Beriberi is quite common in northern Laos and can be life-threatening for infants. Last month, LFHC doctors saved the lives of two critically ill babies afflicted with beriberi.
Two-month-old Airvid Xong was close to death when his parents brought him to the hospital’s Emergency Room, His illness had started three days earlier with a simple runny nose and cough, but now he had difficulty breathing, was vomiting and unable to breastfeed.
As soon as he arrived, the triage nurse noted that he wasn’t breathing and alerted the team. The doctors ascertained that he also had no pulse and started to resuscitate him, using CPR, adrenaline, fluids and antibiotics. They quickly determined that he was solely breastfed and his mother was on a restrictive “taboo” diet, so they administered thiamine (vitamin B1) as well.
Airvid was so shocked that the staff was unable to obtain intravenous access in the usual way, so they inserted needles into a bone and a central vein in his groin to administer the life-saving treatment. Outreach staff supported the parents through these traumatic events.
One hour after arrival, Airvid was stable and breathing, supported by our CPAP machine. However, the team remained concerned about his prognosis, as his brain and other organs had been deprived of oxygen for at least some minutes prior to arrival and during his arrest, and his parents were told to expect the worst. Shortly after resuscitation, Airvid developed seizures, which were treated but seemed to confirm everyone’s fears.
In the ensuing days however, Airvid steadily improved. The team was able to stop his seizure medication and his parents felt that he was back to his normal self. The day that his mother was able to breastfeed him again was a memorable day in Inpatient Department. He was discharged after two weeks and will be followed up in the hospital’s Development Clinic, but it is hoped that he will develop normally.
The other case of infantile beriberi last month involved 2-month-old Thai Lee, who came to LFHC close to cardiac arrest.
Following resuscitation protocols, the team supported his breathing, performed CPR and administered adrenaline. Doctors also quickly administered intravenous vitamin B1 after noting that Thai was exclusively breastfed, was in shock and had an enlarged liver. Thai’s heart rate then recovered but a few minutes later, he arrested. He was given CPR and adrenaline, and this time he recovered and stabilized. The CPAP machine was used to support his breathing. He was given Intravenous medication to support his blood pressure and antibiotics to cover for the possibility of infection.
Two hours after arriving in the ER, Thai was stable enough to move into the Inpatient Department and was taken off CPAP the following morning. By that time, he was breastfeeding and back to his normal self. He was discharged five days later, after completing a course of antibiotics.
Vitamin B1 deficiency, or beriberi, is common in northern Laos due to poverty and a cultural practice of restricting breastfeeding mothers’ diets. Many of these women develop numbness of their arms and legs from the B1 deficiency, as was the case with Thai Lee’s mother. This is often life-threatening for their infants, who develop a type of heart failure and shock, but our staff is experienced enough to instantly recognize and treat it.
These two cases also illustrate the importance and effectiveness of pediatric resuscitation training, and show how our team is able to transfer that training to their clinical practice, work together and do everything that they can to save their patients.
LFHC has been hosting an external research study on infantile beriberi since 2019.