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通过扩大新生儿筛查检测到的母婴维生素B缺乏症

[Maternal and neonatal vitamin B deficiency detected by expanded newborn screening].

作者信息

Papp Ferenc, Rácz Gábor, Lénárt István, Kóbor Jenő, Bereczki Csaba, Karg Eszter, Baráth Ákos

机构信息

Gyermekgyógyászati Klinika és Gyermek-egészségügyi Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Szeged, Korányi fasor 14-15., 6720.

出版信息

Orv Hetil. 2017 Dec;158(48):1909-1918. doi: 10.1556/650.2017.30901.


DOI:10.1556/650.2017.30901
PMID:29172662
Abstract

INTRODUCTION: Infant vitamin B deficiency can manifest as a severe neurodegenerative disorder and is usually caused by maternal deficiency due to vegetarian diet or pernicious anaemia. Its early recognition and treatment can prevent potentially serious and irreversible neurologic damage. Biochemically, vitamin B deficiency leads to an accumulation of methylmalonic acid, homocysteine, and propionylcarnitine. Expanded newborn screening using tandem mass spectrometry may identify neonatal and maternal vitamin B deficiency by measurement of propionylcarnitine and other metabolites in the dried blood spot sample of newborns. AIM: To summarize our experiences gained by screening for vitamin B deficiency. METHOD: Clinical and laboratory data of vitamin B-deficient infants diagnosed in Szeged Screening Centre were retrospectively analysed. RESULTS: In Hungary, expanded newborn screening was introduced in 2007. Since then approximately 395 000 newborns were screened in our centre and among them, we identified four newborns with vitamin B deficiency based on their screening results. In three cases an elevated propionylcarnitine level and in the fourth one a low methionine level were indicative of vitamin B deficiency. We also detected an additional vitamin B-deficient infant with neurological symptoms at 4 months of age, after a normal newborn screening, because of elevated urinary methylmalonic acid concentration. Vitamin B deficiency was secondary to maternal autoimmune pernicious anaemia in all the five infants. As a result of the recognized cases the incidence of infant vitamin B deficiency in the East-Hungarian region was 1.26/100 000 births, but the real frequency may be higher. Conslusions: Optimizing the cut off values of current screening parameters and measuring of methylmalonic acid and/or homocysteine in the dried blood spot, as a second tier test, can improve recognition rate of vitamin B deficiency. Orv Hetil. 2017; 158(48): 1909-1918.

摘要

引言:婴儿维生素B缺乏可表现为严重的神经退行性疾病,通常由母亲因素食或恶性贫血导致的缺乏引起。早期识别和治疗可预防潜在的严重且不可逆的神经损伤。在生化方面,维生素B缺乏会导致甲基丙二酸、同型半胱氨酸和丙酰肉碱的积累。使用串联质谱法进行的扩大新生儿筛查可通过测量新生儿干血斑样本中的丙酰肉碱和其他代谢物来识别新生儿和母亲的维生素B缺乏。 目的:总结我们在筛查维生素B缺乏方面获得的经验。 方法:对在塞格德筛查中心诊断出的维生素B缺乏婴儿的临床和实验室数据进行回顾性分析。 结果:在匈牙利,2007年引入了扩大新生儿筛查。自那时以来,我们中心对约39.5万名新生儿进行了筛查,其中根据筛查结果确定了4名维生素B缺乏的新生儿。在3例中,丙酰肉碱水平升高,在第4例中,蛋氨酸水平降低提示维生素B缺乏。我们还在1例新生儿筛查正常后,于4月龄时检测到1例有神经症状的维生素B缺乏婴儿,原因是尿甲基丙二酸浓度升高。所有5例婴儿的维生素B缺乏均继发于母亲自身免疫性恶性贫血。由于已识别的病例,匈牙利东部地区婴儿维生素B缺乏的发病率为1.26/10万例出生,但实际发生率可能更高。结论:优化当前筛查参数的临界值,并作为二线检测在干血斑中测量甲基丙二酸和/或同型半胱氨酸,可提高维生素B缺乏的识别率。《匈牙利医学周报》。2017年;158(48):1909 - 1918。

相似文献

[1]
[Maternal and neonatal vitamin B deficiency detected by expanded newborn screening].

Orv Hetil. 2017-12

[2]
Two newborns with nutritional vitamin B12 deficiency: challenges in newborn screening for vitamin B12 deficiency.

Haematologica. 2005-12

[3]
Maternal vitamin B12 deficiency detected in expanded newborn screening.

Clin Biochem. 2014-12

[4]
Newborn screening for remethylation disorders and vitamin B deficiency-evaluation of new strategies in cohorts from Qatar and Germany.

World J Pediatr. 2017-4

[5]
Neonatal vitamin B12 deficiency secondary to maternal subclinical pernicious anemia: identification by expanded newborn screening.

J Pediatr. 2008-5

[6]
Maternal and neonatal vitamin B12 deficiency detected through expanded newborn screening--United States, 2003-2007.

J Pediatr. 2010-4-18

[7]
Nutritional vitamin B12 deficiency: two cases detected by routine newborn urinary screening.

Eur J Pediatr. 1992-3

[8]
Diagnostic Challenges Using a 2-Tier Strategy for Methylmalonic Acidurias: Data from 1.2 Million Dried Blood Spots.

Ann Nutr Metab. 2020

[9]
Vitamin B Deficiency in Newborns and their Mothers-Novel Approaches to Early Detection, Treatment and Prevention of a Global Health Issue.

Curr Med Sci. 2020-10

[10]
Implementation of second-tier tests in newborn screening for the detection of vitamin B related acquired and genetic disorders: results on 258,637 newborns.

Orphanet J Rare Dis. 2021-4-30

引用本文的文献

[1]
Low Vitamin B12 and Lipid Metabolism: Evidence from Pre-Clinical and Clinical Studies.

Nutrients. 2020-6-29

[2]
A False-Positive Case of Methylmalonic Aciduria by Tandem Mass Spectrometry Newborn Screening Dependent on Maternal Malnutrition in Pregnancy.

Int J Environ Res Public Health. 2020-5-20

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