Infantile encephalopathy due to vitamin deficiency in industrial countries

Abu-Kishk, Ibrahim; Rachmiel, Marianna; Hoffmann, Chen; Lahat, Eli; Eshel, Gideon

doi:10.1007/s00381-009-0942-3

Cited by 11 publications

(7 citation statements)

References 11 publications

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“…19,44,50 Nerve and muscle biopsy reported in Indian infants with infantile tremor syndrome has revealed partial demyelination, and patchy fibrosis respectively. 29 Brain stem evoked auditory potentials have been studied only infrequently and results have been either normal 36,52,54,64 or nonspecific. 56 Visual evoked response in one case showed prolonged latency 54 and was normal in another.…”

Section: Discussionmentioning

confidence: 99%

Neurology of Nutritional Vitamin B₁₂Deficiency in Infants

2015

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We studied 27 infants aged 6 to 27 months with vitamin B12 deficiency also known as "infantile tremor syndrome" in India. All were exclusively breast-fed by vegetarian mothers. Developmental delay or regression, pallor, skin hyperpigmentation, and sparse brown hair were present in all. Majority were hypotonic and involuntary movements were encountered in 18. Anemia and macrocytosis was found in 83% and 71% infants, respectively. Low serum vitamin B12 was present in 12 of 21 infants. Seven of the 9 infants with normal serum vitamin B12 had received vitamin B12 before referral. Twelve mothers had low serum vitamin B12. Cerebral atrophy was present in all the 9 infants who underwent neuroimaging. Treatment with vitamin B12 resulted in dramatic improvement in general activity and appetite within 48 to 72 hours followed by return of lost milestones. Tremors resolved in all by 3 to 4 weeks. Nutritional vitamin B12 deficiency is a treatable cause of neurologic dysfunction in infants.

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Section: Discussionmentioning

confidence: 99%

Neurology of Nutritional Vitamin B₁₂Deficiency in Infants

2015

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“…In the French island of Mayotte, deficiency was related to inadequate nutrition [ 28 , 36 ]. Infantile thiamine deficiency is periodically reported in intensive care units in babies receiving parenteral nutrition without thiamine or babies with malabsorption receiving prolonged but inadequate vitamin supplements [ 6 , 28 , 37 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

Beriberi (Thiamine Deficiency) and High Infant Mortality in Northern Laos

et al. 2015

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BackgroundInfantile beriberi (thiamine deficiency) occurs mainly in infants breastfed by mothers with inadequate intake of thiamine, typically among vulnerable populations. We describe possible and probable cases of infantile thiamine deficiency in northern Laos.Methodology/Principal FindingsThree surveys were conducted in Luang Namtha Province. First, we performed a retrospective survey of all infants with a diagnosis of thiamine deficiency admitted to the 5 hospitals in the province (2007–2009). Second, we prospectively recorded all infants with cardiac failure at Luang Namtha Hospital. Third, we further investigated all mothers with infants (1–6 months) living in 22 villages of the thiamine deficiency patients’ origin. We performed a cross-sectional survey of all mothers and infants using a pre-tested questionnaire, physical examination and squat test. Infant mortality was estimated by verbal autopsy. From March to June 2010, four suspected infants with thiamine deficiency were admitted to Luang Namtha Provincial hospital. All recovered after parenteral thiamine injection. Between 2007 and 2009, 54 infants with possible/probable thiamine deficiency were diagnosed with acute severe cardiac failure, 49 (90.2%) were cured after parenteral thiamine; three died (5.6%). In the 22 villages, of 468 live born infants, 50 (10.6%, 95% CI: 8.0–13.8) died during the first year. A peak of mortality (36 deaths) was reported between 1 and 3 months. Verbal autopsy suggested that 17 deaths (3.6%) were due to suspected infantile thiamine deficiency. Of 127 mothers, 60 (47.2%) reported edema and paresthesia as well as a positive squat test during pregnancy; 125 (98.4%) respected post-partum food avoidance and all ate polished rice. Of 127 infants, 2 (1.6%) had probable thiamine deficiency, and 8 (6.8%) possible thiamine deficiency.ConclusionThiamine deficiency may be a major cause of infant mortality among ethnic groups in northern Laos. Mothers’ and children’s symptoms are compatible with thiamine deficiency. The severity of this nutritional situation requires urgent attention in Laos.

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“…Diverse TD expressions are described, with clinical, biological (associated hyperlactatemia), and radiologically specific or atypical signs of TD. The cases cover a broad panel of clinical manifestations: shock, pulmonary arterial hypertension, Shoshin beriberi, type B lactic acidosis (reversible by thiamine administration), altered mental status that can progress to coma, limb weakness, ocular abnormalities, and signs of truncated or the entire triad of WE 23,108–127 C10 : PTD related to a few documented cases of autistic spectrum disorders associated with TD and a case of botulism associated with thiaminase production (2%) 128–132 …”

Section: Resultsmentioning

confidence: 99%

Pediatric thiamine deficiency disorders in high‐income countries between 2000 and 2020: a clinical reappraisal

Rakotoambinina

Hiffler²,

Gomes

2021

Annals of the New York Academy of Sciences

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Often thought to be a nutritional issue limited to low-and middle-income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high-income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine-deficient mothers living in disadvantaged socioeconomic conditions are thought to be rare. This study aims to assess PTD in HICs in the 21st century. Literature searches were conducted to identify case reports of PTD observed in HICs and published between 2000 and 2020. The analyzed variables were age, country, underlying conditions, clinical manifestations of PTD, and response to thiamine supplementation. One hundred and ten articles were identified, totaling 389 PTD cases that were classified into four age groups: neonates, infants, children, and adolescents. Eleven categories of PTD-predisposing factors were identified, including genetic causes, lifestyle (diabetes, obesity, and excessive consumption of sweetened beverages), eating disorders, cancer, gastrointestinal disorders/surgeries, critical illness, and artificial nutrition. TD-associated hyperlactatemia and Wernicke encephalopathy were the most frequent clinical manifestations. The circumstances surrounding PTD in HICs differ from classic PTD observed in LMICs and this study delineates its mutiple predisposing factors. Further studies are required to estimate its magnitude. Awareness is of utmost importance in clinical practice.

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Infantile encephalopathy due to vitamin deficiency in industrial countries

Abstract: Avitaminosis, even in industrialized countries, should be considered in an atypical age group with no known risk factors. Early diagnosis and prompt treatment may accomplish a quick recovery with fewer sequelae.

Cited by 11 publications

References 11 publications

Neurology of Nutritional Vitamin B₁₂Deficiency in Infants

Neurology of Nutritional Vitamin B₁₂Deficiency in Infants

Beriberi (Thiamine Deficiency) and High Infant Mortality in Northern Laos

Pediatric thiamine deficiency disorders in high‐income countries between 2000 and 2020: a clinical reappraisal

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Infantile encephalopathy due to vitamin deficiency in industrial countries

Abstract: Avitaminosis, even in industrialized countries, should be considered in an atypical age group with no known risk factors. Early diagnosis and prompt treatment may accomplish a quick recovery with fewer sequelae.

Cited by 11 publications

References 11 publications

Neurology of Nutritional Vitamin B12Deficiency in Infants

Neurology of Nutritional Vitamin B12Deficiency in Infants

Beriberi (Thiamine Deficiency) and High Infant Mortality in Northern Laos

Pediatric thiamine deficiency disorders in high‐income countries between 2000 and 2020: a clinical reappraisal

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Neurology of Nutritional Vitamin B₁₂Deficiency in Infants

Neurology of Nutritional Vitamin B₁₂Deficiency in Infants