title: Craniotabes in normal newborns: the earliest sign of subclinical vitamin D deficiency.
abstract: BACKGROUND
  Craniotabes in otherwise normal neonates has been regarded as physiological and left untreated.
  
  
  OBJECTIVE
  Our objective was to investigate the role of vitamin D deficiency in the development of craniotabes in normal neonates.
  
  
  METHODS
  Newborn screening of craniotabes was conducted at the single largest obstetrical facility in Kyoto, Japan. Follow-up study at 1 month was conducted at Kyoto University Hospital.
  
  
  METHODS
  A total of 1120 consecutive normal Japanese neonates born in May, 2006, through April, 2007, were included in the study.
  
  
  METHODS
  The incidence of craniotabes was scored each month. Neonates with craniotabes were followed up at 1 month with measurements of serum calcium, phosphorus, alkaline phosphatase (ALP), intact PTH, 25-OH vitamin D (25-OHD), urinary calcium, phosphorus, creatinine, and hand x-rays.
  
  
  RESULTS
  Craniotabes was present in 246 (22.0%) neonates, and the incidence had obvious seasonal variations, highest in April-May and lowest in November. At 1 month, infants with craniotabes had significantly higher serum ALP compared with normal neonates; 6.9% of them had elevated intact PTH over 60 pg/ml, and 37.3% had 25-OHD less than 10 ng/ml. When separately analyzed according to the method of feeding, 56.9% of breast-fed infants showed 25-OHD less than 10 ng/ml, whereas none of formula/mixed-fed infants did, and breast-fed infants had significantly higher serum PTH and ALP compared with formula/mixed-fed infants.
  
  
  CONCLUSIONS
  These results suggest that craniotabes in normal neonates is associated with vitamin D deficiency in utero, and the deficiency persists at 1 month in many of them, especially when breast-fed.
authors.affiliation: Department of Pediatrics, Kyoto University Hospital, 54 Shogoin Sakyo, Kyoto 606-8507, Japan. yorif@kuhp.kyoto-u.ac.jp
authors.forename: Junko
authors.initials: J
authors.lastname: Yorifuji
authors.forename: Tohru
authors.initials: T
authors.lastname: Yorifuji
authors.forename: Kenji
authors.initials: K
authors.lastname: Tachibana
authors.forename: Shizuyo
authors.initials: S
authors.lastname: Nagai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawai
authors.forename: Toru
authors.initials: T
authors.lastname: Momoi
authors.forename: Hironori
authors.initials: H
authors.lastname: Nagasaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hatayama
authors.forename: Tatsutoshi
authors.initials: T
authors.lastname: Nakahata
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D002118:Calcium / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012886:Skull; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000175:diagnosis*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002118:Calcium