Thiamine deficiency and cardiac dysfunction in cambodian infants

Samuel G. Porter, Debra Coats, Philip R. Fischer, Kevanna Ou, Elizabeth L. Frank, Phivan Sreang, Soksan Saing, Mark D. Topazian, Felicity T. Enders, Allison K. Cabalka

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17 Scopus citations

Abstract

Objectives To compare blood thiamine concentrations, echocardiography findings, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in infants with clinically diagnosed beriberi and healthy matched controls, and to evaluate changes after thiamine treatment. Study design Sixty-two Cambodian infants (20 cases and 42 controls), aged 2-47 weeks, were enrolled in this prospective study. Echocardiography and phlebotomy were performed at baseline and after thiamine treatment. Results Both cases and controls were thiamine-deficient, with median blood thiamine diphosphate (TDP) concentrations of 47.6 and 55.1 nmol/L, respectively (P =.23). All subjects had normal left ventricular ejection fraction. The median NT-proBNP concentration in cases (340 pg/mL [40.1 pmol/L]) was higher than previously reported normal ranges, but not statistically significantly different from that in controls (175 pg/mL [20.7 pmol/L]) (P =.10), and was not correlated with TDP concentration (P =.13). Two cases with the lowest baseline TDP concentrations (24 and 21 nmol/L) had right ventricular enlargement and elevated NT-proBNP levels that improved dramatically by 48 hours after thiamine administration. Conclusion Only a minority of thiamine-deficient Cambodian infants demonstrate abnormal echocardiography findings. Thiamine deficiency produces echocardiographic evidence of right ventricular dysfunction, but this evidence is not apparent until deficiency is severe. NT-proBNP concentrations are mildly elevated in sick infants with normal echocardiography findings, indicating possible physiological changes not yet associated with echocardiographic abnormalities.

Original languageEnglish (US)
Pages (from-to)1456-1461
Number of pages6
JournalJournal of Pediatrics
Volume164
Issue number6
DOIs
StatePublished - Jun 2014

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Porter, S. G., Coats, D., Fischer, P. R., Ou, K., Frank, E. L., Sreang, P., Saing, S., Topazian, M. D., Enders, F. T., & Cabalka, A. K. (2014). Thiamine deficiency and cardiac dysfunction in cambodian infants. Journal of Pediatrics, 164(6), 1456-1461. https://doi.org/10.1016/j.jpeds.2014.01.049