Rachitic Infants Research Articles

The prevalence of active nutritional rickets in Egyptian infants in Cairo

The Prevalence of Active Nutritional Rickets in Egyptian Infants in Cairo Introduction Rickets is a preventable disease which still exists in many countries needing accurate estimation to properly implement preventive strategies. MethodsA cross sectional study was conducted on 800 healthy infants 385 at the age of 9months and 415 at the age of 18months attending the primary health care centres well distributed all-over Cairo to determine the prevalence of rickets. All had their weight and height measured together with measurement of serum calcium, phosphorus and alkaline phosphatase (ALP). ALP was the screening tool for rickets. ResultsSerum calcium correlated positively with the length of infants in both groups. The prevalence of rickets was 1.125% in the whole studied infants, with 1.04% of those aged 9months and 1.2% of those aged 18months having active rickets. No differences were found between serum calcium and phosphorus between a random sample of the study participants and the positive cases. Rachitic infants received lesser caloric intake than recommended. Positive cases at the age of 18months showed more nutritional calcium deficiency than the younger group who were all deficient in sun exposure. ConclusionRickets is still prevalent in Egypt; however, at a lower prevalence than that reported before. We recommend examining all infants at the age of 18months by primary health care physicians and screening by ALP as this age showed a prevalence of rickets of 12/1000 to direct proper treatment and avoid the physical deformities resulting from insufficient calcium and/or vitamin D in infants in the early stages of walking. For the screening and diagnosis of rickets in a limited resources country like Egypt, we recommend the measurement of ALP. Proper education about calcium rich foods, adequate number of servings/day and adequate sun exposure is of paramount importance.

Prevalence of rickets among children below one-year encounter of North West Armed Forced Hospital in Tabuk

Background: Nutritional rickets is a disorder of bone affecting children early in their life. It tends to be under diagnosed and under treated especially in the primary health care centres. Aims & Objective: To estimate the prevalence of children those attend the North West Armed Forced Hospital, Well Baby Clinic and to find the association between the rickets and certain variables. Materials and Methods: A cross-sectional epidemiological study was conducted in North West Armed Forces Hospital (NWAFH), Saudi Arabia by using questionnaire. Results: The sample was included 114 infants their age ranged between 9-12 months, we was interviewed their mothers using a questionnaire and measuring the serum level of Alkaline phosphate, Calcium and phosphate in infants. The results of this study showed that the prevalence rate of rickets was 3.5% and all rachitic infants were breast-fed compared with 17.3% in non-rachitic infants. Also the height of the child at the time of interview was lowered in rachitic infants comparing with non-rachitic infants. Other studied risk factors were not significant. Conclusion: The rickets was quite existed among Saudi children attending NWAFH-WBC. For that, increase awareness of primary health care physicians about rickets, diagnosis and management were recommended.

Impact of Vitamin D Deficiency on Systemic Inflammatory Markers and Left Ventricular Functions in Rachitic Infants

Impact of Vitamin D Deficiency on Systemic Inflammatory Markers and Left Ventricular Functions in Rachitic Infants

Bone mineral density (BMD) in mothers of rachitic infants: A new causal hypothesis for rickets?

Bone mineral density (BMD) in mothers of rachitic infants: A new causal hypothesis for rickets?

The Frequency of Nutritional Rickets among Hospitalized Infants and its Relation to Respiratory Diseases

This case control study was conducted to determine the frequency of nutritional rickets among hospitalized infants and to assess their relation to respiratory diseases. All infants between the age of 3 months and 2 years admitted to the pediatric ward of Queen Alia Military Hospital during the period February-October 2001 were examined and investigated to rule out nutritional rickets. Children admitted for the first time to hospital for acute illnesses were only included in the study. A special data collection sheet was designed for this study which includes information on the age, sex, causes of admission, family size, the rank of the child in the family, family monthly income, outdoor clothing habit of the mother, and the mode of feeding. Data were collected from the infant charts and/or by interviewing the child's mother or guardian. Clinical signs of rickets were also recorded, including rosary beads, craniotabes, wide anterior fontanel, delayed dentition, widening of epiphysis, bowing of the legs, and double malulous. Blood sample was collected for calcium, phosphorus, alkaline phosphatase, and hemoglobin level. Those infants with any clinical sign of rickets and/or abnormal chemical results had a wrist X-ray to confirm the diagnosis of rickets. The rachitic group (cases) was compared for statistical significance with the remaining non-rachitic infants (controls) for the data collected. Rachitic infants received intramuscular 600,000 IU of vitamin D; a follow-up wrist X-ray and blood sample for calcium, phosphorus and alkaline phosphatase was arranged 3 weeks later. Forty-seven infants (10.6 per cent) out of the 443 included in the study were found to have nutritional rickets. Forty (85.1 per cent) of the rachitic infants were admitted due to lower respiratory tract diseases compared with 30 per cent of the control group and the difference was statistically significant (p < 0.01). Duration of hospital stay in the rachitic infants was also significantly more prolonged than the non-rachitic control group (9.5 days vs. 7.4 days, p = 0.002). Rachitic infants were breastfed in 82.9 per cent, ranked second or more in the family in 87.2 per cent, and had mothers who wore head cover outdoors in 80.8 per cent compared with 60.8, 40.1, and 60.3 per cent, respectively, in the non-rachitic group (p < 0.01). High alkaline phosphatase, hypocalcemia, hypophosphatemia, and anemia was found in 100, 19, 50, and 78.7 per cent, respectively, in the rachitic group compared with 9.8, 2, 1.2, and 43.7 per cent, respectively, in the control group (p < 0.001). Nutritional rickets seems to be a common problem among infants in Jordan. Further studies at national level are needed to determine the prevalence of rickets in Jordan. Rachitic infants are commonly hospitalized due to lower respiratory tract infections, thus there is a high index of suspicion for rickets among hospitalized infants with lower respiratory tract diseases.

Convulsions as a Possible Manifestation of Vitamin D Deficiency Rickets in Infants One to Six Months of Age

During the 42 months of January 1985 through June 1988, five infants between the ages of one and six months had hypocalcemic convulsions associated with vitamin D deficiency rickets. Despite abundant sunlight, convulsions as a manifestation of vitamin D deficiency in young infants are not uncommon in Saudi Arabia and should be considered as a probable cause for hypocalcemic seizure in breast fed infants.

Vitamin D-deficiency rickets and myelofibrosis

This study was aimed at detecting the early appearance of myelofibrosis by bone marrow biopsy examination in children with vitamin D-deficiency rickets. Twelve children, aged 4 to 18 months, were evaluated. Only a minimal increase of the reticulin was shown in rachitic children without anemia in whom no other laboratory evidence of myelofibrosis was present. Early signs of myelofibrosis with increase of reticulin were present in rachitic infants with anemia. In patients of the same age with iron deficiency anemia, the bone marrow reticulin findings were normal. Bone marrow biopsy after successful treatment of rickets could be repeated in one patient with myelofibrosis; results indicated that the myelofibrosis with anemia associated with vitamin D-deficiency rickets is reversible by vitamin D treatment.

Vitamin D Deficiency Rickets in a Sunny Country: Pathogenesis, Clinical Picture and Management

ABSTRACT Vitamin D deficiency rickets occurs in sunny countries, mainly due to man-made environmental factors associated with avoidance of sunshine. This situation can be prevented by more health e...

Vitamin D deficiency in mothers of rachitic infants.

The existence of nutritional deficiency rickets among infants in sunny Riyadh was confirmed radiologically. Most of the rachitic infants were breast-fed, some received unsupplemented infant feeding formulae, and all live in an environment that is devoid of sunlight. Their mean age at the time of onset was 10.5 months. 25-Hydroxyvitamin D (25OHD) levels were found to be low in mothers of the rachitic infants. This maternal deficiency as a factor in pathogenesis of rickets in the infant is discussed. Proposals are made to prevent the occurrence of rickets on this scale.

PLASMA ALKALINE PHOSPHATASE ACTIVITY: A SCREENING TEST FOR RICKETS IN PRETERM NEONATES

Both rickets and raised plasma alkaline phosphatase activity are common in the preterm infant. Measurement of plasma alkaline phosphatase activity is valuable in screening for active disease and in diagnosis, but normal reference data are not available for preterm babies. In 30 consecutive preterm infants (birthweight 1580±410 g, gestational age 31±2·5 weeks) serial measurements of plasma alkaline phosphatase activity, plasma levels of calcium and inorganic phosphorus, and the pattern of alkaline phosphatase isoenzymes were made. Four patterns of changes in plasma alkaline phosphatase activity with time were seen. 4 of the 30 infants were shown to have rickets; these children and 14 of the 26 non-rachitic infants showed an increasing/peak/decreasing pattern with increasing age, but levels were much higher in the rachitic infants. The activity in all 30 was raised above the adult and childhood reference ranges at some point in time. The data suggest that an activity of five times the upper limit of the normal adult reference range is acceptable in the preterm infant but an activity higher than this may suggest rickets.

863 THE QUANTITATIVE EVALUATION OF NUTRITIONAL RICKETS USING URINARY PHOSPHATE EXCRETION

Phosphaturia is a prominent feature of nutritional rickets. This investigation was designed to study the application of phosphaturia in the quantitative assessment of nutritional rickets. Seventeen infants aged 4-7 months with nutritional rickets were studied. The severity of the rickets was determined using clinical, radiological and chemical criteria. A scoring method was designed with 9 parameters, each scored from 0 to 3. The additive score defined the severity of the disease. This was correlated with the degree of phosphaturia, measured by tubular reabsorption of phosphorus (TRP) and the phosphate excretion index (PEI). TRP and PEI were calculated from a single blood and concomitant urine specimen. TRP was negatively correlated with the severity of nutritional rickets r - 0.914 p<0.005. The infants who were most severely affected, as expressed by higher scores, had the lowest TRP (32-70%). The PEI correlated positively with the scores (r = 0.873, p<0.01). The more rachitic infants had higher PEI's, in the range of 0.25-0.61. These data indicate that the severity of nutritional rickets can be assessed by calculating the TRP and PEI from a single blood and urine specimen obtained simultaneously.

Genetic aspects of nutritional rickets.

Amino acid excretion was investigated in 21 rachitic infants and in 22 of their parents. There was (a) increased alpha-amino acid excretion in one-third of the infants a long time after the rickets had healed, (b) an abnormally high excretion of alpha-amino nitrogen and of phosphorus in many of the parents (c) an abnormal pattern of amino acid excretion in all 9 infants tested, and (d) a good correlation between the excretion of individual amino acids by an infant and by its parents. Our findings suggest that in at least some cases of nutritional rickets there is a genetic element which may manifest itself only under adverse environmental conditions.

IS NUTRITIONAL RICKETS A HEREDITARY DISEASE?

Previous work by others and us suggested that nutritional rickets may have a genetic basis. The present paper attempts to obtain further evidence for the hereditary nature of the disease. Biochemical investigations were performed on 22 rachitic infants before and after treatment and on 23 of their parents. The results obtained were a) increased a-amino-nitrogen excretion was found in 1/3 of the infants a long time after healing of rickets b) in the 9 rachitic infants examined abnormal values of pattern amino-acid excretion were found c) 9 of the parents were found to have abnormally high a-amino-nitrogen excretion, 12 abnormally high phosphorus clearance and 10 abnormally high urine phosphorus-urine creatinine concentration d) all 10 examined parents had raised values of the pattern of aminoacid excretion for 1-7 of the aminoacids e) the comparison of the abnormal excretion of individual aminoacids between infants and parents showed that there is a correspondence between them. Our findings suggest that in some at least cases of nutritional rickets there is a genetic element manifesting itself only under adverse environmental conditions.

Aminoaciduria in vitamin D deficiency states in premature infants and older infants with rickets

H Y P E R A 2r I N O A C I D U R I A in rachitic infants was first reported by Jonxis and coworkers 1 in 1952. Further work by this group2, s demonstrated that the excessive loss of amino acids in the urine probably results from diminished reabsorption of amino acids by the renal tubule cells. Renal clearance studies a show that this is true of the basic amino acids; but, as yet, simultaneous clearances of all amino acids have not been reported in vitamin D-deficient infants. Cusworth and Dent 4 have recently reported an endogenous renal clearance study in an adult with osteomalacia whose daily diet contained approximately 20 units of vitamin D. The clearances of all amino acids were increased in this patient. Semiquantitative paper chromatographic studies in many patients

Further studies of the effects of citrate feeding on the calcium, phosphorus, and citrate metabolism of rachitic infants

Summary Observations were made on three rachitic infants during the course of treatment with a citrate mixture without vitamin D. The studies included determinations of calcium, phosphorus, citrate, and phosphatase in the serum and the daily excretions of calcium, phosphorus, and citrate in the urine. X-rays of the long bones were taken at intervals so that the evidences of deposition of bone salt in the rachitic cartilage could be correlated with the concentrations of calcium and phosphorus in the serum. The citrate solution consisted of an equimolar mixture of citric acid and trisodium citrate which was added to the milk feedings in amounts ranging from 30 to 60 mM. of citrate per day. In two infants with advanced floridrickets citrate administration resulted in a rapid drop of the concentrations of serum calcium to hypocalcemic levels while the serum phosphorus values remained low. Deposition of bone salt in the rachitic cartilage was evident by x-ray during the period in which the concentrations of calcium and phosphorus in the serum were below the normal range and Ca×P ratios were less than 30. The urinary excretion of calcium remained low during the period of citrate treatment and the urinary excretion of phosphorus was unchanged. The concentrations of citrate in the serum were not consistently increased during citrate treatment but rose after vitamin D was given. A third infant with early ricketsand tetany showed a somewhat different pattern of response to citrate feedings. The serum calcium level which had risen following high calcium intake decreased somewhat when citrate was given but the concentration of phosphate and of citrate rose to normal values while the alkaline phosphatase activity in the serum decreased. X-rays of the bones showed normal growth and calcification during the period of citrate therapy without vitamin D. It is suggested that the antirachiticeffect of citrate feeding is not simply due to the formation of a diffusible calcium citrate complex in the intestinal contents, nor in the extracellular fluids, but that there is a local action upon proliferating cartilage and bone matrix resulting in increased calcifiability. An analogy is drawn between the sequence of events following citrate feeding to rachitic infants and that seen in patients with decalcification of the skeleton due to hyperparathyroidism when the hyperfunctioning parathyroid tissue is removed. In both instances mineralization of the skeleton is associated with decreased levels of calcium and phosphorus in the serum. In one patient of this series, however,a 2-month-old infant with early rickets, citrate feeding seemed to be a more complete substitute for vitamin D. While on citrate therapy the levels of serum phosphorus and of citrate rose to normal; the alkaline phosphatase activity of the serum decreased; and bone x-rays showed normal ossification. This is another suggestion of an interrelationship between citrate metabolism and the physiological effects of vitamin D.

METABOLIC STUDIES ON RACHITIC INFANTS

DURING the past fifteen years there has been a continuing conflict of data and opinions regarding the comparative effectiveness of vitamin D from ergosterol, the plant sterol activated by irradiation with ultraviolet rays and marketed under the name of viosterol, and the vitamin D preparations from animal sources such as tuna liver oil and cod liver oil. The latter are dependent chiefly on activated 7-dehydrocholesterol for their antirachitic effectiveness, the greater proportion of this probably being present in cod liver oil. Previous studies have chiefly employed one of two methods. Either they dealt with groups of healthy infants or with groups of rachitic infants who were given the various forms of vitamin D through the winter period and for whom consecutive roentgenograms were made and the diagnoses of each group compared with that of the other corresponding group, or serologic studies of calcium and phosphorus of similar healthy and rachitic

The effect of vitamin D from cod-liver oil and a tuna-liver oil upon serum phosphatase concentrations in rachitic infants

I N RECENT years the dual assay method, I using rats and chicks for distinguishing between the various forms of vitamin D found in liver oils of different spee, ies of fish, has become the usual procedure. Using this technique, Bills, Massengale, Imboden and IIalF reported assays on liver oils from twenty-five species of fish. They found that l'at unit for rat unit the oils differed widely in their relative effectivehess on chicks as measured by the ash content of the femurs. Correll and Wise, a, 4 found a variation in the response of chicks to certai.n tunaliver oils when fed at equal rat unit levels, as measured by bone ash, g'rowth, and serum phosphatase. Bills and co-workers 2 suggested tha t the different biologie responses obtained with chickens when compared with rats might be due to the existence of vi tamin D in several different chemical forms in a . s ingle oil, some chemieal entities for a par t icu lar specie being more efficient than others. I t has been repor ted by Barnes a n d ' C a r p e n t e r s tha t serum phosphatase values in otherwise normal infants serve as a sound basis for the clinical diagnosis and prognosis of rickets. We were interested, therefore, to aseertain how cod-liver oil and a tuna-l iver oil (known to be less efficient than cod-liver oil on chieks) would compare as to their effect on the magni tude and ra te of reduct ion of serum phosphatase when administered to rachit ic infants at equal ra t unit dosages (600, 900, and 2,400 I. U. dai ly) . The purpose of this paper is to repor t data on for ty-eight rachitic infants subjected to such a study.

The influence of the menstruum on the effectiveness of vitamin D obtained from the livers of the percomorphi order of fish

Summary This investigation was carried out to determine whether the antirachitic effectiveness of a fish liver oil preparation, such as percomorph liver oil, is increased by dispersion in the daily ration of milk. Throughout the winter months 340 infants, 90 per cent of whom were negroes, were given comparable amounts of percomorph liver oil either in the form of an emulsion which was dispersed in milk, or in the form of an oily solution which was administered in a half teaspoonful of orange juice. Curative tests were also carried out on twenty-one rachitic infants all of whom were negroes. The daily dosage of the various preparations ranged from 90 to 200 units. The results of the prophylactic study revealed that while both the emulsion and oil were effective antirachitic agents, the incidence of rickets was less in the groups of infants receiving the emulsion in milk. In the curative test similar results were obtained, as the healing response was greater in those infants receiving the preparation in milk when compared with those receiving the oily solution. Analysis of the data reveals that the emulsion in milk was approximately twice as effective as the oily preparation at the dosage levels employed in this investigation.

Phosphorus Components in the Blood of Normal and Rachitic Infants

Phosphorus Components in the Blood of Normal and Rachitic Infants

Comparative antirachitic effectiveness of viosterol, cod liver oil, and percomorph liver oil

Summary In order to determine the relative effectiveness of cod liver oil, viosterol and percomorph liver oil, unit for unit, 365 infants were given 135, 435, or 870 U.S.P. xi units daily of one of these antirachitic agents throughout the winter months. At the end of the winter the incidence of rickets among these infants was determined by roentgenologic examination of the wrists. The results of the prophylactic study did not indicate any significant difference in the effectiveness of these agents at the levels of units employed in this investigation. The degree of protection afforded by these antirachitics was extremely high, and only three infants among 146 receiving the lower unitage, 135 units daily, developed roentgenologic evidences of rickets. A comparison of the curative response to cod liver oil, viosterol, percomorph liver oil and irradiated cholesterol was made on fourteen rachitic infants. These tests revealed that the daily administration of 435 units of cod liver oil, percomorph liver oil, and irradiated cholesterol brought about good healing in two, four, and three rachitic infants, respectively, whereas the same number of units of viosterol failed to bring about satisfactory healing in two rachitic infants. The results of the curative study, therefore, would seem to indicate that, rat unit for rat unit, vitamin D of animal source (cod liver oil, percomorph liver oil, and irradiated cholesterol) is more effective in the treatment of infantile rickets than is vitamin D of plant origin (viosterol).