Spiral Fracture in Young Infant Causing a Diagnostic Dilemma: Nutritional Rickets versus Child Abuse

Fractures are uncommon in young, nonambulatory infants. The differential diagnosis includes nonaccidental injury (NAI) and metabolic bone disease, including rickets. While rickets typically present after six months of age, multiple cases have been reported in younger infants. We report a case of an 11-week-old male infant who presented with a spiral fracture of the humerus and no radiologic evidence of rickets. A detailed psychosocial assessment failed to reveal any risk factors for NAI. The patient had elevated alkaline phosphatase and PTH with low 25 hydroxyvitamin D and 1,25 dihydroxyvitamin D levels. Additionally, the mother was noncompliant with prenatal vitamins, exclusively breastfeeding without vitamin D supplementation, and had markedly low vitamin D levels 15 weeks postpartum. The biochemical data and history were consistent with rickets. Given the diagnostic dilemma, the working diagnosis was rickets and the patient was started on ergocalciferol with subsequent normalization of his laboratory values and healing of the fracture. These findings are consistent with nutritional rickets largely due to maternal-fetal hypovitaminosis D. This case highlights that in young infants rickets should be considered even in the absence of positive radiologic findings. Additionally, it illustrates the importance of maintaining adequate vitamin D supplementation during pregnancy and early infancy.

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Demographic Characteristics, Risk Factors, and Presenting Features of Children with Symptomatic Nutritional Rickets: A French Series

Hormone Research in Paediatrics ◽

10.1159/000511419 ◽

2020 ◽

Vol 93 (5) ◽

pp. 304-312

Author(s):

Claire Flot ◽

Valérie Porquet-Bordes ◽

Justine Bacchetta ◽

Anya Rothenbuhler ◽

Anne Lienhardt-Roussie ◽

...

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Pediatric Population ◽

Vitamin D Supplementation ◽

Demographic Characteristics ◽

Total Serum ◽

Nutritional Rickets ◽

Total Serum Calcium ◽

Vitamin D Levels ◽

25 Hydroxy Vitamin D

Aim: To describe the demographic characteristics, risk factors, and presenting features of children with symptomatic nutritional rickets in France. Methods: This is a retrospective study of 38 children diagnosed with nutritional rickets from 1998 to 2019. Results: We observed a higher frequency of rickets in males (74 vs. 26%), in young children (median age at diagnosis: 23 months; 82% were younger than 5 years), and in children with a non-Caucasian ethnic background (89%). Most children were exclusively breastfed (78%) without adequate vitamin D supplementation (89%). The most common presentations were bowed legs (63%), hypocalcemic seizures (21%), and growth retardation (11%). Approximately half (62%) of the children were hypocalcemic. The children presenting with hypocalcemic seizures were significantly younger (0.8 vs. 2.2 years; p = 0.041) and had lower total serum calcium levels (1.44 vs. 2.17 mmol/L; p < 0.0001), higher phosphatemia (1.43 vs. 1.23 mmol/L; p = 0.020), and lower 25-hydroxy vitamin D levels (3 vs. 7 ng/mL; p = 0.020) but similar parathyroid hormone levels (357 vs. 289 ng/mL; p = 0.940) compared to rickets cases who did not experience hypocalcemic seizures. A dilated cardiomyopathy was detected in 14% of the children who had undergone echocardiography. Conclusion: Nutritional rickets remains endemic in the pediatric population and its most severe forms can have life-threatening sequelae. Health practitioners need to be cognizant of these facts to raise awareness and screen high-risk populations.

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Vitamin D status in exclusively breast-fed infants and their mothers

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183541 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1966

Author(s):

Vignesh Kumaran C. R. ◽

Sundari S. ◽

Shanthi Ramesh

Keyword(s):

Vitamin D ◽

Public Awareness ◽

Public Health Problem ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Tropical Country ◽

Cross Sectional ◽

Breastfed Infants ◽

Young Infants ◽

Vitamin D Levels

Background: India, despite being a tropical country has widespread vitamin D deficiency across all age groups. Present study was conducted to estimate the prevalence of subclinical hypovitaminosis D in exclusively breastfed infants and their mothers and also to study the correlation between the Vitamin D levels of these infants and their mothers.Methods: This cross-sectional study was conducted in 37 exclusively breastfed infants aged 6 months and below and their mothers. Under strict aseptic precautions 2 ml of blood was taken from each infant and mother and serum levels of 25(OH) D levels were measured by the direct ELISA method. Statistical analysis was done by using chi-square test, one-way ANOVA f-test and student independent t-test.Results: In present study, authors found that 78.3% of the mothers were Vitamin D deficient and 21.7% of the mothers were Vitamin D insufficient. Among the infants, authors found that 91.9% of the infants were Vitamin D deficient and 8.1% of the infants were Vitamin D insufficient. The association between dietary pattern and socio-economic class and mean maternal vitamin D levels was found to be statistically significant (p <0.05).Conclusions: There is a high prevalence of hypovitaminosis D amongst exclusively breastfed infants and their mothers. Hence, public awareness needs to be created regarding the benefits of sunlight exposure. Vitamin D fortification of food products and routine Vitamin D supplementation program for antenatal and lactating mothers and their young infants may be able to address this emerging public health problem in our country.

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Abstract #224 Sublingual Vitamin D Effective in Improving Low Vitamin D Levels in Patients Resistant to Conventional Vitamin D Supplementation

Endocrine Practice ◽

10.1016/s1530-891x(20)46568-1 ◽

2019 ◽

Vol 25 ◽

pp. 76-77

Author(s):

Sobia Faisal ◽

Faryal Mirza

Keyword(s):

Vitamin D ◽

Vitamin D Supplementation ◽

Vitamin D Levels

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Vitamin D and sleep duration: Is there a bidirectional relationship?

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2020-0025 ◽

2020 ◽

Vol 41 (4) ◽

Author(s):

Maryam Mosavat ◽

Aisling Smyth ◽

Diana Arabiat ◽

Lisa Whitehead

Keyword(s):

Vitamin D ◽

Sleep Duration ◽

Vitamin D Supplementation ◽

The Body ◽

Bone Homeostasis ◽

Limited Information ◽

Physiological Processes ◽

Vitamin D Levels ◽

Bidirectional Relationship ◽

Sleep Length

AbstractVitamin D contributes to numerous physiological processes within the body but primarily calcium and bone homeostasis. Emerging evidence highlights a novel role for vitamin D in maintaining and regulating optimal sleep. Sleep is a known regulator of bone health, highlighting the interconnectedness between vitamin D concentrations, sleep duration and bone metabolism. It is possible that the relationship between sleep length and vitamin D is bidirectional, with vitamin D playing a role in sleep health and conversely, sleep affecting vitamin D levels. Nevertheless, limited information on the direction of the interaction is available, and much remains to be learned concerning the complex relationship between insufficient sleep duration and vitamin D deficiency. Given the potential to implement interventions to improve sleep and vitamin D supplementation, understanding this relationship further could represent a novel way to support and improve health.

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The 25(OH)D3, but Not 1,25(OH)2D3 Levels Are Elevated in IBD Patients Regardless of Vitamin D Supplementation and Do Not Associate with Pain Severity or Frequency

Pharmaceuticals ◽

10.3390/ph14030284 ◽

2021 ◽

Vol 14 (3) ◽

pp. 284

Author(s):

Anna Zielińska ◽

Aleksandra Sobolewska-Włodarczyk ◽

Maria Wiśniewska-Jarosińska ◽

Anita Gąsiorowska ◽

Jakub Fichna ◽

...

Keyword(s):

Vitamin D ◽

Disease Activity ◽

Pain Intensity ◽

Disease Duration ◽

Dietary Habits ◽

Vitamin D Supplementation ◽

Pain Severity ◽

Clinical Activity ◽

Inflammatory Status ◽

Vitamin D Levels

Due to its immunomodulatory effect, vitamin D has been associated with clinical parameters and outcomes in inflammatory bowel diseases (IBDs) which are chronic conditions of the gastrointestinal tract. Upon synthesis or digestion, vitamin D is metabolized in the liver to form 25(OH)D3, the major circulating metabolite. Further renal hydroxylation generates 1,25(OH)2D3, the most potent metabolite. Our aim was to examine the association between vitamin D levels, and its supplementation and pain intensity in 39 IBD patients and 33 healthy individuals. 25(OH)D3 and 1,25(OH)2D3 serum levels were measured. Each subject filled out visual analog scale (VAS) and Laitinen’s pain assessment scales. Laboratory results were obtained, and disease activity was assessed. Linear regression was employed to investigate the correlation between 25(OH)D3, 1,25(OH)2D3 and pain intensity, clinical activity parameters, C-reactive protein, disease duration, and dietary habits. In IBD patients, 25(OH)D3 was increased, whereas 1,25(OH)2D3 was not. Vitamin D3 supplementation did not influence their levels. No correlation was found between pain scores, disease activity, inflammatory status, disease duration or dietary habits and both forms of vitamin D. Elevated 25(OH)D3 and normal 1,25(OH)D3 were found in IBD patients as compared to the controls. We discovered no effect from supplementation and no association between pain severity and vitamin D.

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Low Dose Depot Oral Vitamin D3 Versus Daily Oral Vitamin D3 for Treating Nutritional Rickets: A Randomized Clinical Trial

British Journal Of Nutrition ◽

10.1017/s0007114521002713 ◽

2021 ◽

pp. 1-18

Author(s):

Ravneet Kaur Saluja ◽

Pooja Dewan ◽

Sunil Gomber ◽

SV Madhu ◽

Shuchi Bhatt ◽

...

Keyword(s):

Vitamin D ◽

Alkaline Phosphatase ◽

Vitamin D3 ◽

Low Dose ◽

Care Hospital ◽

Oral Vitamin ◽

Nutritional Rickets ◽

Vitamin D Levels ◽

Radiological Healing ◽

25 Oh Vitamin D

Abstract Objective: To compare the efficacy of daily versus low dose depot oral vitamin D3 for treating nutritional rickets. Design: Randomized Controlled Trial Setting: Paediatrics department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India Methods: We randomized 66 children aged 3 months to 5 years with nutritional rickets to receive either daily oral vitamin D3 drops (3-12 months: 2000 IU; >12 months-5y: 4000 IU; n=33) for 12 weeks duration, or a single oral depot dose of vitamin D3 granules (3-12 months: 60,000 IU; >12 months-5y: 150,000 IU; n=33). Results: Participants in both groups had comparable demographic characteristics, laboratory features and radiological severity of rickets. 33 participants in each group received the assigned intervention and all were followed up till 12 weeks. At 12 weeks follow up, children in both groups showed a significant improvement in all biochemical parameters [serum calcium, phosphorus, alkaline phosphatase, parathormone and 25(OH) vitamin D levels] as well as radiological healing. At 12 weeks, the mean (SD) serum 25(OH) vitamin D levels (nmol/L) were statistically comparable in both groups [daily: 120.2 (83.2), depot: 108 (74), P=0.43] and 31 (94%) children in each group had radiological healing (Thacher score <1.5). Two children in each group persisted to have raised alkaline phosphatase and one child each in the daily group continued to have hypocalcemia and hypophosphatemia at 12 weeks. Conclusion: Low dose oral depot vitamin D3 is an effective alternative to daily oral vitamin D3 for nutritional rickets.

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The effects of vitamin D supplementation during pregnancy and maternal vitamin D levels on neonatal vitamin D levels and birth parameters

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2017.1326897 ◽

2017 ◽

Vol 31 (13) ◽

pp. 1727-1734 ◽

Cited By ~ 5

Author(s):

Ayse Özlem Kılıcaslan ◽

Ruhusen Kutlu ◽

Ibrahim Kilinc ◽

Derya Isıklar Ozberk

Keyword(s):

Vitamin D ◽

Vitamin D Supplementation ◽

Maternal Vitamin ◽

Vitamin D Levels

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Prevalence and Correlates of Vitamin D Deficiency among Young South African Infants: A Birth Cohort Study

Nutrients ◽

10.3390/nu13051500 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1500

Author(s):

Jabulani R. Ncayiyana ◽

Leonardo Martinez ◽

Elizabeth Goddard ◽

Landon Myer ◽

Heather J. Zar

Keyword(s):

Vitamin D ◽

Child Health ◽

Vitamin D Deficiency ◽

Birth Cohort ◽

Early Life ◽

Vitamin D Supplementation ◽

Sub Saharan Africa ◽

Health Study ◽

Birth Cohort Study ◽

Young Infants

Early-life vitamin D deficiency is associated with adverse child health outcomes, but the prevalence of vitamin D deficiency and its correlates in infants remains underexplored, particularly in sub-Saharan Africa. We aimed to investigate the prevalence of vitamin D deficiency and its correlates among young infants in South Africa. This study included 744 infants, aged 6–10 weeks from the Drakenstein Child Health Study, a population-based birth cohort. Infants were categorized into distinct categories based on serum 25(OH)D concentration level including deficient (<50 nmol/L), insufficient (50–74 nmol/L), and sufficient (≥75 nmol/L). Using multivariable Tobit and logistic regression models, we examined the correlates of serum 25(OH)D3 levels. The overall prevalence of vitamin D deficiency was 81% (95% confidence intervals (CI]) 78–83). Multivariable regression analysis showed that serum 25(OH)D3 concentration was independently associated with study site, socioeconomic status, and sex. Birth in winter and breastfeeding were the strongest predictors of lower serum 25(OH)D3 concentration levels. Compared to non-breastfed children, children breastfed were at higher risk of vitamin D deficiency (AOR, 1.96; 95% CI, 1.04–3.67) and breastfeeding for more than one month was associated with greater likelihood of vitamin D deficiency (AOR, 5.40; 95% CI, 2.37–12.32) and lower vitamin D concentrations (−16.22 nmol/L; 95% CI, −21.06, −11.39). Vitamin D deficiency in infants is ubiquitous, under-recognised, and strongly associated with season of birth and breastfeeding in this setting. Nutritional interventions with vitamin D supplementation in national health programs in low- and middle-income countries are urgently needed to improve early-life vitamin D status in infants.

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