Characteristics of vitamin D deficiency in early infancy

Year 2022, Volume: 47 Issue: 4, 1447 - 1454, 28.12.2022

Mehmet Fatih Orhan Behzat Özkan

https://doi.org/10.17826/cumj.1130958

Abstract

Purpose: Vitamin D deficiency is a health problem in developing countries. This study aims to investigate the characteristics of children with vitamin D deficiency in early infancy.
Materials and Methods: Hundred and forty infants with vitamin D deficiency (mean age:3.5 ± 1.7 [0-6] months) and a control group of 200 healthy infants (mean age: 3.4 ± 1.7 [0-6] months) were included in the study. Serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25(OH)D) levels were measured in the patient, control groups, and the mothers of the patients. In 38 patients, radiological findings were evaluated with knee and wrist radiographs. Thacher Rickets Severity Scoring (RSS) system was used for radiological evaluation of rickets severity.
Results: The most common (42%) complaints were respiratory symptoms, including cough, respiratory distress, and wheezing. The most common finding of physical examination was the rachitic rosary. Serum calcium (Ca++), alkaline phosphatase (ALP), 25(OH) vitamin D, and parathormone (PTH) levels were significantly different in the patient and the control groups. The mean Thacher radiological score of 38 patients was 3.1 ± 2.1 (0-8) points. The mother's dressing style of covering up the whole body, i.e., veiling, increased the infant's risk of vitamin D deficiency by 17.5 times.
Conclusion: Subtle clinical, laboratory, and radiological findings of vitamin D deficiency are detected in early infancy. Vitamin D deficiency should be considered primarily in infants with hypocalcemia whose mothers are less frequently exposed to sunlight due to geographical conditions and their preferred or imposed lifestyle.

Keywords

Vitamin D Deficiency, Infant, Maternal-Fetal Relations, Secondary Hyperparathyroidism, Thacher Radiological Score

Erken bebeklik döneminde D vitamini eksikliğinin özellikleri

Abstract

Amaç: D vitamini eksikliği gelişmekte olan ülkelerde sağlık sorunu olmaya devam etmektedir. Bu çalışma erken bebeklik döneminde D vitamini eksikliği olan çocukların özelliklerini araştırmaktadır.
Gereç ve Yöntem: Çalışmaya, yaş ortalaması 3,5±1,7 (0-6) ay ve D vitamini eksikliği olan 140 infant ve kontrol grubu olarak yaş ortalaması 3,4±1,7 (0-6) olan 200 sağlıklı bebek alındı. Hasta ve kontrol grupları ile hastaların annelerinin serum kalsiyum, fosfor, alkalen fosfataz, paratiroid hormon ve 25 hidroksivitamin D düzeyleri ölçüldü. 38 hastada radyolojik bulgular diz ve el bileği grafileri ile değerlendirildi. Raşitizm şiddetinin radyolojik değerlendirilmesinde Thacher skoru kullanıldı..
Bulgular: En sık görülen şikayetler (%42) öksürük, solunum sıkıntısı, hırıltılı solunum gibi solunum yolu semptomları idi. Fizik muayenede en sık rastlanan bulgu raşitik rozary idi. Hasta ile kontrol grubu arasında serum kalsiyum (Ca), alkalen fosfataz (ALP), 25 (OH) D vitamini ve parathormon (PTH) değerleri arasında anlamlı fark vardı. Thacher radyolojik skoru incelenen 38 olgunun ortalama skoru 3,1±2,1 (0-8) puan idi.; Annenin tüm vücudunu kapatacak şekilde giyinmesinin, bebekte D vitamini eksikliği riskini 17,5 kat artırdığı görüldü.
Sonuç: Erken süt çocukluğu dönemindeki D vitamin eksikliğinin klinik, laboratuvar ve radyolojik bulguları silik olmaktadır. Yaşanan coğrafya ve yaşam tarzı nedeniyle güneş ışığına az maruz kalan annelerin çocuklarında hipokalsemi var ise öncelikle D vitamini eksikliği düşünülmelidir.

Keywords

Vitamin D Eksikliği, Bebek, Maternal-Fetal İlişkiler, Sekonder Hiperparatiroidizm, Thacher Radyolojik Skoru

References

• 1. Andıran N, Yordam N, Özön A. Risk factors for vitamin d deficiency in breast-fed newborns and their mothers. Nutrition 2002; 18:47–50. https://doi.org/10.1016/S0899-9007(01)00724-9
• 2. Hatun S, Ozkan B, Orbak Z, et al. Vitamin D Deficiency in Early Infancy. The Journal of Nutrition 2005; 135:279–282. https://doi.org/10.1093/jn/135.2.279
• 3. Kruse K, Bartels H, Kracht U. Parathyroid function in different stages of vitamin D deficiency rickets. European Journal of Pediatrics 1984; 141:158–162. https://doi.org/10.1007/BF00443214
• 4. Specker BL, Valanis B, Hertzberg V, et al. Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants. The Journal of Pediatrics 1985; 107:372–376. https://doi.org/10.1016/S0022-3476(85)80509-6
• 5. Yılmaz B, Aygün C, Çetinoğlu E. Vitamin D levels in newborns and association with neonatal hypocalcemia. The Journal of Maternal-Fetal & Neonatal Medicine 2018; 31:1889–1893. https://doi.org/10.1080/14767058.2017.1331430
• 6. Özdemir AA, Ercan Gündemir Y, Küçük M, et al. Vitamin D Deficiency in Pregnant Women and Their Infants. Journal of Clinical Research in Pediatric Endocrinology 2018; 10:44–50. https://doi.org/10.4274/jcrpe.4706
• 7. Sahin ON, Serdar M, Serteser M, et al. Vitamin D levels and parathyroid hormone variations of children living in a subtropical climate: a data mining study. Italian Journal of Pediatrics 2018; 44:40. https://doi.org/10.1186/s13052-018-0479-8
• 8. Thacher TD, Fischer PR, Pettifor JM, et al. A Comparison of Calcium, Vitamin D, or Both for Nutritional Rickets in Nigerian Children. New England Journal of Medicine 1999; 341:563–568. https://doi.org/10.1056/NEJM199908193410803
• 9. Yeşiltepe-Mutlu G, Aksu ED, Bereket A, et al. Vitamin D Status Across Age Groups in Turkey: Results of 108742 Samples from a Private Laboratory. Journal of Clinical Research in Pediatric Endocrinology 2019; 12:0–0. https://doi.org/10.4274/jcrpe.galenos.2019.2018.0097
• 10. Kiebzak GM, Neal KM, Hosseinzadeh P, et al. Pitfalls with Vitamin D Research in Musculoskeletal Disorders and Recommendations on How to Avoid Them. Journal of Clinical Research in Pediatric Endocrinology 2019; 11:220–226. https://doi.org/10.4274/jcrpe.galenos.2019.2019.0007