Abstract
Background
Kashmir has a population that largely consumes polished rice which is deficient in thiamine. Furthermore, lactating women in this region are prone to severe thiamine deficiency because of their traditional food avoidance practices. Infantile beriberi is common in exclusively breastfed infants of thiamine deficient mothers in Kashmir.
Methods
This was a one year prospective hospital-based study. We included 50 exclusively breastfed infants in our study. All patients were evaluated as per unit protocol including complete septic workup and metabolic workup. Most of our patients belonged to low and middle income group families, and mothers were on customary dietary restriction. Demographic and anthropometric data were collected from all the study participants. In addition, data regarding the treatments received by the study population and overall mortality were collected.
Results
The mean age, male:female ratio, and mean weight of the study population were 3.15±0.97 months, 1.5:1, and 5.1±1.1 kg, respectively. Traditional food avoidance practices were followed by 80% of the mothers. Irritability was observed in 40 (80%) patients. Blepharoptosis was observed in 30 (60%). Septic workup including cerebro spinal fluid analysis was normal in all patients. Predominant magnetic resonance imaging finding was bilateral basal ganglia hyperintensity. Whole blood thiamine diphosphate levels showed a drastic decrease (10-49 nmol/L). Ten percent of the study infants died.
Conclusion
In exclusively breastfed infants, we observed acute infantile encephalopathy with epidemiological, clinical, biochemical, and radiological features suggestive of infantile Wernicke’s encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.
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Funding: None.
Ethical approval: This study was approved by the Departmental Ethical Committee of SKIMS Srinagar.
Competing interest: None.
Contributors: Bhat JI conceived the study idea and conducted the study. Ahmad QI did the literature search. Ahangar AA analyzed the data and prepared the initial draft of the manuscript. Charoo BA and Sheikh MA provided intellectual inputs in the preparation of manuscript. Syed WA planned the study and supervised the conduct of the sessions. All authors approved the version to be published.
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Bhat, J.I., Ahmed, Q.I., Ahangar, A.A. et al. Wernicke’s encephalopathy in exclusive breastfed infants. World J Pediatr 13, 485–488 (2017). https://doi.org/10.1007/s12519-017-0039-0
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DOI: https://doi.org/10.1007/s12519-017-0039-0