Does Low Vitamin D Have a Role in Pediatric Morbidity and Mortality? An Observational Study of Vitamin D in a Cohort of 52 Postmortem Examinations

Pediatric and Developmental Pathology (Impact Factor: 0.87). 07/2014; 17(6). DOI: 10.2350/14-05-1491-OA.1
Source: PubMed


Abstract Vitamin D is required for calcium absorption and normal bone mineralization; it has a key role in immune regulation against infections and is believed to be involved in immunomodulation in asthma. We did a retrospective analysis of 52 post-mortem cases (aged 2 days to 10 years). 17 children had vitamin D deficiency (<25nmol/L); 24 children had vitamin D insufficiency (25-49nmol/L); 10 children had suboptimal vitamin D levels (50-79nmol/L) and only 1 child had adequate levels ({greater than or equal to}80nmol/L). Three infants had fractures. Growth plate histology was abnormal in 10 cases with vitamin D deficiency (59%) but radiology was abnormal in only 3 of those cases. Eight infants (33%) with vitamin D insufficiency had abnormal histology but radiology was normal in all cases. In 3 children vitamin D deficiency was considered accountable for death; they all showed radiological and histological rickets: 2 babies had cardiomyopathy and a 3 year old had hypocalcemic seizures. Children from all ethnic groups had a high proportion of low vitamin D levels. Conclusions: Vitamin D deficiency (the most common form of pediatric metabolic bone disease) is preventable and treatable. Severe rickets combined with profound hypocalcemia can cause unexpected death in babies and young children. Measuring serum vitamin D levels post-mortem may provide invaluable information on sudden unexplained death in 'at risk' children. Vitamin D deficiency may be relevant in children asthma and with multiple infections and in babies with bone fractures. Post mortem vitamin D levels are stable and easy to measure.

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    • "The use of radiographic abnormalities to diagnose rickets may not be as clear cut as is generally thought. Scheimberg and Perry recently published their findings on an autopsy study of 52 children who had died in hospital [14]. Twenty of the 52 autopsies revealed histological abnormalities at the growth plate in keeping with but milder than those characteristically noted in rickets. "
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    ABSTRACT: Concern has been expressed about the rising incidence of nutritional rickets with its associated long-term sequelae in children globally. In order to address the condition worldwide, it is imperative that accurate figures of its incidence are available particularly in at-risk communities. In order to obtain these figures, various screening tools and diagnostic criteria have been used with no standardization of methodologies, resulting in varying prevalences which may under- or over-estimate the prevalence depending of the techniques used. This review discusses the advantages and disadvantages of various screening tests used to diagnose rickets in communities. Clinical signs characteristic of rachitic deformities have been used extensively, but are likely to over-estimate the prevalence and are dependent on the clinical skills of the observer. Biochemical tests such as alkaline phosphatase and 25-hydroxyvitamin D have also been proposed. There is no consensus on the usefulness of alkaline phosphatase as a screening tool, while there is general agreement that the measurement of vitamin D status is unhelpful in screening for rickets. Finally, the confirmation of the presence of active rickets in suspected infants and children is dependent on radiographic findings, although these may be less helpful in adolescents whose growth plates might be closed or nearly so. In order to obtain uniformity in screening for rickets globally, the is a need for consensus among public health specialists, paediatric endocrinologists and those interested in paediatric bone disease as to the best methods to be employed to determine the prevalence of rickets, particularly in communities with limited resources.
    The Journal of steroid biochemistry and molecular biology 09/2015; DOI:10.1016/j.jsbmb.2015.09.008 · 3.63 Impact Factor
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    • "This limitation of radiology is particularly true of children under the age of one year [2] [16] [17]. Histological evidence of rickets is often present in the absence of radiological abnormalities [18] [19] [20]. It is likely that fractures due to rickets are more frequent than the number of reported cases would suggest. "
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    ABSTRACT: While the bone deformities classically associated with rickets have been recognised for many years, the fact that fractures also occur has been less well appreciated. In fact an association with fractures has been reported since the nineteenth century. This chapter summarises the published reports of fractures in rickets due to vitamin D deficiency. It is clear that fractures often occur spontaneously, may be asymptomatic and may be multiple. While the reported cases were identified because of the finding of radiological evidence of rickets it is important to recognise that rickets may occur without radiological abnormality. Fractures due to rickets are likely to be more frequent than the modest number of cases would suggest. The chapter reviews published reports on fracture risk associated with vitamin D deficiency. It also reviews fractures in forms of rickets not due to vitamin D deficiency and emphasises the differential diagnosis of fractures in young children.
    Bone disorders: Screening and Treatment, Edited by A M Stone, 01/2015: chapter 7: pages 127 - 135; Nova Science Publishers, New York., ISBN: 978-1-63482-155-1
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    ABSTRACT: Purpose: The bone changes of vitamin D deficiency rickets have been invoked as an alternate explanation for child-abuse related fractures identified through medical imaging. The lack of modern histopathologic comparisons between these two entities limits the abilities of the forensic pathologist to address this differential diagnosis, both in their autopsy reports and on the witness stand. Methods: We report a comparison of the histologic appearance of the bones in a two year old child with vitamin D deficiency rickets with fractures occurring in three young children with child abuse. Results: In the case of rickets, there was marked architectural disorganization of endochondral ossification at the costochondral junctions and growth plates of long bones. The child abuse-related fractures showed osteochondral callus at different stages of healing, either centered on a discrete fracture line or at metaphyses (e.g. classical metaphyseal lesions). In many instances, the healing fractures disrupted the line of endochondral ossification. In none of the child abuse-related fractures was there any similarity to the histologic appearance of rickets. Conclusion: The maturation disturbance in the growth plate that occurs in rickets is a distinctive entity that cannot be confused histologically with healing fractures, including the classical metaphyseal lesion.
    Forensic Science Medicine and Pathology 01/2015; 11(1). DOI:10.1007/s12024-014-9639-3 · 1.98 Impact Factor
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