Decline in Age of Nutritional Rickets, Need for Routine Vitamin D Supplementation in Young Infants

Abstract

Objective: To determine the age at the diagnosis of rickets in children in a tertiary care hospital of Karachi and to assess the association of age at the diagnosis of rickets with serum levels of vitamin D. Methods: This cross-sectional descriptive study was carried out from January 2016 to July 2017 on 240 patients >1 month to 36 months of age, both genders, admitted in the paediatric ward, Civil Hospital, Karachi for various reasons. Children having clinical signs suggestive of rickets were confirmed to have the disease by radiological evidence, raised serum alkaline phosphatase and reduced serum vitamin D levels. Children with rickets secondary to chronic diarrhoea, non-nutritional aetiologies and those taking anticonvulsants, corticosteroids, or vitamin D supplements were excluded from the study. Data was analysed using SPSS 16 for frequencies of age at the time of diagnosis of rickets and for classification of vitamin D levels into severely deficient, deficient, insufficient and normal. Association of the age at the diagnosis of rickets was tested with serum levels of vitamin D by applying chi- square test of independence. Statistical significance was considered at p-value <0.05. Results: Mean age was 6.2 ± 5.9 months. A total of 130 (54.2%) subjects were £6 months of age, in- cluding 84 (35%) £3 months. Serum Vitamin D levels were done in 210 (87.5%) cases. Total of 168 (80%) cases were either deficient [141 (67.1%)] or severely deficient [27 (12.9%)] in vitamin D while 42 (20%) had insufficient levels. There was significant association of age at diagnosis of rickets with serum vitamin D levels. Rickets was an incidental diagnosis in most patients. Conclusion: Nutritional rickets was most common in cases £ 6 months age with a sizable number £3 months. Vitamin D deficiency was the cause in all patients. Significant association was established between serum vitamin D levels and age at diagnosis of rickets. Most of the subjects remained unde- tected until they were investigated on basis of clinical suspicion.

Keywords

• Rickets, vitamin D, nutritional deficiency, metabolic bone disease, children, infants