4.1 Article

Neurology of Nutritional Vitamin B12 Deficiency in Infants: Case Series From India and Literature Review

Journal

JOURNAL OF CHILD NEUROLOGY
Volume 30, Issue 13, Pages 1831-1837

Publisher

SAGE PUBLICATIONS INC
DOI: 10.1177/0883073815583688

Keywords

vitamin B-12 deficiency; infants; nutritional; vegetarianism

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We studied 27 infants aged 6 to 27 months with vitamin B-12 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 B-12 was present in 12 of 21 infants. Seven of the 9 infants with normal serum vitamin B-12 had received vitamin B-12 before referral. Twelve mothers had low serum vitamin B-12. Cerebral atrophy was present in all the 9 infants who underwent neuroimaging. Treatment with vitamin B-12 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 B-12 deficiency is a treatable cause of neurologic dysfunction in infants.

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