Infant Methemoglobinemia in the Transylvania Region of Romania

The incidence of infant methemoglobinemia reported in three counties of Transylvania, Romania, was evaluated from medical records, field visits, and interviews. Well water was the main source of nitrate for induction of acquired infant methemoglobinemia, which occurred post-breast-feeding when the infants consumed nitrate-contaminated water used in mixing formula. The average age of reported infants with methemoglobinemia was 39 days, supporting earlier observations that infants less than 4 months old are the most susceptible segment of the population. Vitamin C, rather than methylene blue, was the main medical intervention in the Transylvania region. The mean incidence rates of methemoglobinemia in the three counties (Saut-Mare, Mures, and Bistrita-Nasaud) ranged from 24 to 363 per 100,000 live births over a five-year period (1990-1994). These rates are below earlier reported incidence rates of up to 13% (13,000 per 100,000 live births). Three selected case reports are presented to describe hospital/clinic data, well-water data, and infant feeding practices. Recommendations for appropriate intervention programs are described. The significances of possible physical and neuropsychological effects on the development of children following methemoglobinemia are discussed and the need for further investigations is outlined.