Abstract
ObjectiveThe aim of this study was to determine, retrospectively, the serum 25OHD and calcium concentrations of screened neonates of mothers at high risk of 25OHD deficiency and examine whether their measurement contributes to the management of these neonates.MethodsSerum 25OHD and calcium concentrations from 600 samples of umbilical cord blood or venous blood collected from neonates over a 12-month period were analysed.ResultsThere was a high prevalence of vitamin D insufficiency (27.6%, 30–50 nmol/L) and deficiency (21.3%, < 30 nmol/L) in neonates from high-risk maternal groups. There was a statistically positive but weak correlation (ρ = 0.22, P < 0.0001) between 25OHD and serum calcium. Only 7 neonates out of 569 (1.2%) had calcium concentrations in the hypocalcaemic range; however, a significant number (47.6%) were reported to be in the hypercalcaemic range. Nearly all of these were venous samples collected in first 24 h after birth.ConclusionVitamin D deficiency is prevalent in neonates of high-risk mothers but the risk of hypocalcaemia due to vitamin D deficiency at birth is low. Screening neonates entails blood testing which can cause distress to neonates and their parents, substantial imposition on staff and financial burden on the health care system. Vitamin D supplementation of these neonates from birth without routine screening appears more reasonable. Also, the data from this study suggest that the paediatric reference range for corrected calcium concentrations in neonates should be re-evaluated.
Highlights
Vitamin D (25 hydroxy-vitamin D (25OHD)) deficiency is a global health problem and together with poor calcium intake is responsible for nutritional rickets and osteomalacia
The levels were obtained from the hospital laboratory records, and the neonatal medical record was used to determine the babies’ gestational age, sex and birth weight. 25 hydroxyvitamin D and calcium concentrations were measured by automated immunoassay. 25OHD was assayed on the DiaSorin Liaison XL analyser
Most neonates had a cord blood or venous blood test done on the first day of life (81.1%) and most samples were collected within 4 days of birth
Summary
Vitamin D (25 hydroxy-vitamin D (25OHD)) deficiency is a global health problem and together with poor calcium intake is responsible for nutritional rickets and osteomalacia. When severe, it leads to fractures and skeletal deformities in growing infants and children as well as asymptomatic and symptomatic hypocalcaemia in the form of cardiomyopathy, tetany and seizures [1,2,3,4]. If a child is deficient in only vitamin D or calcium, adequate bone mineralisation can still be sustained [14] An exception to this is neonates and infants, who are growing rapidly and need both adequate vitamin D and calcium intake for bone mineralisation [4, 14, 15]. The parathyroid hormone stimulates osteoclasts to increase bone resorption to maintain normocalcaemia and impaired renal phosphate absorption and low phosphate levels leading to nutritional rickets and osteomalacia [16, 17]
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