குழந்தை நரம்பியல் மற்றும் மருத்துவ இதழ்

Epidemiology and Neurodevelopmental Correlates of Cobalamin Deficiency in Hospitalized North Indian Infants

Abstract

Neha Agarwal, Chandrakanta, S Koonwar, AA Mahdi and Rashmi Kumar

Vitamin B12 deficiency has been associated with neurodevelopmental disorders in infants. Role of maternal and infant diet and other epidemiological features have not been reported from India.

Objective: To compute the prevalence of vitamin B12 deficiency in hospitalized children 2 months to 2 years of age and compare demographic, clinical, dietary and developmental status between those found deficient and sufficient.

Methods: The first 3 children aged 2 months to 2 years hospitalized to the Pediatric Medicine wards of King George’s Medical University Hospital, Lucknow on a predecided weekday were enrolled for study and subjected to a proforma driven work up. Those with history of vitamin supplements were excluded. Vitamin B12 and folate levels were measured by chemiluminiscence method. Vitamin B12 cut off value below 200 pg/ml and folic acid cut off value of <3 ng/ml were considered deficient. Neurodevelopmental status was assessed by Vineland Social Maturity Scale. Demographic data, dietary history of mother and child, anthropometry, clinical features and neurodevelopmental status were compared between the 2 groups.

Results: A total of 91 children [mean age 9.64+/- 4.42 months; 57.1% male] were enrolled, of which 17 [18.7%; 95% CI 11.3-28.2] were vitamin B12 deficient. No child was folic acid deficient. Vitamin B12 deficient children were significantly more likely to belong to lower socioeconomic status, be exclusively breast fed infants of vegetarian mothers with higher mean corpuscular volume and mean corpuscular hemoglobin concentration but lower mean platelet count. They also had higher odds of having a developmental quotient [DQ]<70 [OR=7.8; 95% CI 2.4-24.8; p=0.000] and significantly lower mean DQ [p=0.018].

Conclusion: Clear association of vitamin B12 deficiency with maternal and infant diet and impaired neurodevelopmental status was found which has important implications for millions of children in this country.