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Aetiological factors in rickets of prematurity
Insights
Rickets can cause late-onset respiratory distress in very preterm infants. Monitoring for rickets is crucial, especially in infants with pre-eclampsia history or prolonged illness, with vitamin D prophylaxis sometimes indicated.
Area of Science:
- Neonatology
- Pediatric Respiratory Medicine
- Nutritional Pediatrics
Background:
- Very preterm infants (< 32 weeks' gestation) are susceptible to respiratory complications.
- Late-onset respiratory distress can be a challenging diagnosis in preterm neonates.
- Rickets, a condition affecting bone mineralization, can manifest with respiratory symptoms.
Purpose of the Study:
- To investigate the association between rickets and late-onset respiratory distress in very preterm infants.
- To identify potential etiological factors contributing to rachitic respiratory distress.
- To emphasize the importance of monitoring for rickets in high-risk preterm infants.
Main Methods:
- Case-control study design matching preterm infants with late-onset respiratory distress (index cases) to controls.
- Radiological and biochemical assessments to diagnose rickets.
- Analysis of maternal and infant clinical histories, including pre-eclampsia and prolonged illness.
Main Results:
- Rickets was diagnosed in index cases presenting with late-onset respiratory distress.
- A significantly higher incidence of pre-eclampsia was noted in the pregnancies of index cases.
- Prolonged illness, including heart failure from patent ductus arteriosus or prolonged ventilation for apnea, was significant in index cases.
Conclusions:
- Rickets should be considered in the differential diagnosis of late-onset respiratory distress in very preterm infants.
- Maternal pre-eclampsia and prolonged infant illness (e.g., related to patent ductus arteriosus or apnea) are significant risk factors.
- Monitoring for rickets and considering water-soluble vitamin D prophylaxis (e.g., 1 alpha-hydroxy-vitamin D) is indicated in these infants.
Abstract:
Six very preterm (< 32 weeks' gestation) infants who developed late-onset respiratory distress were each matched for sex and gestation with 2 control preterm infants. Radiologically and biochemically the diagnosis of rickets and rachitic respiratory distress seemed clear and the pattern conformed with other reports of the syndrome. The control infants were of similar gastational ages but there was a significantly higher incidence of pre-eclampsia in the pregnancies of index cases. Also significant was a prolonged illness of several weeks' duration in the index cases; this illness was either heart failure due to patent ductus arteriosus or prolonged ventilation in the early weeks of life for apnoeic attacks. Awareness of these 2 aetiological factors shows the necessity of monitoring such infants for evidence of rickets. The use of water-soluble antirachitic prophylaxis such as 1 alpha-hydroxy-vitamin D or 1,25-dihydroxy-vitamin D is sometimes indicated.