Thiamine Deficiency in Exclusive Breastfed Infants with Encephalopathy Attending Govind Ballabh Panth Children Hospital Srinagar, India
Asian Journal of Pediatric Research, Volume 11, Issue 4,
Page 16-22
DOI:
10.9734/ajpr/2023/v11i4227
Abstract
Introduction: Thiamine deficiency has historically affected countries and populations consuming milled white rice. Thiamine deficiency in infants can have an acute presentation of encephalopathy with shock with severe metabolic acidosis and death sometimes, if not promptly treated with an intravenous dose of thiamine.
Aims: To study the biochemical deficiency of thiamine in exclusively breastfed infants presenting with encephalopathy and compare them with age-matched controls and to study their clinical course and short-term outcome (till discharge).
Materials and Methods: After dividing infants into four groups based on age in days: (31-60 days; 13 in cases and 8 in controls; 61-90; 4 in cases and 3 in controls; 91-120 days; 2 in cases and none in controls; and >120 days 4 each in cases and controls. This study primarily included the selection of case/control subjects. Two case-control analyses were conducted. In the first one, blood thiamine levels were compared between infants with encephalopathy and without encephalopathy. In the second one, breast milk thiamine levels were compared between infants with encephalopathy and without encephalopathy. Student's independent t-test was used for statistical analysis.
Results: Out of 38 infants, 23 had presented with encephalopathy, and 15 were healthy taken as controls. The mean blood levels of thiamine in infants with encephalopathy in cases were 17.29nmol/l with a Standard deviation of 8.86: the levels ranged between 13.47 and 21.13. The mean value of controls was 51.31, with a Standard deviation of 25.52 ranging between 23.25 and 124.7. The P value was <0.001 and was considered statistically significant. The ROC analysis of the data obtained from thiamine levels obtained in the study 'patient's blood compared with the control group.
Conclusion: Thiamine deficiency can be clinically and biochemically attributed to the presentation of infants with acute encephalopathy.
- Thiamine levels
- breastfed infants
- shock
- encephalopathy
- metabolic acidosis
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References
Manzetti S, Zhang J, van der Spoel D. Thiamine function, metabolism, uptake, and transport. Biochemistry. 2014;53(5): 821–35
Singleton CK, Martin PR. Molecular mechanisms of thiamine utilization. Curr Mol Med. 2001;1(2):197–207.
Bettendorff L. Thiamine in excitable tissues: reflections on a non-cofactor role. Metab Brain Dis. 1994;9(3):183–209. .
Bettendorff L, Wins P. Biological functions of thiamine derivatives: focus on non-coenzyme roles. OA Biochem. 2013; 1(1):10.
Khounnorath S, Chamberlain K, Taylor AM, et al. Clinically unapparent infantile thiamine deficiency in Vientiane, Laos. PLoS Negl Trop Dis. 2011; 5(2):e969.
Rao SN, Chandak GR. Cardiac beriberi: often a missed diagnosis. J Trop Pediatr. 2010;56(4):284–5.
Crook MA, Sriram K. Thiamine deficiency: the importance of recognition and prompt management. Nutrition. 2014;30(7-8): 953-4.
Frank LL. Thiamine in clinical practice. JPEN J Parenter Enteral Nutr. 2015;39(5):503–20.
Claus D, Eggers R, Warecka K, Neundorfer B. Thiamine deficiency andnervous system function disturbances. Eur Arch Psychiatry Neurol Sci. 1985;234(6):390-94.
Kerns JC, Arundel C, Chawla LS. Thiamine deficiency in people with obesity. Adv. Nutr. 2015;6(2):147–53.
Klein M, Weksler N, Gurman GM. Fatal metabolic acidosis caused by thiamined eficiency. J Emerg Med. 2004;26(3):301–3.
Bourassa MW, Bergeron G, Brown KH. A fresh look at thiamine deficiency—new analyses by the global thiamine alliance. Annals of the New York Academy of Sciences. 2021;1498(1):5-8.
Smith TJ, Johnson CR, Koshy R, Hess SY, Qureshi UA, Mynak ML, Fischer PR. Thiamine deficiency disorders: a clinical perspective. Annals of the New York Academy of Sciences. 2021;1498(1):9-28.
Jeffrey HE, McCleary BV, Hensley WJ, Read DJ. Thiamine deficiency – a neglected problem of infants and mothers – possible relationships to sudden infant death syndrome. Aust N Z J Obstet Gynaecol. 1985;25(3):198-202.
Christopher D, Watkins J, Allan WW. Nutrition in pediatrics. 4th ed Pmph U S A. Halmilton: BC Decker Inc. 2008;106.
Madl C, Kranz A, Liebisch B, Traindl O, Lenz K, Druml W. Lactic acidosis in thiamine deficiency. ClinNutr 1993;12(2): 108–11
Boonsiri P, Tangrassameeprasert R, Panthongviriyakul C, Yongvanit P. A preliminary study of thiamine status in northeastern Thai children with acute diarrhea. Southeast Asian J Trop Med Public Health 2007;38(6):1120–5.
Duce M, Escriba JM, Masuet C t al. Suspected thiamine deficiency in Angola. Field Exch 2003; (20): 26-8.
Greenspon J, Perrone EE, Alaish SM. Shoshin beriberi mimicking central line sepsis in a child with short bowel syndrome. World J Pediatr. 2010;6(4): 366-8.
Roman-Campos D, Cruz JS. Current aspects of thiamine deficiency on heart function. Life Sci 2014;98(1):1–5.
Bhat JI, Ahmed QI, Ahangar AA, Charoo BA, Sheikh MA, Syed WA. Wernicke's encephalopathy in exclusive breastfed infants. World J Pediatr. 2017;13 :485-488
Qureshi UA, Sami A, Altaf U, Ahmad K, Iqbal J, Wani NA, Mir Z, Ali I. Thiamine responsive acute life threatening metabolic acidosis in exclusively breastfed infants. Nutrition. 2016;32: 213-216
Wani NA, Qureshi UA, Jehangir M et al. Infantile encephalitic beriberi magnetic resonance imaging findings. Peiatr Radiol. 2016;46:96-103
Kornreich L, Bron-Harlev E, Hoffmann C, Schwarz M, Konen O, et al. Thiamine deficiency in infants: MR findings in the brain. Am J Neuroradiol 2005;26(7): 1668-74.
Stuetz W, Carrara VI, McGready R, Lee SJ, Biesalski HK, et al. Thiamine diphosphate in whole blood, thiamine and thiamine monophosphate in breast milk in a refugee population. PLoS ONE. 2012;7(6):e36280.
Keating EM, Nget P, Kea S, Kuong S, Daly L, Phearom S, Enders Fet al. Thiamine deficiency in tachypnoeic Cambodian infants. Paediatr Int Child Health. 2015;35(4):312-8
Bowman BA, Pfeiffer CM, Barfield WD. Thiamine deficiency, beriberi, and maternal and child health: why pharmacokinetics matter. Am J Clin Nutr. 2013;98(3): 635–636
Ornoy A, Tekuzener E, Braun T, Dichtiar R, Shohat T, Cassuto H, Boker LK. Lack of severe long-term outcomes of acute, subclinical B1 deficiency in 216 children in Israel exposed in early infancy. Pediatric Research. 2013;73:111-119.
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