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Nutritional rickets in 2 very low birthweight infants with chronic lung disease
Insights
Very low birthweight infants with rickets may develop bone undermineralisation due to factors like frusemide and low calcium intake. Ensuring daily vitamin D supplements is crucial for at-risk infants.
Area of Science:
- Pediatrics
- Neonatology
- Nutritional Science
Background:
- Rickets is a significant concern in very low birthweight (VLBW) infants.
- Bone undermineralisation can arise from multifactorial causes in this vulnerable population.
Observation:
- Two VLBW infants presented with rickets, one exhibiting low 25-hydroxy-vitamin D3 levels.
- Both infants had low birthweights, low calcium intake, and uncertain vitamin D status.
- Chronic use of frusemide and sodium bicarbonate was noted in both cases, alongside resolution of chronic lung disease prior to rickets treatment.
Findings:
- Frusemide and sodium bicarbonate, alongside nutritional deficiencies, are potential contributors to bone undermineralisation in VLBW infants.
- The clinical course suggests a complex interplay of factors leading to rickets development.
Implications:
- Clinicians should exercise caution when administering frusemide and sodium bicarbonate to VLBW infants at risk for rickets.
- Routine and adequate daily vitamin D supplementation is essential for preventing rickets in high-risk infant populations.
Abstract:
Two very low birthweight infants with rickets are described; one had a low serum 25-hydroxy-vitamin D3 concentration. Similarities in their clinical courses included low birthweights, low calcium intakes, uncertain vitamin D intakes, and chronic administration of frusemide and sodium bicarbonate--all potential aetiological factors in the development of bone undermineralisation. Both infants had a resolution of their chronic lung disease before their treatment for rickets. This experience has led us to the more cautions use of frusemide and sodium bicarbonate in infants at risk for rickets, and shows the need to ensure daily vitamin D supplements.