Breastfed Infants With Spells, Tremor, or Irritability: Rule Out Vitamin B12 Deficiency

• Published in: Pediatric neurology Vol. 131; pp. 4 - 12
• Main Authors: Ljungblad, Ulf Wike, Astrup, Henriette, Mørkrid, Lars, Hager, Helle Borgstrøm, Lindberg, Morten, Eklund, Erik A., Bjørke-Monsen, Anne-Lise, Rootwelt, Terje, Tangeraas, Trine
• Format: Journal Article
• Language: English; Norwegian
• Published: United States Elsevier Inc 01.06.2022
• Subjects: Apnea; Breast Feeding; Breastfeeding; Case-Control Studies; Child; Clinical Medicine; Cobalamin; Female; Formula; Homocysteine; Humans; Infant; Infant, Newborn; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Nitrous oxide; Nitrous Oxide - adverse effects; Pediatrics; Pediatrik; Seizure; Seizures - complications; Tremor - chemically induced; Tremor - etiology; Vitamin B 12; Vitamin B 12 Deficiency - complications; Vitamin B 12 Deficiency - diagnosis; Vitamin B12; Cobalamin; Formula; Apnea; Infant; Nitrous oxide; Seizure; Vitamin B12; Breastfeeding
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2022.03.003

In Norway, 5-10% of neonates and infants have biomarkers suggesting vitamin B12 deficiency from newborn screening tests and unselected clinical screening, respectively. The aims were to identify risk factors and describe presenting symptoms and biochemical profiles in infants diagnosed with vitamin B12 deficiency. In this case-control study, we searched hospital medical records for infants younger than one year born in 2011-2018, diagnosed with vitamin B12 deficiency. We compared 85 cases with a control group of 252 infants aged 3-7 months. Parents completed questionnaires. Of the 85 cases with vitamin B12 deficiency, 80% presented with spells (37%) of apneas, motor seizures, or absences within the first two months of life. Tremor (29%) and irritability (18%) were the most common findings at the first examination. Serum total homocysteine ≥10 μmol/L was found in 77% of cases compared to 28% of controls (P < 0.001). None of the mothers were vegetarians, but 25% reported a previous history of vitamin B12 deficiency and 7% had celiac disease. The dose of nitrous oxide given during labor was significantly associated with infant serum total homocysteine level at diagnosis (r = 0.37, 95% confidence interval = 0.16-0.55, P < 0.001) for cases, but not for controls. Spells, tremor, and irritability are common findings in early infant vitamin B12 deficiency. Nitrous oxide given during labor is proposed as a contributing risk factor to the development of early infant vitamin B12 deficiency.