Development delay in children with severe acute malnutrition and its association with Vitamin B12 deficiency

Aishvarya Adhualia; Manisha Maurya; A. D. Tewari

doi:10.18203/2349-3291.ijcp20194721

Authors

Aishvarya Adhualia Department of Pediatrics, MLN Medical College, Prayagraj, Uttar Pradesh, India
Manisha Maurya Department of Pediatrics, MLN Medical College, Prayagraj, Uttar Pradesh, India
A. D. Tewari Department of Pediatrics, MLN Medical College, Prayagraj, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20194721

Keywords:

Child, Nutritional Rehabilitation Center, Severe acute malnutrition, Vitamin B12 deficiency, Macrocytic anemia, Developmental delay

Abstract

Background: About half of the under five children are malnourished in India and so is morbidity associated with it. Malnutrition is also associated with multiple vitamin deficiency one of which is vitamin B12. Vitamin B12 is essential for DNA, RNA and protein synthesis; and for myelination of brain during the early childhood period. Deficiency of vitamin B12 can lead to megaloblastic anemia and neurological problems. So, authors aimed to look prevalence of vitamin B12 deficiency and; its hematological and neurological effects in severe acute malnourished children.

Methods: it was an observational case control study, in which severe acute malnourished (SAM) children aged 0- 59 months who were admitted in Nutritional Rehabilitation Centre (NRC) were enrolled. Vitamin B12 levels were estimated and levels <200 pg/ml, 200-350 pg/ml, and >350 pg/ml were considered deficient, insufficiency and sufficient. Complete blood count was done for hematological effects and; developmental assessment was done to look for neurological effects.

Results: Vitamin B12 was deficient, insufficient, normal in 15(16.3%), 25 (27.5%) and 52 (56.5%) children respectively. Vitamin B12 deficiency was significantly associated with hyperpigmentation and glossitis. Infant and young child feeding practices were not associated vitamin B12 deficiency. Macrocytic anemia was found in 23.4% SAM children and macrocytosis was not significantly associated with vitamin B12 deficiency. Developmental delay was found in 55.3 % children and was not significantly associated with severe acute malnutrition.

Conclusions: There is high prevalence of Vitamin B12 deficiency and insufficiency in children with severe acute malnourished children. Macrocytic anemia and developmental delay are not significantly associated with vitamin B12 deficiency.

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References

UNICEF/WHO/World Bank Joint child malnutrition estimates. Available at: website htt://data.unicef.org on Accessed 29 June 2019.

Dubal J. Prevalence of Folate and Vitamin B12 Deficiency Aged 1 to 6 Years. Int J Sci Res. 2014;5:611.

Goyal S, Tiwari K, Meena P, Malviya S and Asif M. Cobalamine and folate status in malnourished children. Int J Contemp Pediatr. 2017;4(4):1480-84.

Jain R, Singh A, Mittal M, Talukdar B. Vitamin B12 deficiency in children: a treatable cause of neurodevelopmental delay. J Child Neurol. 2015;30(5):641-3.

Agarwa N, Chandrakanta KS. Epidemiology and neurodevelopmental correlates of cobalamin deficiency in hospitalized North Indian infants. J Pediatr Neurol Med. 2016;1(1):1-5.

Paul VK, Bagga A. Ghai Essential Pediatrics. CBS Publishers and Distributors;2018.

Dhirar N, Dudeja S, Khandekar J, Bachani D. Childhood Morbidity and Mortality in India-Analysis of National Family Health Survey 4 (NFHS-4) Findings. Indian Pediatr. 2018;55(4):335-8.

Choudhary M, Sharma D, Nagar RP, Gupta BD, Nagar T, Pandita A. Clinical profile of severe acute malnutrition in Western Rajasthan: a prospective observational study from India. J Pediatr Neonatal Care. 2015;2(1):00057.

Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Co-morbidities in hospitalized children with severe acute malnutrition. Indian Pediatr. 2014;51(2):125-7.

Meena DK, Sharma D, Meena NK, Jain A. Children with Severe Acute Malnutrition, Outcome and its Complications in Children admitted at tertiary level Centre (MTC) –A Prospective Study. JMSCR. 2016;4:9509-9512.

Dhanalakshmi K, Devi GC. The outcome of severe acute malnutrition children admitted to nutrition rehabilitation centre of a tertiary level care hospital. Int J Contemp Pediatr. 2017;4(3):801-3.

Kapil U, Sareen N. Prevalence of Ferritin, Folate and Vitamin B12 Deficiencies Amongst Children in 5-18 years of Age in Delhi. Indian J Pediatr. 2014;81(3):312.

Jain R, Kapil M, Gupta GN. Mcv should not be the only criteria to order vitamin B12 for anemia under evaluation. J Gastroenterol. 2012;2(04):187.

Kwok T, Cheng G, Woo J, Lai WK, Pang CP. Independent effect of vitamin B12 deficiency on hematological status in older Chinese vegetarian women. Am J Hematol. 2002;70(3):186-90.

Bhatia P, Kulkarni JD, Pai SA. Vitamin B12 deficiency in India: Mean corpuscular volume is an unreliable screening parameter. Natl Med J India. 2012;25(6):2012.

Biancheri R, Cerone R, Rossi A, Schiaffino MC, Caruso U, Minniti G, Perrone MV, Tortori‐Donati P, Veneselli E. Early‐onset cobalamin C/D deficiency: epilepsy and electroencephalographic features. Epilepsia. 2002;43(6):616-22.

Graham SM, Arvela OM, Wise GA. Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants. J Pediatr. 1992;121(5):710-4.