INFANTILE TREMOR SYNDROME IN CHILDREN AND MATERNAL VITAMIN B12 DEFICIENCY: A TIME FOR PRIMARY PROPHYLAXIS
DOI:
https://doi.org/10.22159/ajpcr.2022.v15i6.44104Keywords:
Child, Deficiency, Mother, Tremors, Vitamin B12Abstract
Objective: The aim of the study was to determine the percentage of Vitamin B12 deficiency in mothers of children suffering from infantile tremor syndrome (ITS). Other objectives were to determine the percentage of Vitamin B12 deficiency in children and to look for percentage of children having neurological changes in contrast enhanced computed tomography (CT) scan of brain.
Methods: Data of children between 1 and 60 months admitted between April 2019 and December 2019 with ITS in a tertiary care hospital were collected. Serum Vitamin B12 levels of both mother and child were determined. Vitamin B12 deficiency and insufficiency were defined as levels <200 pg/ mL and 200–350 pg/mL, respectively. The primary outcome was percentage of mother with Vitamin B12 deficiency and the secondary outcomes were percentage of children with Vitamin B12 deficiency and percentage of children with cerebral atrophy on contrast-enhanced CT of brain.
Results: Forty-five children were enrolled in our study. Vitamin B12 deficiency was found in 29 (64.4%) children and 22 (55%) of their mothers. Cerebral atrophy in CT scan was found in 29 (70%) out of 41 children.
Conclusion: The most of the mothers of children with ITS are also Vitamin B12 deficient. ITS occurs in infants and toddler with underlying Vitamin B12 deficiency and causes early cerebral atrophy in children, which is crucial period of brain growth. Hence, screening and supplementing anemic pregnant women with vitamin B12 can be one of the primary prevention in India.
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References
Gorayal JS, Kaur S. Infantile tremor syndrome-down but not out. Ind Pediatr 2015;52:249-53.
Gupte S. Miscellaneous and unclassified Pediatric issues. In: Gupte S, editor. The Short Textbook of Pediatrics. 12th ed. New Delhi: Jaypee Brothers Medical Publishers Ltd.; 2016. p. 846-7.
Gupta R, Rawat AK, Singh P, Gupta J, Pathak A. Infantile tremor syndrome: Current perspectives. Res Rep Trop Med 2019;10:103-8. doi: 10.2147/RRTM.S180604, PMID 31308787
Gowda VK, Kolli V, Benakappa A, Srinivasan VM, Shivappa SK, Benakappa N. Case series of infantile tremor syndrome in tertiary care paediatric centre from Southern India. J Trop Pediatr 2018;64:284-8. doi: 10.1093/tropej/fmx062, PMID 28977620
Gautam P, Sharma N, Chaudhary S, Kaushal A. Infantile tremor syndrome in modern times. J Pediatr Neurosci 2017;12:232-6. doi: 10.4103/jpn.JPN_150_16, PMID 29204197
Goraya JS, Kaur S. Infantile Tremor syndrome: A review and critical appraisal of its etiology. J Pediatr Neurosci 2016;11:298-304. doi: 10.4103/1817-1745.199475, PMID 28217150
Sirolia V, Arya S. Study of clinical profile and estimation of vitamin B12 level in infantile and pre-infantile tremor syndrome. J Evol Med Dent Sci 2014;3:10134-37. doi: 10.14260/jemds/2014/3315
Roumeliotis N, Dix D, Lipson A. Vitamin B12 deficiency in infants secondary to maternal causes. CMAJ 2012;184:1593-8. doi: 10.1503/ cmaj.112170, PMID 22711730
Seth T. Hematological disorders. In: Paul VK, Bagga A editors. Ghai Essential Pediatrics. 9th ed. New Delhi: CBS Publishers and Distributors Pvt Ltd.; 2019. p. 331.
Menkes JH. Toxic and Nutritional disorders. In: Menkes JH, Sarnat HB, editors. Child Neurology. 6th ed. United States: Lippincot Williams and Wilkins Publisher; 2017. p. 776.
Updates on Management of Severe Acute Malnutrition in Infants and Children. World Health Organization; 2013 Available from: https:// www.apps.who.int [Last accessed on 2021 Aug 22].
Kumar A, Shrikhande DY, Singh E, De N, Verma S. To study clinical, hematological and neuroimaging profile in patients of infantile tremor syndrome in rural based tertiary care centre. Int J Med Res Profession 201;3:63-6.
Gupta R, Mandliya J, Sonker P, Patil V, Agrawal M, Pathak A. Infantile tremor syndrome: Role of vitamin B12 revisited. J Pediatr Neurosci 2016;11:305-8. doi: 10.4103/1817-1745.199463, PMID 28217151
Gorayal JS, Bansal K, Singla A, Kaur S. Vitamin B12 of mothers with infantile tremor syndrome. Indian Pediatr 2016;53:256-7.
Chaudhary H, Verma S, Bhatia P, Vaidya PC, Singhi P, Sankhyan N. Infantile tremor syndrome or neurocutaneous infantile B12 deficiency syndrome? Indian J Pediatr 2020;87:179-84. doi: 10.1007/s12098-019- 03117-w, PMID 31984470
Gehlot P, Gupta R, Mandliya JC, Singh P, Pathak A. Cranial neuroimaging in infantile tremor syndrome: the road ahead. J Clin Diagn 2018;12:SC01-4. doi: 10.7860/JCDR/2018/29522.11240
Rajpoot KS, Poswal L, Goyal S. Assessment of iron, folate and vitamin B12 status in children with infantile tremor syndrome. Int J Contemp Pediatr 2016;3:587-92. doi: 10.18203/2349-3291.ijcp20161044
Garewal G, Narang A, Das KC. Infantile tremor syndrome: A Vitamin B12 deficiency syndrome in infants. J Trop Pediatr 1988;34:174-8. doi: 10.1093/tropej/34.4.174, PMID 2459405
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Copyright (c) 2022 Manisha Maurya, DR, DR Nandita Mishra, DR Mukesh Vir singh, DR santosh Kumar shukla
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