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

Ulf Wike Ljungblad1, Henriette Astrup2, Lars Mørkrid3

  • 1Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway.

Pediatric Neurology
|April 19, 2022
PubMed

Insights

Infants with vitamin B12 deficiency often show spells, tremors, and irritability. Nitrous oxide exposure during labor may be a risk factor for this deficiency in infants.

Area of Science:

  • Pediatrics
  • Nutritional Science
  • Biochemistry

Background:

  • Vitamin B12 deficiency affects 5-10% of Norwegian neonates and infants.
  • Biomarkers for deficiency are detected through newborn and clinical screenings.

Purpose of the Study:

  • Identify risk factors for vitamin B12 deficiency in infants.
  • Describe presenting symptoms and biochemical profiles of affected infants.

Main Methods:

  • Case-control study of infants under one year old (2011-2018).
  • 85 cases diagnosed with vitamin B12 deficiency compared to 252 controls.
  • Parental questionnaires and medical record review were utilized.

Main Results:

  • 80% of deficient infants presented with spells (apneas, seizures, absences) within two months.
  • Tremor (29%) and irritability (18%) were common initial findings.
  • Elevated serum total homocysteine (≥10 μmol/L) was significantly higher in cases (77%) vs. controls (28%). Maternal history included previous B12 deficiency (25%) and celiac disease (7%). Nitrous oxide dose during labor correlated with infant homocysteine levels.

Conclusions:

  • Early infant vitamin B12 deficiency commonly presents with spells, tremor, and irritability.
  • Nitrous oxide administration during labor is a potential contributing risk factor.
Abstract

Keywords:
ApneaBreastfeedingCobalaminFormulaInfantNitrous oxideSeizureVitamin B12

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