title: Clinical, biochemical, and radiological manifestations of vitamin D deficiency in newborns presented with hypocalcemia.
abstract: BACKGROUND
  The Clinical and radiological manifestations of newborns with severe VDD have not been studied well.
  
  
  METHODS
  We studied the clinical, biochemical, and radiological manifestations of 10 full-term (FT) newborns (6: M, 4: F) infant presented to with symptomatic hypocalcemia (seizure) secondary to vitamin D deficiency (VDD) during the first 10 days of life are described. All were exclusively breastfed since birth. All their mothers have low 25 hydroxy vitamin D (25OHD) level <10 ng/mL and were not taking vitamin supplements during pregnancy.
  
  
  RESULTS
  FT newborns with hypocalcemia secondary to VDD presented with generalized convulsions (10/10) and craniotabes (8/10), but none had rachitic chest rosaries or joint broadening. Cranial ultrasonographic evaluation was normal. Serum 25OHD concentrations were low in these newborns (13.2 ± 3.8 ng/mL) and their mothers (8.1 ± 1.5 ng/mL). A total of 60% of them had increased parathormone (PTH) concentrations (>60 ng/mL) and 60% had decreased magnesium (Mg) concentrations (<0.7 mmol/L). Their alkaline phosphatase (ALP) concentrations were significantly higher than normal newborns. All other laboratory results (liver function tests, urea and electrolytes, C reactive protein, lumbar puncture, blood culture, and lactate) were normal. In all patients, seizures ceased within 2 days of starting treatment with alphacalcidol and calcium. Radiological manifestations included metaphyseal band of relative lucency (osteopenia), just under the line of provisional calcification, within distal radius (7/10), femur (4/10), and tibia (3/10), mild cupping and haziness of distal radius (2/10).
  
  
  CONCLUSIONS
  Newborns with VDD had significantly lower serum calcium, ALP and PTH and higher phosphate concentrations, compared to older infants with VDD rickets. In newborns with VDD, serum calcium levels were correlated significantly with 25OHD (r = 0.597, P < 0.001), Mg concentrations (r = 0.436, P < 0.001) and negatively with ALP concentrations (r = -0.451, P < 0.001). Serum PTH concentrations were correlated significantly with serum Mg (r = 0.78, P < 0.0001) but not with serum calcium (r = -0.103, P = 0.3) or 25OHD (r = -0.03, P = 0.7) concentrations.
  
  
  CONCLUSIONS
  The clinical, biochemical, and radiological manifestations of VDD in newborns indicate that they are less adapted to VDD compared to older infants. VD supplementation for mothers and newborns should be considered to avoid short-term complications of VDD in the neonatal period and on the growing infants especially in countries with high prevalence of VDD.
authors: Department of Pediatrics, Women's Hospital, Hamad Medical Center, Doha, Qatar.
authors: Ashraf
authors: A
authors: Soliman
authors: Husam
authors: H
authors: Salama
authors: Sufwan
authors: S
authors: Alomar
authors: Emad
authors: E
authors: Shatla
authors: Khaled
authors: K
authors: Ellithy
authors: Elsaid
authors: E
authors: Bedair
keywords: 25OH vitamin D; Adaptation; calcium; infants; maternal; newborns; parathormone; phosphate; radiology; rickets; vitamin D deficiency
references: Metabolism. 2008 Jan;57(1):95-102
references: 18078865
references: J Bone Miner Res. 2013 Jan;28(1):206-12
references: 22887693
references: J Pediatr. 1986 Aug;109(2):328-34
references: 3488384
references: BMC Pediatr. 2011 Aug 31;11:76
references: 21884590
references: J Pediatr. 1985 Sep;107(3):372-6
references: 3839846
references: Pak J Biol Sci. 2010 May 1;13(9):437-42
references: 20973397
references: J Biol Chem. 1982 Oct 10;257(19):11416-23
references: 6288684
references: Lancet. 2006 Jan 7;367(9504):36-43
references: 16399151
references: Am J Clin Nutr. 2006 Aug;84(2):350-3; quiz 468-9
references: 16895882
references: Lancet. 1973 Oct 13;2(7833):811-4
references: 4126615
references: J Clin Endocrinol Metab. 1978 Oct;47(4):800-6
references: 263326
references: J Pediatr. 1980 Oct;97(4):637-40
references: 6968347
references: J Pediatr. 1991 Sep;119(3):417-23
references: 1880657
references: Clin Pediatr (Phila). 2007 Jan;46(1):42-4
references: 17164508
references: Br Med J. 1973 Jul 28;3(5873):211-2
references: 4541627
references: J Clin Endocrinol Metab. 1988 Oct;67(4):850-2
references: 3047164
references: N Z Med J. 2006 Sep 08;119(1241):U2144
references: 16964296
references: Br J Nutr. 2010 Jul;104(1):108-17
references: 20193097
references: Proc Nutr Soc. 2012 Feb;71(1):38-45
references: 21861949
references: Mayo Clin Proc. 2006 Mar;81(3):353-73
references: 16529140
references: Br Med J (Clin Res Ed). 1981 Oct 17;283(6298):1024
references: 6794748
references: J Clin Endocrinol Metab. 1985 Nov;61(5):933-40
references: 3840173
references: Br Med J. 1980 Jul 5;281(6232):11-4
references: 7407476
references: J Nutr. 1981 Jul;111(7):1240-8
references: 6788913
references: J Trop Pediatr. 2010 Apr;56(2):108-10
references: 19622711
references: Arch Dis Child. 1980 Feb;55(2):155-7
references: 7377839
references: Am J Clin Nutr. 2006 Aug;84(2):273
references: 16895872
references: J Nutr. 2004 Mar;134(3):691S-695S
references: 14988469
references: J Clin Endocrinol Metab. 2008 May;93(5):1784-8
references: 18270256
references: Helv Paediatr Acta. 1978 Jun;33(2):95-103
references: 659262
references: Nutr J. 2007 Sep 19;6:23
references: 17880694
references: J Nutr. 2007 Feb;137(2):447-52
references: 17237325
references: J Clin Invest. 1974 Aug;54(2):287-96
references: 4858778
references: Pediatrics. 2012 Jun;129(6):e1461-7
references: 22614771
references: Acta Paediatr. 1995 Aug;84(8):941-2
references: 7488823
references: J Biol Chem. 1991 Mar 15;266(8):4764-71
references: 2002026
references: Arch Dis Child. 1982 Oct;57(10):754-7
references: 7138064
references: Endocrinol Metab Clin North Am. 2006 Mar;35(1):21-51, v
references: 16310641
references: Nutr Rev. 2010 Aug;68(8):465-77
references: 20646224
references: Clin Endocrinol (Oxf). 1976 May;5(3):209-24
references: 182417
references: Arch Dis Child. 1974 Oct;49(10):810-1
references: 4429363
references: J Clin Endocrinol Metab. 2010 Apr;95(4):1749-57
references: 20139235
references: Clin Chim Acta. 2003 Jul 1;333(1):1-11
references: 12809730
references: Am J Physiol. 1990 Jun;258(6 Pt 1):C1077-85
references: 2360619
references: Case Rep Pediatr. 2012;2012:945437
references: 23056981
references: Br Med J. 1980 Mar 15;280(6216):751-4
references: 6989438
references: J Nutr. 2005 Feb;135(2):279-82
references: 15671226
references: N Engl J Med. 1980 Feb 7;302(6):315-9
references: 7350498