Headline: "An infant and mother with severe B12 deficiency"


Further down: "not a vegan/vegetarian"


Summary:
  • non-vegetarian mother, exclusively breastfed 9 month-old girl
  • mother 33 years old, healthy and physically active
    "mother is not a vegan/vegetarian"
  • mother with B12 and iron deficiency - this lead to B12 deficient breast milk - this led to a nutritional B12 deficiency in the baby
  • baby exclusively breastfed from birth - introducing solids at 5 months unsuccessful 
  • "Maternal B12 deficiency, most likely masked by iron deficiency and a normal haemoglobin count on antenatal screening, led to severe B12 deficiency in the infant."
    "Exclusive breastfeeding and a subsequent failure to wean exacerbated the infant’s B12
    deficiency leading to developmental delay."
  • "This case highlights the need for development of guidelines for assessment of B12 status during pregnancy as well as public awareness of the risks of exclusive breastfeeding beyond 6 months of age."

Interesting statements:
  • "Humans source their vitamin B12 from animal-derived foods, predominantly as hydroxocobalamin." [not all of us! 😸]
  • "biochemical evidence of impaired B12 status has been reported in up to two-thirds of exclusively breastfed infants aged 6 weeks to 4 months."
  • "Studies have shown that breast milk alone is not sufficient to support the daily requirements of B12 intake, even from mothers with normal B12 status and especially if exclusive breastfeeding is continued beyond 6 months of age."
  • "the mothers of breastfed children who develop B12 deficiency are often asymptomatic."

Symptoms the baby displayed:

  • developmental delay
  • abnormal movements (head dropping forward and arms moving up; 6–10 episodes per day)
  • "She previously smiled and was rolling front to back and back to front, however she had lost these skills. She was unable to sit unaided"
  • "Brain magnetic resonance imaging showed a generalised lack of white matter bulk with evidence of delayed myelination [from B12 deficiency]"

Treatment:

  • "MMA and homocysteine normalised after 3 days of intramuscular hydroxocobalamin (B12) 1 mg per day and 40 mg elemental iron daily"
  • "Parents reported a remarkable improvement in the infant’s health. The infant was able to sit well unsupported, roll from both directions and had begun communicating her needs well."




Reference
Sobczyńska-Malefora A, Ramachandran R, Cregeen D, Green E, Bennett P, Harrington DJ, Lemonde HA: An infant and mother with severe B12 deficiency: vitamin B12
status assessment should be determined in pregnant women
with anaemia. European Journal of Clinical Nutrition (2017), 1–3,advance online publication, 24 May 2017; doi:10.1038/ejcn.2017.85

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