Vitamin D deficiency rickets in breast-fed infants presenting with hypocalcaemic seizures

Area of Science:

• Pediatrics
• Endocrinology
• Nutritional Science

Background:

• Rickets, a condition causing bone deformities, is a significant concern in infants.
• Hypocalcaemic seizures in infants can be a symptom of underlying metabolic disorders like rickets.
• Breastfeeding is crucial for infant nutrition but can pose risks if maternal nutrient status is inadequate.

Purpose of the Study:

• To investigate the prevalence and causes of rickets in infants presenting with hypocalcaemic seizures.
• To assess vitamin D levels in mothers and infants with rickets.
• To determine the role of maternal and infant vitamin D supplementation in the development of rickets.

Main Methods:

• Retrospective analysis of 65 infants with hypocalcaemic seizures diagnosed with rickets at Aga Khan Hospital.
• Analysis of feeding patterns, focusing on breastfeeding duration.
• Biochemical assessment of plasma 25(OH) vitamin D levels in a subgroup of 15 mothers and their infants.

Main Results:

• 65 infants presented with hypocalcaemic seizures and rickets.
• 46 infants under 6 months were totally or predominantly breastfed.
• Very low maternal and infant plasma 25(OH) vitamin D levels (< 5 µg/L and 7.5 ± 3.3 µg/L) were found in supplemented mothers and infants.

Conclusions:

• Maternal vitamin D deficiency and lack of infant supplementation are likely causes of rickets in this cohort.
• Prophylactic vitamin D supplementation is recommended for pregnant/lactating women and infants up to 2 years.
• Public health initiatives should focus on vitamin D supplementation to prevent infant rickets.