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Indian Pediatr 2016;53:
256-257 |
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Vitamin B12 Status of Mothers of Children with Infantile Tremor Syndrome
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Jatinder Singh Goraya, Kartik Bansal, Sekhar Singla and
*Sukhjot Kaur
Division of Pediatric Neurology, Departments of
Pediatrics and *Dermatology,
Dayanand Medical College and Hospital, Ludhiana,
Punjab, India.
Email: [email protected]
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Retrospective chart review of 15
patients with infantile tremor syndrome in which mothers had their serum
vitamin B12 measured, showed low (<200 pg/mL) serum vitamin B12 in 9 and
low-normal (<200-350 pg/mL) in 6. Of the 9 mothers who had undergone
complete blood counts, anemia was present in 6 and macrocytosis in 3.
Vitamin B12 deficiency appears to be common in mothers of infants with
infantile tremor syndrome.
Keywords: Deficiency, Management,
Micronutrient.
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Several studies have shown vitamin B 12
deficiency in infants with ITS [1-6]; but systematic study of maternal
vitamin B12 status has
infrequently been done through appropriate investigations [1,2,4,7]. We
herein report on the vitamin B12
status of the mothers of children with ITS.
We retrospectively reviewed the laboratory
investigations undertaken to determine the vitamin B 12
status of the mothers of the infants diagnosed with ITS between February
2010 and March 2015. Vitamin B12
status of mothers is investigated at our center depending of
affordability of the test. All the mothers, coming from poor families,
were vegetarian with little or no milk intake. Serum vitamin B12
levels in this study were defined as low (< 200 pg/ml), and low normal
(200-350 pg/ml) [8]. The deficient mothers are treated with either oral
or intramuscular vitamin B12.
Supplementation with oral iron and folic acid was also done, as deemed
appropriate.
Fifteen mothers had serum vitamin B 12
estimation and 9 had complete blood counts. Hemoglobin ranged from 9.6
to 13.0 g/dl (mean, 11.5 g/dl). Anemia (hemoglobin <12g /dl) was present
in 9 but was only mild. Macrocytosis (MCV > 95 fl) was noted in 3 and
another 3 mothers had borderline elevated MCV (91-93 fl). Serum vitamin
B12 ranged from 49 to 260
pg/ml (mean, 157.3 pg/ml). Overall, serum vitamin B12
was low in 9 mothers and low normal in 6.
Jadhav, et al. [1] were the first to
demonstrate low vitamin B 12
in the maternal serum as well as in the breast-milk, thus confirming
vitamin B12 deficiency. The
study also proved that vitamin B12
deficiency in the infants in ITS was secondary to maternal vitamin B12
deficiency. Similar findings were described by Srikantia and Reddy [2].
Kaul, et al. [7] reported low serum vitamin B12
in all the 7 mothers tested but only in 3 of the 11 infants tested. The
authors concluded that vitamin B12
deficiency was not causally related to ITS but could not explain low
serum vitamin B12 in the
mothers. Majority of the studies on ITS have not commented on maternal
vitamin B12 status.
Our study has re-emphasized the presence of vitamin B 12
deficiency in mothers of infants with ITS. The vitamin B12
deficiency in the mother-infant pairs in ITS is not unexpected, given
the fact that mothers were strict vegetarian and infants exclusively
breast-fed [9]. Finding of normal serum vitamin B12
in 6 infants in our study whose mothers had low serum vitamin B12
was unusual since breast-milk was the only source of nutrition in these
infants. Prior administration of vitamin B12
was revealed from medical records. Low serum vitamin B12
in the mother provided an indirect evidence of infantile vitamin B12
deficiency in these 6 infants with discrepant serum vitamin B12.
This finding could also explain apparently normal serum vitamin B12
in some infants with ITS reported previously in some studies [7].
Additionally, testing of mothers for vitamin B12
deficiency also allowed us to treat them appropriately, which might have
been missed otherwise. We also found that anemia and macrocytosis were
not always present in the presence of low serum vitamin B12,
and absence of these hematological parameters therefore cannot reliably
exclude the diagnosis of vitamin B12
deficiency [8].
Major limitation of our study is its retrospective
nature, absence of a control group and a small sample size. Breast milk
vitamin B 12 as well as
detailed laboratory assessment of the mothers for other nutritional
deficiencies could not done due to financial constraints.
To conclude, majority of the mothers of infants with
ITS suffered from nutritional vitamin B 12
deficiency. Vitamin B12
status in the mothers should be assessed by measuring serum vitamin B12,
as anemia and macrocytosis may not always be present.
Contributors: JSG: conceptualized the study, and
revised the manuscript; KB, SS: were involved in patient care, data
collection and revision of the manuscript; SK: performed the data
analysis, and wrote the initial draft.
Funding: None; Competing Interests: None
stated.
References
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