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Rickets of prematurity: a case report
1Department of Paediatrics, Jos University Teaching Hospital, Nigeria.
Insights
This case report details a premature infant with progressive rickets and fractures, unresponsive to standard vitamin D, calcium, and phosphate therapy. Treatment with 1-alphahydroxy vitamin D led to clinical, biochemical, and radiological cure.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Nutritional Rickets
Background:
- Rickets is a significant concern in extremely premature infants due to immature bone metabolism.
- Standard supplementation with calcium, phosphate, and calciferol (vitamin D) may be insufficient in some cases.
- Bronchopulmonary dysplasia can complicate the management of premature infants.
Observation:
- An extremely premature infant (750g birth weight) presented with progressive rickets and fractures.
- Biochemical evidence of rickets was noted by 6 weeks post-natal age (31 weeks post-conceptional age).
- The infant also experienced respiratory distress syndrome and later developed bronchopulmonary dysplasia.
Findings:
- Despite standard supplementation, the infant's rickets progressed.
- Administration of 1-alphahydroxy vitamin D resulted in a cure of rickets.
- This suggests a potential deficiency or impaired metabolism of the active vitamin D metabolite.
Implications:
- This case highlights the potential need for alternative vitamin D therapies in extremely premature infants with refractory rickets.
- It underscores the importance of monitoring bone metabolism in vulnerable preterm populations.
- Further research into vitamin D metabolism and requirements in extremely low birth weight infants is warranted.
Abstract:
A case report is given, and an attempt made to summarize our knowledge about this disorder. An extremely premature infant (birth weight 750 grammes) developed progressive rickets resulting in fractures despite phosphate, calcium and calciferol (vitamin D) supplementation. The patient had mild respiratory distress syndrome but later developed broncopulmonary dysplasia. Initial biochemical evidence of rickets occurred by the 6th week of post-natal life (or 31 weeks post-conceptional age). Although the serum levels of vitamin D or 1-alphahydroxy vitamin D were not determined, it is assumed that the levels of the active metabolite was probably low since clinical, biochemical and radiologic cure of the rickets occurred following its usage.