ObjectiveThe UK national incidence of nutritional rickets is unknown. We aimed to describe the incidence, presentation and clinical management of children under 16 years with nutritional rickets in the UK presenting to secondary care.MethodsProspective data were collected monthly between March 2015 and March 2017 from 3500 consultant paediatricians using British Paediatric Surveillance Unit methodology. Clinicians completed online clinical questionnaires for cases fitting the surveillance case definition.Results125 cases met the case definition, an annual incidence of 0.48 (95% CI 0.37 to 0.62) per 100 000 children under 16 years. 116 children were under 5 years (annual incidence of 1.39 (95% CI 1.05 to 1.81) per 100 000. Boys (70%) were significantly more affected than girls (30%) (OR 2.17, 95% CI 1.25 to 3.78). The majority were of Black (43%) or South Asian (38%) ethnicity. 77.6% of children were not taking vitamin D supplements despite being eligible. Complications included delayed gross motor development (26.4%), fractures (9.6%), hypocalcaemic seizures (8%) and dilated cardiomyopathy (3%). Two children died (1.6%). In eight cases, rickets was confirmed radiologically and biochemically [raised serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) levels ] but were excluded from the incidence analysis for not meeting the case definition of 25-hydroxyvitamin D of <25 nmol/L.ConclusionThe incidence of nutritional rickets in the UK is lower than expected. Serious complications and unexpected deaths, particularly in Black and South Asian children under 5 years, occurred. Both vitamin D deficiency and dietary calcium deficiency are role players in pathogenesis. Uptake of vitamin D supplementation remains low.
Maternal vitamin D deficiency is a significant public health issue. This retrospective multicentre audit was undertaken to identify the scale of maternal vitamin D deficiency in London, using infant vitamin D deficiency as a surrogate marker. During January 2006 to June 2008, 74 infants presented with symptomatic vitamin D deficiency, a prevalence of 1.6 per 1000 deliveries in London. Of these, 49% were hypocalcaemic at presentation and 27% had hypocalcaemic seizures. A telephone survey in June 2008 showed that no London National Health Service antenatal units had departmental guidelines on vitamin D. This audit is presented to raise awareness of current recommendations and the sequelae of maternal vitamin D deficiency.
AimsRickets is a disease of growing children with serious short and long-term complications. Although the prevalence of rickets has been reported widely to be increasing the actual national incidence of nutritional rickets (NR) in the United Kingdom (UK) is unknown. This study aims to describe the incidence, presentation, and clinical management of children with NR in the UK and ROI.MethodsData was collected prospectively monthly between March 2015-March 2017 from 3500 paediatricians using British Paediatric Surveillance Unit reporting methodology with the following definition (table 1):Abstract I16 Table 1 Clinical rickets with any of the following:• Leg deformity/Swollen wrists or knees or ribs AND 250 hour vitamin D<25 nmol/L with one or more abnormalities of serum calcium, alkaline phosphatase, phosphate, parathyroid hormone OR Radiological rickets with:• Widening, cupping, splaying of metaphysis (of any long bone) AND 25OHVitamin D<25 nmol/L Results130 cases met the case definition with an overall annual incidence of 5.04 cases per million children under 16 years.London, East Midlands, West Midlands and Scotland had estimated incidences above the national incidence. Boys (91/130; 70%) were significantly more affected than girls (39/130; 30%) and the majority were of Black (44.6%) and South Asian (36.2%) ethnicity with a median age of 18 months. The commonest clinical presentations were bowed legs, swollen wrists and radiological rickets. Comorbidities included fractures (15/130; 11.5%) hypocalcaemic seizures (11/130; 8.5%;), and dilated cardiomyopathy (4/130; 3%) Two children died of dilated cardiomyopathy from vitamin D deficiency. The commonest associated conditions were cows milk protein allergy (19/51; 19%; ) iron deficiency (8/51; 7%) and eczema (8/51; 7%) At the time of diagnosis 77% of children were not receiving vitamin D supplements. 19 children had rickets despite being reported to be receiving appropriate supplementation. All confirmed radiological cases had either high parathyroid hormone and/or low phosphate. Following diagnosis, most clinicians initially prescribed treatment themselves, with huge variation in duration of prescriptions. In a further 10 cases, rickets was confirmed but excluded in the incidence analysis, for not meeting the case definition (specifically Vitamin D<25 OHnmol/L), suggesting both dietary calcium deficiency and vitamin D insufficiency as role-players in the presentation of NR in the UK.ConclusionsNR continues to affect children in the UK with serious sequelae. Uptake of vitamin D supplementation remains low and constitutes a failure of current public health policy. A UK national policy focusing on vitamin D and calcium supplementation and adherence is required to eliminate this entirely preventable condition.
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