Klavikula kırığı saptanan yenidoğan hastalarda serum D vitamini düzeyleri

Year 2022, , 266 - 274, 31.03.2022

Erhan Aygün , Sinan Tüfekci , Seda Yılmaz Semerci

https://doi.org/10.17826/cumj.1031453

Abstract

Amaç: Bu çalışmada yenidoğan döneminde klavikula kırığı üzerine D vitamininin olası rolünün belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Bu retrospektif kesitsel çalışma 2018-2020 yılları arasında yapılmıştır. Klavikula kırığı nedeniyle yenidoğan yoğun bakım ünitesinde izlenen bebekler çalışmaya alındı. Kontrol grubu kırığı olmayan ancak dışlama kriterleri dışındaki nedenlerle hastaneye başvuran bebeklerden oluşturuldu. Doğum ağırlığı, boyu, baş çevresi, cinsiyeti, gebelik haftası, doğum şekli, bebekte brakiyal pleksus felci gibi diğer klinik bulgular, anne yaşı, gebelik sayısı, tanı zamanı ve risk faktörleri kaydedildi. Yenidoğanlar serum 25-OH D vitamini düzeylerine göre D vitamini düzeyi normal (>30 ng/mL), D vitamini yetersiz (20-30 ng/mL) veya eksikliği olanlar (<20 ng/mL) olarak sınıflandırıldı. Gruplar D vitamini düzeyleri, demografik ve klinik özellikler açısından karşılaştırıldı.
Bulgular: Çalışmamıza 48 bebek dahil edildi. Gruplar demografik açıdan benzer bulundu. Klavikula kırığı için tanı yaşı doğum sonrası 1 ila 6 gündü. Serum kalsiyum düzeyleri vaka grubunda anlamlı olarak daha düşüktü. Fosfor ve alkalin fosfataz düzeyleri gruplar arasında farklılık göstermemesine rağmen, D vitamini düzeyleri vaka grubunda anlamlı derecede düşüktü.
Sonuç: Bu çalışma, klavikula kırığı olan yenidoğan bebeklerde D vitamini düzeylerinin düşük olduğunu göstermiştir. Klavikulanın dikkatli bir şekilde palpasyonu hastaneden taburcu olmadan önce kırığı yakalayabilir ve bu bebeklerde olası eksikliği zamanında saptamak için serum D vitamini düzeyine bakılmalıdır.

Keywords

Clavicle fracture, newborn, vitamin D

Serum vitamin D levels in newborn with clavicle fracture

Abstract

Purpose: The aim of this study was to determine the possible role of vitamin D on the clavicle fracture in the newborn.
Materials and Methods: This retrospective cross-sectional study was conducted between 2018-2020. Infants who were admitted to neonatal intensive care unit due to the clavicle fracture were included. Infants who did not have a fracture, but were admitted to the hospital for reasons instead of exclusion criteria were included as the control group. Birth weight, height, head circumference, gender, gestational week, delivery type, other clinical findings such as brachial plexus paralysis in the infant, maternal age, number of pregnancies, risk factors time to diagnosis were recorded. According to the serum 25-OH vitamin D levels, newborns were classified as having normal vitamin D status (>30 ng/mL), vitamin D insufficient (between 20-30 ng/mL), or deficiency (<20 ng/mL). Groups were compared for the vitamin D levels, the demographics and clinical characteristics.
Results: A total of 48 infants were included. The groups did not differ in terms of demographics. Age of diagnosis ranged from postnatal 1 to 6 days of life. Serum calcium levels were significantly lower in the case group. Although phosphorus and alkaline phosphatase levels did not differ between groups, vitamin D levels were significantly lower in the case group.
Conclusion: This study shows that newborns with clavicle fracture had lower vitamin D levels. Cautious palpation of the clavicle can catch the fracture before the hospital discharge even there is no evident symptom and serum vitamin D level of those infants should be checked in order to detect the possible deficiency timely.

Keywords

Clavicle fracture, newborn, vitamin D

References

• Grober U, Spitz J, Reichrath J, Kisters K, Holick MF. Vitamin D: Update 2013: From rickets prophylaxis to general preventive healthcare. Dermatoendocrinol. 2013;5:331-47.
• Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. In: Dietary Reference Intakes for Calcium and Vitamin D. (Eds Ross AC, Taylor CL, Yaktine AL, Del Valle HB) Washington (DC), National Academies Press, 2011.
• Wacker M, Holick MF. Vitamin D - effects on skeletal and extraskeletal health and the need for supplementation. Nutrients. 2013;5:111-48.
• Holick MF. Vitamin D: extraskeletal health. Endocrinol Metab Clin North Am. 2010;39:381-400.
• Anderson LN, Heong SW, Chen Y, Thorpe KE, Adeli K, Howard A, et al. Vitamin D and fracture risk in early childhood: A case-control study. Am J Epidemiol. 2017;185:1255-62.
• Gomella T, Eyal FG. Traumatic Delivery. In: Neonatology: Management, procedures, on-call problems, diseases, and drugs. (Eds Gomella T, Eyal FG, Bany-Mohammed F) 6th ed.. New York, McGraw-Hill.,2020.
• Casellas-Garcia G, Cavanilles-Walker JM, Alberti-Fito G. Clavicular fracture in the newborn: Is fracture location a risk factor for obstetric brachial palsy? J Neonatal Perinatal Med. 2018;11:61-4.
• Mumtaz Hashmi H, Shamim N, Kumar V, Anjum N, Ahmad K. Clavicular fractures in newborns: What happens to one of the commonly injured bones at birth? Cureus. 2021;29:13-e18372.
• Albertini F, Marquant E, Reynaud R, Lacroze V. Two cases of fractures in neonates associated with maternofetal vitamin D deficiency. Arch Pediatr. 2019;26:361-64.
• Hocaoglu-Emre FS, Saribal D, Oguz O. Vitamin D deficiency and insufficiency according to the current criteria for children: Vitamin D status of elementary school children in Turkey. J Clin Res Pediatr Endocrinol. 2019;11:181-8.
• James JR, Massey PA, Hollister AM, Greber EM. Prevalence of hypovitaminosis D among children with upper extremity fractures. J Pediatr Orthop. 2013;33:159-62.
• Marcdante KJ, Kliegman RM. Assessment of the mother, fetus, and newborn. In: Nelson Textbook of Pediatrics. (Eds Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM) 21st ed., Philadelphia, Elsevier, 2020.
• Olney RC, Mazur JM, Pike LM, Froyen MK, Ramirez-Garnica G, Loveless EA et al. Healthy children with frequent fractures: how much evaluation is needed? Pediatrics. 2008;121:890-7.
• Ergür AT, Berberoğlu M, Atasay B, Şıklar Z, Bilir P, Arsan S et al. Vitamin D deficiency in Turkish mothers and their neonates and in women of reproductive age. J Clin Res Pediatr Endocrinol. 2009;1:266-9.
• Paterson CRD. Fractures in rickets due to Vitamin D deficiency. Curr Orthop Pract. 2015;26:261-4.
• Contreras JJ, Hiestand B, O'Neill JC, Schwartz R, Nadkarni M. Vitamin D deficiency in children with fractures. Pediatr Emerg Care. 2014;30:777-81.
• Trajanoska K, Morris JA, Oei L, Zheng HF, Evans DM, Kiel DP et al. Assessment of the genetic and clinical determinants of fracture risk: genome wide association and mendelian randomisation study. BMJ. 2018;362:k3225.
• Awang MS ARA, Che Ahmad A, Mohd Rus R. Neonatal clavicle fracture: A review of fourteen cases in east coast Peninsular Malaysia. IIUM Medical Journal Malaysia. 2017;16:79-83.
• Yenigul AE, Yenigul NN, Baser E, Ozelci R. A retrospective analysis of risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury: A single-center experience. Acta Orthop Traumatol Turc. 2020;54:609-13.
• Brown BL, Lapinski R, Berkowitz GS, Holzman I. Fractured clavicle in the neonate: a retrospective three-year review. Am J Perinatol. 1994;11:331-3.
• Mehta SH, Blackwell SC, Bujold E, Sokol RJ. What factors are associated with neonatal injury following shoulder dystocia? J Perinatol. 2006;26:85-8.
• Abrams SA. Vitamin D in preterm and full-term infants. Ann Nutr Metab. 2020;76:6-14.
• Sato Y, Kaji M, Higuchi F, Yanagida I, Oishi K, Oizumi K. Changes in bone and calcium metabolism following hip fracture in elderly patients. Osteoporos Int. 2001;12:445-9.
• Johansen A SM, O’Mahony MS, Westlake H, Woodhead JS, Woodhouse KW. Reliability of parathyroid hormone measurements in the period immediately following hip fracture. Age Ageing. 1997;26:175-8.
• Campos-Obando N, Koek WNH, Hooker ER, van der Eerden BC, Pols HA, Hofman A et al. Serum phosphate is associated with fracture risk: The Rotterdam study and MrOS. J Bone Miner Res. 2017;32:1182-93.
• Amato D, Maravilla A, Montoya C, Gaja O, Revilla C, Guerra R, et al. Acute effects of soft drink intake on calcium and phosphate metabolism in immature and adult rats. Rev Invest Clin. 1998;50:185-9.
• Bleicher K, Cumming RG, Naganathan V, Blyth FM, Le Couteur DG, Handelsman DJ et al. U-shaped association between serum 25-hydroxyvitamin D and fracture risk in older men: results from the prospective population-based CHAMP study. J Bone Miner Res. 2014;29:2024-31.
• Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208-18.
• Andiran N, Yordam N, Ozon A. Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition. 2002;18:47-50.
• Bowyer L, Catling-Paull C, Diamond T, Homer C, Davis G, Craig ME. Vitamin D, PTH and calcium levels in pregnant women and their neonates. Clin Endocrinol. 2009;70:372-7.