587 Infantile beriberi as a cause of acute infantile encephalopathy in a referral hospital in Southern Bhutan

Abstract

<h3>Background</h3> Thiamine deficiency may lead to acute encephalopathy (infantile beriberi/infantile Wernicke’s encephalopathy) and resembles infections like meningitis and acute encephalitis syndrome (AES)/meningoencephalitis. Infants with acute encephalopathy admitted to the Pediatric Department of Central Regional Referral Hospital (CRRH) in Gelephu, Bhutan, historically had high mortality (&gt;70%). In August 2018, suspecting thiamine deficiency as a possible cause, a protocol was deployed to administer thiamine to all children with acute encephalopathy. <h3>Objectives</h3> We aimed to describe the clinical presentation of children admitted with acute encephalopathy from January 2015-December 2020, comparing morbidity and mortality outcome before and after administration of thiamine. <h3>Methods</h3> We retrospectively collected record-based data from children 1–59 months, admitted with acute encephalopathy between January 2015-December 2020, including clinical presentation, laboratory results and investigations such as cerebrospinal fluid analysis and neuroimaging. We excluded children with infectious meningitis, chronic neurodegenerative disorders and traumatic brain injury. Data was analyzed to assess changes in morbidity and mortality outcome before (Group A: January 1^st 2015-July 31^st 2018) and after (Group B: August 1^st 2018-December 31^st 2020) the thiamine administration protocol. <h3>Results</h3> In the 6 year period, 153 children (40.5% female) presented with acute encephalopathy with a median age of 3 months (IQR 1.5 to 4), and 88.2% below 6 months. Almost all (99.3%) were born at term, and majority (88.9%) were exclusively breastfed. There were no significant differences between children who did not receive thiamine (65; 42.5%) and those who received thiamine (88; 57.5%) with respect to age, gender, gestational age at birth. The most common presentation was irritability followed by seizures and reduced sensorium. Overall, 59 children died (38.6%), most of whom had not received thiamine (Group A mortality rate 81.5%, Group B mortality rate 6.8%, p≤0.001). A disproportionate number of deaths were noted in infants below 6 months of age (81.4%). Respiratory failure was the most common morbidity followed by shock, and acute kidney injury. There was a significantly lower incidence of respiratory failure (p≤0.001) and shock (p=0.003) in children who received thiamine. <h3>Conclusions</h3> In children admitted with acute encephalopathy, administration of thiamine appeared to significantly reduce mortality and morbidity. Prospective studies of children presenting with acute encephalopathy, including measurement of thiamine levels, may validate our preliminary findings suggestive of acute infantile beriberi.