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- W4236062212 abstract "We agree with Dr.Hartmann that an increased level of methylmalonic acid in urinary organic acids profile is an easy and non-invasive screening test of vitamin B12 deficiency in infants. High sensitivity of methylmalonic aciduria in infants with B12 deficiency is corroborated by the fact that all but one patient from our study 1 Honzik T. Adamovicova A. Smolka V. Magner M. Hruba E. Zeman J. Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency – what have we learned?. Eur J Pediatr Neurol. 2010; 14: 488-495 Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar showed this finding. On the other hand, not all infants with methylmalonic aciduria have vitamin B12 deficiency. For example, in a selective screening program for metabolic disorders carried out in the Czech Republic between January 2010 and November 2010, we analysed urinary organic acids profile in 1216 infants from all regions of the country with birth rate 116 000. Increased excretion of methylmalonic acid was found in 96 samples (8%) (the median 30 mg/g creatinine, range 16–5746 mg/g creatinine, controls <15 mg/g; patients with known methylmalonyl-CoA mutase deficiency were excluded). All 96 infants were recommended for B12 analyses by their district paediatricians. However, only six of 16 infants monitored at our out-patient clinic actually had vitamin B12 deficiency. In remaining 10 infants, the methylmalonic aciduria was transitory and could not be explained by vitamin B12 deficiency (all infants had vitamin B12 and holotranscobalamin levels at reference range). In addition, the cost of organic acids measurement is three times higher than the vitamin B12 analysis. Furthermore, the B12 analysis is available in most biochemical laboratories across the country, while the organic acids profile is available in the Czech Republic only in three laboratories. This impedes the use of organic acids analysis as a routine screening method for vitamin B12 deficient infants. Finally, infants with failure to thrive or developmental delay usually undergo laboratory work-up, so adding blood vitamin B12 to the list of biochemical tests does not increase invasiveness. Re: Honzik T, Adamovicova A, Smolka V, Magner M, Hruba E, Zeman J. Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency – What have we learned? Eur Jour Ped Neurol 14 (2010) 488–495European Journal of Paediatric NeurologyVol. 15Issue 4PreviewThe observation that 40 breastfed infants and small toddlers out of approximately 5000 children referred to the participating centers with suspected metabolic disease had nutritional cobalamin deficiency, is highly interesting. The inclusion criteria were described as “low or borderline cobalamin level in serum in breastfed infants, causing high urinary-methylmalonic acid excretion and/or high plasma-homocysteine concentration, reversible on enteral cobalamin substitution”. They found that all but one infant had methylmalonic aciduria, and 80% had hyperhomocysteinemia. Full-Text PDF" @default.
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- W4236062212 date "2011-07-01" @default.
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- W4236062212 title "Response to the ‘letter to the Editor’" @default.
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