for the primary care physician.Arch Intern Med 1999;159:1289-98.
13. Monagle PT, Tauro GP. Infantile megaloblastosis secondary to maternal vitamin B12 defiiency. Clin Lab Haematol 1997;19:23-25.
14. Emery ES, Homans AC, Colletti RB. Vitamin B12 defiiency: a cause of abnormal movements in infants. Pediatrics 1997;99:255-6.
15. Al Essa M, Sakati NA, Dabbagh O et al. Inborn error of vitamin B12 metabolism: a treatable cause of childhood dementia/paralysis. J Child Neurol 1998;13:239-43.
16. Whitehead VM, Rosenblatt RD, Cooper BA. Megaloblastic anemia. In: Nathan DG, Orkin SH, editors. Nathan and Oski’s hematology of infancy and childhood. Philadelphia: WB Saunders Company 1998;385-22.
17. Middleman AB, Emans SJ, Cox J. Nutritional vitamin B12 defiiency and folate defiiency in an adolescent patient presenting with anemia, weight loss, and poor school performance. J Adolesc Health 1996;19:76-9.
18. Allen LH. Vitamin B12 metabolism and status during pregnancy,lactation and infancy. In: Nutrient Regulation During Pregnancy, Lactation, and Infant Growth. New York: Plenum Press 1994;173-86.
19. Graham SM, Arvela OM, Wise GA. Long-term neurologicalconsequences of nutritional VB12 defiiency in infants. J Pediatr. 1992;121:710-4.
20. Von Schenck U, Gotze CB, Koletzko B. Persistence of neurological damage induced by dietary vitamin B12 defiiency in infancy. Arch Dis Child 1997;77:137-9.
21. Kumar R, Kalra SP, Kumar H et al. Pancytopenia-a six year study. J Assoc Physicians India. 2001;49:1078- 81.
22. Allen LH. Causes of vitamin B12 and folate defiiency. Food Nutr Bull 2008;29:20-34.
23. Casterline JE, Allen LH, Ruel MT. Vitamin B-12 defiiency is very prevalent in lactating Guatemalan women and their infants at three months postpartum. J Nutr 1997;127:1966-72.
24. Specker BL, Black A, Allen L et al. Vitamin B-12: low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic aciduria in their infants. Am J Clin Nutr 1990;52:1073-6.
25. Williams AM, Stewart CP, Shabab-Ferdows S et al. Infant Serum and Maternal Milk Vitamin B-12 Are Positively Correlated in Kenyan Infant-Mother Dyads at 1–6 Months Postpartum, Irrespective of Infant Feeding Practice1-3. J Nutr 2018;148:86-93.
26. Finkelstein JL, Kurpad AV, Thomas T et al. Vitamin B12 status in pregnant women and their infants in South India. European J of Clin Nutrition 2017;71:1046-53.