Assessment of iron, folate and vitamin B12 status in children with infantile tremor syndrome
Keywords:ITS, Vitamin B12 deficiency, Folate deficiency, Ferritin deficiency
Background: Infantile tremor syndrome (ITS) is a clinical syndrome of infants and young children characterized by acute or gradual onset with mental and psychomotor changes, pigmentary disturbances of hair and skin, pallor and tremors.
Methods: The study was conducted on 50 children of age group 6 – 24 months with clinical diagnosis of infantile tremor syndrome. The demographic profile and relevant information of individual patient were collected by using structured proforma and an informed consent was taken for enrolling the children into the study. Serum ferritin, folate and vitamin B12 levels were estimated to assess iron, folic acid and vitamin B12 status by electrochemiluminiscence (ECL) method.
Results: Significantly higher numbers of patients (68%) were exclusively breastfed. All children had dark skin pigmentation and regression (82%)/delayed (18%) developmental milestones; while most of children had palmer pallor (98%), hypopigmented hair (92%) and majority of the patients (52%) had tremors. Significant number of patients had vitamin B12 deficiency (P=0.005) whereas none of the child was found to be having folate and ferritin deficiency. There was significant association between vitamin B12 deficiency with severity of anemia (P=0.011) and thrombocytopenia (P=0.002).
Conclusions: Vitamin B12 deficiency was present in 70% of children with ITS while none of them had iron or folate deficiency.
Kalra V. Infantile tremor syndrome in central nervous system. In: Vinod K Paul, Arvind Bagga, Aditi Sinha editors. Ghai Essential Paediatrics 8th edn. New Delhi: CBS Publisher & Distributors. 2013:580-81.
Gupte S, Pal M, Gupta SK, Sangra KR. Infantile tremor syndrome (ITS). In Gupte S, ed. Text book of pediatric Nutrition. New Delhi: Peepee. 2006;255-65.
Shrikantia SG, Reddy V. Megaloblastic anemia of infancy and vitamin B12. Br J Hematology. 1967;13:949-53.
Jadhav M, Webb JKG, Vaishnav S. vitamin B12 deficiency in Indian infants: A clinical syndrome. Lancet. 1962;2:903-6.
WHO/UNICEF/UNU. Iron deﬁciency anemia: assessment, prevention, and control. A guide for program managers. Geneva, Switzerland: World Health Organization. 2001.
Thurnham DI, McCabe LD, Haldar S, Wieringa FT, Northrop-Clewes CA, McCabe GP. Adjusting plasma ferritin concentrations to remove the effects of subclinical inﬂamation in the assessment of iron deﬁciency: a meta-analysis. Am J Clin Nutr. 2010;92:546-55.
WHO; CDC. Assessing the iron status of populations: including literature reviews: report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level. 2nd ed. Geneva, Switzerland: World Health Organization & Centers for Disease Control and Prevention. 2004.
De Benoist B. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deﬁciency. Food Nutr Bull. 2008;29:S238-44.
Ramkumar L, Pandave SP. Infantile tremor syndrome. Indian J Pediatrics. 1975;42;215-25.
Sachdev KK, Manchanda SS, Lal H. the syndrome of tremors, mental regression and anemia in infant and young children: a study of 102 cases. Indian Pediatrics. 1965;2:239-51.
Pandove SP. Nutritional dystrophy in chidren-a clinical study. A thesis for MD (medicine) examination of the Punjab University, Patiala, Punjab. 1964.
Bajpai PC, Tandon PN, Misra PK, Sharma NL. Acta Neurol Scandinav. 1965;41:473-6.
Garg BK, Srivastav JR. Infantile tremor syndrome; Indian J Pediatrics. 1969;36(257):213-8.
Arya LS, Singh M, Aram GN, Farahmand S. infantile tremor syndrome. Indian J Pediatrics. 1988;55:913-7.
BPL Census, government of rajasthan. Bpl2002.raj.nic.in
Agrawal R, Singh RN, Gupta BD, Agrawal DK, Arora AK. Serum magnesium, calcium, zinc in infantile tremor syndrome, Indian Pediat. 1993;30:374-6.
Nazar M. Mohammad Amin and Jamal Mohammad Zeki. Infantile tremor syndrome in Iraqi Kurdistan. Indian J Pediat. 2005;72(10):839-42.
Mahajan CM, Walia BNS, Dutta BN. Infantile tremor syndrome-some aspects of serum biochemistry and liver histology. Indian Pediatrics. 1971;8(12):831-3.
Mahajan CM, Walia BNS, Perkash A. Anemia in infantile tremor syndrome; Indian J Pediat. 1971;38:362.
Grattan–smith PJ. the neurological syndrome of infantile cobalamin deficiency: developmental regression and involuntary movements; Movement Disorders. 1997;12(1):39-46.
Allen LH. Vitamin B12 metabolism and status during pregnancy, lactation and infancy. Adv Exp Med Biol. 1994;352:173-86.
Allen LH. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr. 2005;81:1206S-12S.
Menon KC, Skeaff SA, Thomson CD, Gray AR, Ferguson EL. Concurrent micronutrient deﬁciencies are prevalent in nonpregnant rural and tribal women from central India. Nutrition. 2011;27:496-502.
Sant-Rayn P, Shet AS, Black JF, Sudarshan H, Prashanth NS, Beverley-Ann Biggs. Vitamin B-12, folate, iron, and vitamin A concentrations in rural Indian children are associated with continued breastfeeding, complementary diet, and maternal nutrition. Am J Clin Nutr. 2011;94:1358-70.
Mackey AD, Picciano MF. Maternal folate status during extended lactation and the effect of supplemental folic acid. Am J Clin Nutr. 1999;69:285-92.
Allen LH. B vitamins: proposed fortification levels for complementary foods for young children. J Nutr. 2003;133:3000S-7S.
Maureen M. Black. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull. 2008;29(2):S126-S131.
Chandra J, Jain V, Narayan S. Folate and cobalamin deficiency in megaloblastic anemia in children. Indian Pediatr. 2002;39:453-7.