Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy

详细信息    查看全文

• 作者：Sophie Guez (1)
  Gabriella Chiarelli (1)
  Francesca Menni (1)
  Simona Salera (1)
  Nicola Principi (1)
  Susanna Esposito (1)
  
• 关键词：Anemia ; Iron deficiency ; Neurological problems ; Vegan diet ; Vegan mothers ; Vitamin B12 deficiency
• 刊名：BMC Pediatrics
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：12
• 期：1
• 全文大小：135KB
• 参考文献：1. Ludwig ML, Matthews RG: Structure-based perspectives on B12-dependent enzymes. / Annu Rev Biochem 1997, 66:269-13. CrossRef
  2. Stabler SP, Allen RH, Savage DG, Lindenbaum J: Clinical spectrum and diagnosis of cobalamin deficiency. / Blood 1990, 76:871-81.
  3. Watkins D, Rosenblatt DS: Inborn errors of cobalamin absorption and metabolism. / Am J Med Genet C Semin Med Genet 2011, 157:33-4. CrossRef
  4. Van Winckel M, Vande Velde S, De Bruyne R, Van Biervliet S: Clinical practice: vegetarian infant and child nutrition. / Eur J Pediatr 2011, 170:1489-494. CrossRef
  5. Institute of Medicine Food and Nutrition Board: / Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academy Press, Washington, DC; 1998.
  6. L?vblad K, Ramelli G, Remonda L, Nirkko AC, Ozdoba C, Schroth G: Retardation of myelination due to dietary vitamin B12 deficiency: cranial MRI findings. / Pediatr Radiol 1997, 27:155-58. CrossRef
  7. Quentin C, Huybrechts S, Rozen L, De Laet C, Demulder A, Ferster A: Vitamin B12 deficiency in a 9-month-old boy. / Eur J Pediatr 2012, 171:193-95. CrossRef
  8. Baker H, Frank O, Deangelis B, Feingold S, Kaminetzky HA: Role of placenta in maternal-fetal vitamin transfer in humans. / Am J Obstet Gynecol 1981, 141:792-96.
  9. Specker BL, Black A, Allen L, Morrow F: 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, 52:1073-076.
  10. Erdeve O, Arsan S, Atasay B, Ileri T, Uysal Z: A breast-fed newborn with megaloblastic anemia-treated with the vitamin B12 supplementation of the mother. / J Pediatr Hematol Oncol 2009, 31:763-65. CrossRef
  11. Jones KM, Ramirez-Zea M, Zuleta C, Allen LH: Prevalent vitamin B-12 deficiency in twelve-month-old Guatemalan infants is predicted by maternal B-12 deficiency and infant diet. / J Nutr 2007, 137:1307-313.
  12. Katre P, Bhat D, Lubree H, Otiv S, Joshi S, Joglekar C, Rush E, Yajnik C: Vitamin B12 and folic acid supplementation and plasma total homocysteine concentrations in pregnant Indian women with low B12 and high folate status. / Asia Pac J Clin Nutr 2010, 19:335-43.
  13. Jadhav M, Webb JK, Vaishnava S, Baker SJ: Vitamin B12 deficiency in Indian infants. A clinical syndrome. / Lancet 1962, 2:903-07. CrossRef
  14. Thomas MR, Sneed SM, Wei C, Nail PA, Wilson M, Sprinkle EE: The effects of vitamin C, vitamin B6, vitamin B12, folic acid, riboflavin, and thiamin on the breast milk and maternal status of well-nourished women at 6?months postpartum. / Am J Clin Nutr 1980, 33:2151-156.
  15. Sneed SM, Zane C, Thomas MR: The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women. / Am J Clin Nutr 1981, 34:1338-346.
  16. Allen LH: Multiple micronutrients in pregnancy and lactation: an overview. / Am J Clin Nutr 2005, 81:1206S-1212S.
  17. Dror DK, Allen LH: Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. / Nutr Rev 2008, 66:250-55. CrossRef
  18. Honzik T, Adamovicova M, Smolka V, Magner M, Hruba E, Zeman J: Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency -what have we learned? / Eur J Paediatr Neurol 2010, 14:488-95. CrossRef
  19. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2431/12/85/prepub
  
• 作者单位：Sophie Guez (1)
  Gabriella Chiarelli (1)
  Francesca Menni (1)
  Simona Salera (1)
  Nicola Principi (1)
  Susanna Esposito (1)
  
  1. Pediatric Clinic 1, Fondazione IRCCS Ca-Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, Milano, 20122, Italy
  

文摘

Background In infants, vitamin B12 deficiency may be due to an inborn error of absorption and metabolism, or nutritional problems. Case presentation An exclusively breastfed 5-month-old Italian male infant, who was born after a normal full-term pregnancy to a vegan mother who was apparently daily treated with a multivitamin oral preparation during the second and third trimester, was hospitalised because of poor weight gain, feeding difficulties, severe pallor, muscle hypotonia and somnolence. Upon admission, his weight, length and head circumference were below the third percentile, he had an enlarged liver and spleen, and showed a significant delay in developmental milestones and communicative reactions. He had a hemoglobin level of 4.7?g/dL with an MCV of 84.2?fL, a white blood cell count of 4,680/mm3, and a platelet count of 45,000/mm3. His serum vitamin B12 level was 57?pg/mL (normal value 180-00?pg/mL) and serum folate level 12.8?ng/mL (normal value >3?ng/mL). The results of metabolic examinations excluded a cobalamin C disorder, whereas nutritional screening showed a serum iron concentration of 9?μg/dL and serum ferritin of 4?ng/mL. Magnetic resonance imaging of the brain showed mild dilatation of the lateral ventricles with diffuse delayed myelination. The child was diagnosed as having vitamin B12 and iron deficiency due to nutritional inadequacy and was immediately treated with packed red blood cells, intramuscular vitamin B12 injections, and iron supplementation. A few days after the start of therapy, his hemoglobin levels and other hematological parameters rapidly improved, and a clinical improvement was observed within few weeks. There was an increase in his achievement of developmental milestones, but his development was still retarded seven months after the start of therapy. Conclusion This case underlines the importance of adequately controlling maternal vitamin B12 intake during pregnancy by means of supplementation which, in the case of vegan mothers, should be significantly greater than that usually given. Moreover, the supplementation should be continued during lactation in order to avoid the development of signs of deficiency that may be associated with persistent neurological problems in infants. The case also highlights the need to consider vitamin B12 deficiency in infants with severe anemia even if their hematological parameters do not indicate megaloblastic anemia because the concomitant presence of substantial iron deficiency may modify the characteristics of the anemia.