Relationship Between Prolonged Jaundice and Vitamin B12 Levels in Term Newborn

Yıl 2023, , 671 - 675, 31.07.2023

Emine Esin Yalınbaş , Yaşar Durmaz , Fezan Mutlu

https://doi.org/10.16899/jcm.1309898

Öz

Abstract
Aim: Vitamin B12 deficiency, when observed during the neonatal period, can generally be traced back to maternal causes. In cases of vitamin B12 deficiency, hyperbilirubinemia may occur due to hem overproduction as the result of erythrocyte lysis. Prolonged jaundice is common during the neonatal period, and its underlying etiological causes should be analyzed. The aim of this study was to analyze whether vitamin B12 deficiency has any effect on prolonged jaundice formation in infants.
Material and Method: The study examined 89 infants; this included 45 that had been diagnosed with prolonged jaundice and 44 in the control group. Their clinical and demographic characteristics were recorded. Patient group was formed with term infants with prolonged jaundice excluding possible etiological causes of prolonged jaundice. Both the maternal and infant vitamin B12 levels were analyzed.
Results:An indirect bilirubin level of 11.8 mg/dl in the prolonged jaundice group and 3.16 mg/dl (p < 0.001), a hemoglobin level of 14.18 gr/dl and 15.7 gr/dl (p = 0.005), and infant vitamin B12 level of 168 pg/ml and 205.2 pg/ml (p=0.013) in the patient and control groups, respectively, showed significant differences between the two. Maternal vitamin B12 levels were found to be similar in the patient and control groups (p= 0.315), and there was no significant correlation between the vitamin B12 levels of the infants and mothers (r = 0.278, p = 0.064).
Conclusion: Vitamin B12 deficiency can be related to prolonged jaundice in neonatals, and an early diagnosis of vitamin B12 deficiency in high risks group in the neonatal period can be useful in terms of potentially identifying and controlling related conditions.
Keywords: Jaundice, newborn, vitamin B12 deficiency

Anahtar Kelimeler

Jaundice, newborn, vitamin B12 deficiency

Destekleyen Kurum

none

Proje Numarası

none

Term Yenidoğanlarda Uzamış Sarılık ile Vitamin B12 Düzeyleri Arasındaki İlişki

Öz

Özet
Amaç: Yenidoğan döneminde görülen vitamin B12 eksikliği genellikle maternal nedenlerle ilişkilidir. Vitamin B12 eksikliğinde yenidoğan döneminde eritrosit lizisi sonucunda aşırı hem üretimine bağlı hiperbilirubinemi gelişebilmektedir Uzamış sarılık ise yenidoğan döneminde yaygın görülen bir durumdur, allta yatan etiyolojik nedenler araştırılmalıdır. Bu çalışmanın amacı, bebeklerde uzamış sarılık gelişiminde vitamin B12 eksikliğinin etkisinin olup olmadığını araştırmaktır.
Gereç ve Yöntem : 45 uzamış sarılık tanısı alan yenidoğan ile 44 kontrol grubunun yer aldığı toplam 89 bebek çalışmaya dahil edildi. Klinik ve demografik özellikleri kaydedildi. Hasta grubu uzamış sarılığa neden olabilecek etiyolojik nedenler dışlanmış, uzamış sarılığı olan term bebeklerden oluşturuldu. Anne ve bebeklerden vit B12 düzeyleri ile çalışıldı.
Bulgular: Uzamış sarılık grubunda indirekt bilirubin düzeyi 11.8 mg/dl, kontrol grubunda 3.16 mg/dl (p< 0.001), hemoglobin düzeyi hasta grubunda 14.18 gr/dl, kontrol grubunda 15.7 gr/dl (p= 0.005), bebek vitamin B12 düzeyleri hasta grubunda 168 pg/ml (p= 0.013) olmak üzere kontrol grubuna 205.2 pg/ml (p=0.013) göre anlamlı farklılık vardı. Anne vitamin B12 düzeyleri hasta ve kontrol grubunda benzer bulundu (p= 0.315). Bebek ve annelerden bakılan vitamin B12 düzeyleri arasında anlamlı bir korelasyon olmadığı saptandı (r= 0.278, P= 0.064). Sonuç: Yenidoğanlarda vitamin B12 eksikliğinin uzamış sarılık ile ilişkili olabileceği ve yenidoğan döneminde riskli grupta erken konulan vitamin B12 eksikliği tanısının buna bağlı gelişebilecek durumların kontrol altına alınmasında fayda sağlayabileceğini düşünmekteyiz

Anahtar Kelimeler

Sarılık, yenidoğan, vitamin B12 eksikliği

Proje Numarası

none

Kaynakça

• 1. Lyon P, Strippoli V, Fang B. et al. B vitamins and one-carbon metabolism: Implications in human health and disease. Nutrients 2020;12(9):2867.
• 2. Thakkar K, Billa G. Treatment of vitamin B12 deficiency- methylcobalamine? Cyancobalamine? Hydroxocobalamin?-clearing the confusion. Eur J Clin Nutr. 2015;69(1):1-2.
• 3. Koury MJ, Ponka P. New insights into erythropoiesis: the roles of folate, vitamin B12 and iron. Annu Rev Nutr 2004;24:105–31.
• 4. Roschinger W, Sonnenschein S, Schuhmann E, et al. Neue zielerkrankungen im neugeborenen-screening. Monatsschrift Kinderheilkunde 2015;163: 142-9.
• 5. Gramer G, Fang-Hoffmann J, Feyh P, et al. Newborn screening for vitamin B12 deficiency in Germany: strategies, results, and public health implications. J Pediatr 2020;216:165-72.e4.
• 6. Hinton CF, Ojodu JA, Fernhoff PM, et al. Maternal and neonatal vitamin B12 deficiency detected through expanded newborn screening–United States, 2003-2007. J Pediatr 2010;157:162-3. 7. Ng’eno BN, Perrine CG, Whitehead RD, et al. High Prevalence of vitamin B12 deficiency and no folate deficiency in young Children in Nepal. Nutrients 2017;9(1):72.
• 8. Cuevas-Nasu L, Mundo-Rosas V, Shamah-Levy T, et al. Prevalence of folate and vitamin B12 deficiency in Mexican children aged 1 to 6 years in a population-based survey. Salud Publica Mex 2012;54:116-24.
• 9. Taneja S, Bhandari N, Strand TA, et al. Cobalamin and folate status in infants and young children in a lowto-middle income community in India. Am J Clin Nutr 2007;86:1302.
• 10. Mütze U, Walter M, Keller M, et al. Health Outcomes of Infants with Vitamin B12 Deficiency Identified by Newborn Screening and Early Treated. J Pediat 2021;235:42-8.
• 11. Weng YH, Cheng SW, Yang CY, et al. Risk assessment of prolonged jaundice in infants at one month of age: A prospective cohort study. Sci Rep. 2018;8(1):14824.
• 12. Hannam S, McDonnell M, Rennie JM. Investigation of prolonged neonatal jaundice. Acta Paediatr 2000;89:694–7.
• 13. Koury MJ, Ponka P. New insights into erythropoiesis: the roles of folate, vitamin B12, and iron. Annu Rev Nutr 2004;24:105–31.
• 14. Stabler SP. Vitamin B12 deficiency. N Engl J Med 2013;368(2):149-60.
• 15. Chowdhury T, Kisat H, Tullus K. Does UTI cause prolonged jaundice in otherwise well infants? Eur J Pediatr. 2015;174(7):971-3.
• 16. Rodie MD, Barclay A, Harry C, et al. NICE recommendations for the formal assessment of babies with prolonged jaundice: too much for well infants? Arch Dis Child. 2011;96(1):112-3.
• 17. Gundur NM, Kumar P, Sundaram V, et al. Natural history and predictive risk factors of prolonged unconjugated jaundice in the newborn. Pediatr Int. 2010;52(5):769-72.
• 18. Perkins SL (1999) Normal blood and bone marrow values in humans. In: Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM (eds) Wintrobe’s clinical hematology, 10th edn. Williams & Wilkins, Baltimore, pp 2798–2748 (Table A.3 and Table A.17)
• 19. Hannibal L, Lysne V, Bjorke-Monsen AL, et al. Biomarkers and algorithms for the diagnosis of vitamin B12 deficiency. Front Mol Biosci 2016;3:27.
• 20. Hay G, Clausen T, Whitelaw A, et al. Maternal Folate and Cobalamin status predicts vitamin status in newborns and 6-month old Infants. J Nutr. 2010;140:557–64.
• 21. Minet JC, Bissé E, Aebischer CP, et al. Assessment of vitamin B-12, folate, and vitamin B-6 status and relation to sulfur amino acid metabolism in neonates. Am J Clin Nutr 2007;72: 751-7.
• 22. Ba Y, Yu H, Liu F, et al. Relationship of folate, vitamin B12 and methylation of insulin-like growth factor-II in maternal and cord blood. Eur J Clin Nutr 2011;65:480–5.
• 23. Sukla KK, Tiwari PK, Kumar A, et al. Low Birthweight (LBW) and Neonatal Hyperbilirubinemia (NNH) in an Indian Cohort: Association of Homocysteine, Its Metabolic Pathway Genes and Micronutrients as Risk Factors. PLoS One 2013;8(8):e71587.
• 24. Koc A, Kocyigit A, Soran M, et al. High frequency of maternal vitamin B12 deficiency as an important cause of infantile vitamin B12 deficiency in Sanliurfa province of Turkey. Eur J Nutr. 2006;45:291-7.
• 25. Karademir F, Suleymanoglu S, Ersen A, et al. Vitamin B12, folate, homocysteine and urinary methylmalonic acid levels in infants. 2007;35(3):384-8.
• 26. Eroglu N, Kandur Y, Kalay S et al. Neonatal Hyperbilirubinemia in a Turkish Cohort: Association of Vitamin B 12. J Clin Med Res. 2015;7:556-9.
• 27. Katakam PK, Hegde AP, Venkataramaiahyappa M. Vitamin B12 deficiency: unusual cause of jaundice in an adolescent. BMJ Case Rep. 2018;2018:bcr2017222302.
• 28. Erdol S, Ozgur T. Vitamin B12 deficiency associated with hyperbilirubinemia and cholestasis in infants. Pakistan J Med Sci. 2018;34(3):714-8.
• 29. Finkelstein JL, Guillet R, Pressman EK, et al. Vitamin B12 Status in Pregnant Adolescents and Their Infants. Nutrients. 2019;11(2):397.
• 30. Bergen NE, Schalekamp-Timmermans S, Jaddoe VW, et al. Maternal and neonatal markers of the homocysteine pathway and fetal growth: the generation R Study. Paediatr Perinat Epidemiol. 2016; 30(4):386–96. 31. Balci YI, Ergin A, Karabulut A, et al. Serum vitamin B12 and folate concentrations and the effect of the Mediterranean diet on vulnerable populations. Pediatr Hematol Oncol. 2014; 31(1):62–7.
• 32. Reischl-Hajiabadi AT, Garbade SF, Feyh P, et al. Maternal vitamin B12 deficiency detected by newborn screening-evaluation of causes and characteristics. Nutrients. 2022;14(18):3767.