Clinical Profile, Serum Vitamin B12 Levels and Outcome of Children with Infantile Tremor Syndrome (ITS) and Correlation with Maternal Serum Vitamin B12 Levels

Abstract

Background: Infantile tremor syndrome (ITS) is a tetrad of mental and motor changes, pigmentary disturbances of skin and hair, pallor and tremors. It was first described in 1957 by Dikshit from Hyderabad who named it as Nutritional dystrophy and Anaemia. Usually, cortical atrophy and calcification takes time to develop and ITS has been reported as early as 3 to 6 months of age. Objective: To compare vitamin B12 levels of ITS patients with non-ITS healthy infants of similar age group. Methodology: This study was a prospective study, conducted at department of paediatrics, medical college & S.S.G hospital, Vadodara, Gujarat over the period of 2 years. Children between the age 6 months to 2 years, admitted with their mothers in department of paediatrics diagnosed as ITS clinically based upon clinical features like pallor, delayed milestones, skin pigmentation, hair changes and with/without tremors. 30 controls were also taken in same age group with history of appropriate complementary feeding with normal development and no or mild anaemia and no malnutrition or PEM I/II. Results: Majority of the subjects had fever (86.7%) has a major clinical symptoms followed by Cough (80%) and delayed development milestone in 567% of the subjects. In the present study 56.7% of the children were exclusively breastfed and 43.3% had inadequate complimentary feeding practices. The levels of vitamin B 12 was compared with the case and control group, among the study group 93.3% of the subjects had low Vitamin B 12 level and in the control group 13.3% had low Vitamin B 12 levels. The Association between study subjects and vitamin B12 levels was found to be statistically significant. Among the case subjects with ITS only 2 children subjects had normal vitamin B12 and 28 had low vitamin B 12 levels. On comparing with vitamin B 12 levels of mother it was found that 83.45 of the subjects had low Vitamin B12 Levels and the association was also found to be statistically significant. Conclusion: mothers having strict vegetarian diet making themselves prone to vit B12 deficiency leading to low vit B12 serum levels in their exclusive breastfed or inadequately weaned infants. Upon supplementation of vit B12 general condition including tremors, pigmentary changes, anaemia improves as well as mental motor quotient improves. However, they were still lagging behind their normal counterparts, more so in mental scale.