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Rickets of prematurity- a case report
E A Adejuyigbe1, O C Famurewa, T Adegboyega
1Department of Paediatrics and Child Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.
Insights
Rickets of prematurity can affect very low birth weight infants in Nigeria, even with vitamin D supplementation. This case highlights mineral deficiency as a key factor in breastfed premature neonates.
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.
Objective:
This case report seeks to create awareness of the aetiology of rickets of prematurity among very low birth weight infants in Nigeria
Methods And Result:
This is a case report of an 800 gramme premature male neonate delivered by caesarean section at 28 weeks gestation following severe maternal pre-eclampsia. The infant was hospitalised for sixty days and fed exclusively on his mother's breast milk for seven months. He had two episodes of sepsis and was transfused twice while on admission. He was on Abidec drops, which contained 400 IU/0.6 ml of vitamin D from the age of two weeks. He defaulted from the follow up clinic at postnatal age of 16 weeks only to reappear at 30 weeks postnatal age with overt clinical, biochemical and radiologic signs of rickets. He responded well to calcium and phosphate supplementation.
Conclusion:
This case highlights the role of mineral deficiency in the aetiology of rickets of prematurity in very low birth weight infants fed with their mothers' breast milk.
