A mother's deficiency, a baby's challenge: vitamin B12 deficiency-related seizures and pancytopenia in an infant
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20240011Keywords:
Infant, Anemia, Cobalamin, B12, B12 deficiency, Pernicious anemia, Neurocognitive impairment, PregnancyAbstract
Anemia is prevalent in pediatric age and it stems from diverse factors. While iron deficiency is a common cause above six months of age, other nutritional deficits contribute to the disease burden. During pregnancy, anemia due to nutritional deficits is associated with adverse outcomes for the newborn. Precise diagnosis of dietary deficits in the pediatric population is vital to avert negative health consequences. We describe the case of a six-month-old exclusively breastfed infant with a mother having unspecified anemia under folic acid supplementation. The infant presented with neurological symptoms, including paroxysmal events and developmental regression. Laboratory analysis revealed pancytopenia and severe vitamin B12 deficiency. The patient’s mother's serum level of vitamin B12 was also low and ant parietal cell antibodies were positive, suggesting maternal autoimmune gastritis. Treatment with hydroxocobalamin led to clinical and analytical improvement. Maternal deficiency is the major cause of cobalamin deficiency in infants. It is paramount to raise awareness to this issue to prevent its avoidable repercussions.
References
Slimane A, Valentine B, Anne-Sylvia S, Martin C, Mariane DM. Anemia in children: prevalence, causes, diagnostic work-up, and long-term consequences. Expert Review Hematol. 2017;10(11):1023-8.
Chaparro, CM, Suchdev, PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann NY Acad Sci. 2019;1450(1):15-31.
Chandra, J. Megaloblastic anemia: Back in focus. Indian J Pediatr. 2010;77(7);795-9.
Jafari SM, Heidari G, Nabipour I, Roya A, Majid A, Afshar B et al. Serum retinol levels are positively correlated with hemoglobin concentrations, independent of iron homeostasis: a population-based study. Nutr Res. 2013;33(4):279-85.
Wieringa FT, Dahl M, Chamnan C, Etienne P, Khov K, Prak S et al. The High Prevalence of Anemia in Cambodian Children and Women Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders. Nutrients. 2016;8(6):348.
Scholl TO. Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutr Rev. 2011;69(1):S23-9.
Daphna KD, Lindsay HA, Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutrit Rev. 2008;66(5):250-5.
Serin HM, Arslan EA. Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta Clin Croat. 2019;58(2):295-302.
Agrawal S, Nathani S. Neuro-regression in vitamin B12 deficiency. BMJ Case Rep. 2009;2009:bcr06.2008.0235.
Schenck U, Bender-Götze C, Koletzko B. Persistence of neurological damage induced by dietary vitamin B-12 deficiency in infancy. Arch Dis Child. 1997;77(2):137-9.
Ekici F, Tekbas G, Hattapoğlu S, Yaramış A, Önder H, Bilici A. Brain MRI and MR Spectroscopy Findings in Children with Nutritional Vitamin B12 Deficiency. Clin Neuroradiol. 2016;26(2):215-20.
Arıcan P, Bozkurt O, Cavusoglu D, Gencpınar P, Haspolat S, Duman O et al. Various Neurological Symptoms with Vitamin B12 Deficiency and Posttreatment Evaluation. J Pediatr Neurosci. 2020;15(4):365-9.
Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299-326.
Sukumar N, Venkataraman H, Wilson S, Ilona G, Selvin S, Vinod P et al. Vitamin B12 Status among Pregnant Women in the UK and Its Association with Obesity and Gestational Diabetes. Nutrients. 2016;8(12):768.
Honzik T, Miriam A, Vratislav S, Martin M, Eva H, Jiri Z. Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency-What have we learned? Eur J Paediatr Neurol. 2010;14(6):488-95.
