Rickets of prematurity- a case report.

Area of Science:

• Neonatology
• Pediatric Endocrinology
• Nutritional Science

Background:

• Rickets of prematurity is a significant concern in very low birth weight (VLBW) infants.
• Exclusive breastfeeding, while beneficial, can pose challenges in meeting the high nutritional demands of premature neonates.
• Understanding the aetiology is crucial for timely intervention and prevention strategies.

Observation:

• A case of an 800-gram premature male neonate (28 weeks gestation) born via C-section due to severe pre-eclampsia.
• The infant received exclusive breastfeeding for seven months, experienced two sepsis episodes, and was supplemented with vitamin D drops (400 IU/0.6 ml) from two weeks of age.
• The infant presented at 30 weeks postnatal age with clinical, biochemical, and radiological signs of rickets after defaulting from follow-up.

Findings:

• The patient developed overt signs of rickets despite vitamin D supplementation, suggesting a potential role for other mineral deficiencies.
• Biochemical and radiological assessments confirmed rickets, which subsequently responded well to calcium and phosphate supplementation.
• This case underscores the complex interplay of factors contributing to rickets of prematurity.

Implications:

• Highlights the critical need for monitoring mineral status (calcium, phosphate) in VLBW infants, particularly those exclusively breastfed.
• Suggests that standard vitamin D supplementation may not be sufficient to prevent rickets in all VLBW infants, emphasizing the importance of adequate mineral intake.
• Informs clinical practice regarding the aetiology and management of rickets of prematurity in resource-limited settings like Nigeria.