Oh shit – Vegan baby in Morocco with brain shrinkage caused by vitamin B12 deficiency

This mother[.] was on [a] strict vegetarian diet (excluded all animal products from her diet)

Medical scientists at Mohammed V University (جامعة محمد الخامس) in Rabat, the capital of Morocco, have reported the case of a 9-month-old exclusively breastfed vegan baby girl with severe vitamin B12 deficiency. This case was reported in June 2018 in the Pan African Medical Journal, but only added to the PubMed library today.
The baby girl's vitamin B12 deficiency was caused by her vegan mother not consuming vitamin B12 – i.e. no B12 supplements, no B12 fortified foods (or not enough) and, of course, no animal products.

Take home messages:
  • All humans need to consume vitamin B12.
  • All vegans need to consume enough vitamin B12. We don’t need to eat animal products. We can obtain all the vitamin B12 we need in a vegan way from vitamin B12 supplements and/or vitamin B12 fortified foods.
  • Consuming enough vitamin B12 is extremely important for vegan pregnant and breastfeeding women.
  • Babies should NOT be exclusively breastfed (= no other food except breastmilk) for longer than 6 months. That means: At the age of 4 to 6 months (6 months at the latest) every baby should receive their first foods in addition to breastmilk.
This baby girl displayed the following symptoms:
  • Pale skin
  • Feeding difficulties = problems with drinking the breast milk (probably no appetite) 
  • Hypotonia = muscle weakness 
  • Apathy & lethargy = tiredness, listlessness 
  • Cerebral atrophy = brain shrinkage 
  • Delayed myelination of nerve cells = Her nervous system could not develop properly 
  • Tachycardia = fast heart beat
“After normal development within the first 4 months, she had lost developmental milestones, activity had generally decreased, and she had progressively feeding difficulties. The girl was pale and tachycardic at presentation, motor skills and cognitive development of infants were delayed.”
“The brain CT revealed cerebral atrophy and delayed myelination” 

Blood/urine levels in the baby:
Very low vitamin B12, very high homocysteine, and macrocytic anemia + high MMA in urine = all confirming a clear diagnosis of vitamin B12 deficiency

B12 therapy:
Vitamin B12 injections cured the symptoms, but possible long-term damage cannot be completely ruled out.
Regarding neurocognitive development, the girl had achieved appropriate head control and was able to sit with slight assistance.”
“Vitamin B12 supplementation normalizes the hematological and metabolic disturbances, but early treatment is crucial to prevent neurological sequelae such as learning or behavioural problems, secondary epilepsy or mental retardation.

The mother was from a low socio-economic background (= poor)
The pregnancy had been normal. Normal weight, length, head circumference and no preterm birth.

Lessons from the authors:
“This case figures out the importance of an early diagnosis in front of psychomoteur regression and hypotonia, given the risk of incomplete neurologic recovery due to vitamin B12 deficiency mainly in the setting of maternal nutritional deficiency.”
“Typical neurological symptoms in infancy are irritability, weakness, developmental delay and failure to thrive, finally apathy and coma.”
“[…] Vitamin B12 deficiency in infants who undergo extensive growth and development of the brain: Vitamin B12 deficiency may cause severe impairment in only a few weeks. The most common symptoms include failure to thrive, hypotonia, irritability or lethargy, developmental delay and even regression, [22,23] epilepsy or movement disorder [13,14].”
“[Vitamin B12] treatment does not necessarily result in appropriate psychomotor long-term development.”

Bousselamti, Amal; El Hasbaoui, Brahim; Echahdi, Hanae; Krouile, Yamna (2018): Psychomotor regression due tovitamin B12 deficiency. In: The Pan African medical journal 30, S. 152. DOI: 10.11604/pamj.2018.30.152.12046.