Celiker M Y, Chawla A
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
J Perinatol. 2009 Sep;29(9):640-2. doi: 10.1038/jp.2009.16.
Here we present a case of severe B12 deficiency in an exclusively breastfed infant, born to a mother who had undergone gastric bypass 6 years earlier. At 4 months of age, the infant presented with pancytopenia and developmental delay. Our evaluation revealed physical and neurological developmental delay, pancytopenia with macrocytosis, with head imaging showing cortical and subcortical atrophy. Serum studies showed low B12, normal folate and iron. Treatment with parenteral B12 led to the resolution of the pancytopenia, steady weight gain and improved neurological status. The child is currently 16 months old with normal anthropometric and hematological parameters and normal B12 levels on a regular diet. Gross motor and speech developments are significantly delayed. This case illustrates that maternal B12 deficiency following gastric bypass surgery may lead to severe B12 deficiency with long-term neurological sequelae in their infants. Screening and prompt treatment of these deficiencies both during pregnancy and during infancy are important.
在此，我们报告一例纯母乳喂养婴儿严重维生素B12缺乏的病例，其母亲6年前接受了胃旁路手术。婴儿4个月大时出现全血细胞减少和发育迟缓。我们的评估发现其存在体格和神经发育迟缓、伴有大细胞性的全血细胞减少，头部影像学显示皮质和皮质下萎缩。血清学检查显示维生素B12水平低、叶酸和铁水平正常。经肠外补充维生素B12治疗后，全血细胞减少得到缓解，体重稳步增加，神经状态改善。该儿童目前16个月大，常规饮食下人体测量和血液学参数正常，维生素B12水平正常。大运动和语言发育明显延迟。该病例表明，胃旁路手术后母亲维生素B12缺乏可能导致婴儿严重维生素B12缺乏并伴有长期神经后遗症。孕期和婴儿期对这些缺乏症进行筛查和及时治疗很重要。
