Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement

Vitamin D deficiency has re-emerged as a significant paediatric health issue, with complications including hypocalcaemic seizures, rickets, limb pain and fracture. A major risk factor for infants is maternal vitamin D deficiency. For older infants and children, risk factors include dark skin colour, cultural practices, prolonged breastfeeding, restricted sun exposure and certain medical conditions. To prevent vitamin D deficiency in infants, pregnant women, especially those who are dark-skinned or veiled, should be screened and treated for vitamin D deficiency, and breastfed infants of dark-skinned or veiled women should be supplemented with vitamin D for the first 12 months of life. Regular sunlight exposure can prevent vitamin D deficiency, but the safe exposure time for children is unknown. To prevent vitamin D deficiency, at-risk children should receive 400 IU vitamin D daily; if compliance is poor, an annual dose of 150,000 IU may be considered. Treatment of vitamin D deficiency involves giving ergocalciferol or cholecalciferol for 3 months (1000 IU/day if < 1 month of age; 3000 IU/day if 1-12 months of age; 5000 IU/day if > 12 months of age). High-dose bolus therapy (300,000-500,000 IU) should be considered for children over 12 months of age if compliance or absorption issues are suspected.     

武汉市孕妇及新生儿维生素D水平的现状调查

目的探讨武汉市孕妇及新生儿维生素D水平,研究孕期维生素D缺乏与新生儿先天性佝偻病的相关性,为孕期补充维生素D提供理论依据。方法膳食调查法研究孕妇食物摄取的维生素D,放免法测定孕妇血清以及新生儿脐血维生素D水平,确定新生儿是否患有先天性佝偻病。结果武汉市孕妇通过食物摄取的维生素D量为(172±56)IU/d。孕妇血清平均维生素D水平为23.7nmol/L,维生素D水平随孕周增加递减。不同季节孕妇维生素D水平为:夏季高于春、秋、冬季。孕妇中维生素D缺乏率为5.7%。新生儿先天性佝偻病的发病率为14%。孕妇分娩前维生素D水平与新生儿先天性佝偻病呈负相关(P<0.05)。结论武汉市孕妇维生素D摄入不足,新生儿先天性佝偻病的发病率较高,孕期应加强维生素D的摄入。     

Congenital rickets presenting with hypocalcaemic seizures

At Ataturk University Hospital, eight infants who presented with hypocalcaemic seizures were subsequently found to have rickets. Their mothers had osteomalacia. Neither mothers nor infants received vitamin D supplementation. Maternal vitamin D deficiency and non-supplementation in the infants were causes of rickets in these patients. It is recommended that neonatal hypocalcaemia may be due to maternal vitamin D deficiency and all unsupplemented vitamin D infants presenting with seizures should be investigated for rickets.     

Northern infant syndrome: a deficiency state?

A syndrome is described that affected 16 Indian and Inuit infants roughly 3 months old, most of whom were born in settlements in the Canadian Arctic. The infants presented with a clinical picture that included hepatitis, hemolytic anemia, rickets and respiratory distress, a combination that resembled a syndrome first described in malnourished infants at the turn of the century by von Jaksch and Luzet. The clinical course was self-limited, and all the infants survived without sequelae. The cause of the syndrome was not determined; no infectious agents were discovered. However, low levels of vitamins A, C, D and E were found in a few infants in whom assays were done. The implications of these findings and their relation to the possible cause of this "northern infant syndrome" are discussed.     

Postnatal evaluation of vitamin D and bone health in women who were vitamin D-deficient in pregnancy, and in their infants

OBJECTIVE: To determine the postnatal vitamin D status and bone health of women identified as vitamin D-deficient in pregnancy, and of their infants. DESIGN AND PARTICIPANTS: Retrospective audit conducted between 27 August and 5 November 2003. The study included women delivering between August and October 2002 at the Royal Women's Hospital, Melbourne, who had had a 25-hydroxyvitamin D (25-[OH]D) level < 30 nmol/L in pregnancy, and their infants at age 4-10 months. SETTING: The outpatient clinic at the Royal Children's Hospital, Melbourne. MAIN OUTCOME MEASURES: Maternal and infant serum levels of vitamin D, total alkaline phosphatase (tALP), parathyroid hormone (PTH), calcium and phosphorus; x-ray results in children with clinical or laboratory findings suggestive of rickets. RESULTS: Of 69 mother-infant pairs invited to participate, 47 (68%) attended. All 47 women had 25-(OH)D levels < 50 nmol/L, and 39 (83%) had levels < 30 nmol/L. Vitamin D supplements had been prescribed in pregnancy for 35 women (74%), and 19/35 reported having taken them as prescribed. None had continued to take supplements postnatally, but one had recently started taking them again. Among 45 infants from whom blood samples were successfully obtained, 18 (40%) had 25-(OH)D levels < 50 nmol/L, and 14 (31%) had levels < 30 nmol/L. Twelve of 16 breastfed infants had 25-(OH)D levels < 30 nmol/L, compared with 2/29 fed formula milk (P = 0.001). CONCLUSIONS: Most mothers who had been vitamin D-deficient in pregnancy were also deficient postnatally, indicating that treatment offered, counselling and/or treatment compliance were inadequate. Their infants, especially if breastfed, were at high risk of vitamin D deficiency and increased bone formation. Breastfed infants of mothers at high risk of vitamin D deficiency should receive vitamin D supplements.     

184例婴儿骨碱性磷酸酶检测结果分析

目的了解佝偻病在婴儿中的患病率及发生佝偻病的原因。方法对184名3～6月的婴儿进行骨碱性磷酸酶(BALP)检测和问卷调查。结果BALP阳性168例,阳性检出率91.3%;体重≥(x s112例(60.9%),3月龄组母乳喂养27例(48.2%),4～6月龄组母乳喂养4个月共有65例(50.8%),合理补充维生素D共128例(69.6%)。结论3～6月婴儿佝偻病患病率较高,与生长发育较快、母乳喂养率低、无合理补充维生素D有关。     

Policy for prevention of Asian rickets in Britain: a preliminary assessment of the Glasgow rickets campaign

Evidence of continuing hospital admissions of patients with Asian rickets and osteomalacia led to a further attempt to provide more effective preventive measures for the Glasgow Asian community. Dose-response studies showed that the equivalent of 10 microgram of vitamin D daily would provide effective prophylaxis, and a general practice survey showed that self-administered vitamin D supplements would reduce the prevalence and severity of Asian rickets. A multidisciplinary working group devised a preventive campaign based on the free issue of vitamin D supplements on demand to children who required them. Supported by a health education programme for community health personnel and the Asian community, the first 16 months of the campaign produced an eight-fold rise in the issue of supplements to older Asian children and a 33% increase in their issue to infants of all ethnic groups. Because more children are receiving vitamin D supplementation the campaign seems likely to reduce the prevalence of Asian rickets in Glasgow.     

小剂量维生素D注射预防维生素D缺乏性佝偻病效果观察

目的观察小剂量维生素D注射预防婴幼儿维生素D缺乏性佝偻病发病效果。方法我院采取小剂量维生素D注射预防婴幼儿维生素D缺乏性佝偻病3年。结果观察组婴幼儿维生素D缺乏性佝偻病发病率(5.01%)较对照组(11.17%)明显下降,而且没有发生中重症病儿。结论应用小剂量维生素D注射预防婴幼儿维生素D缺乏性佝偻病效果显著,值得推广。     

3岁内儿童维生素D缺乏性佝偻病的影响因素

目的 :探讨可能存在维生素D缺乏的3岁内儿童维生素D缺乏性佝偻病发病率、临床特征及影响因素.方法 :483例可疑维生素D缺乏的3岁内儿童根据年龄分为0~12个月组(n=275),13~24个月组(n=136),25~36个月组(n=72),对比三组儿童佝偻病发病率,分析佝偻病临床特点,并探讨其相关因素.结果 :0~12个月组患病率为50.5%,13~24个月组患病率为39.7%,25~36个月组患病率为23.6%,三组比较0~12个月组患病率高于13~24个月组,而13~24个月组患病率高于25~36个月组,差异具统计学意义;0~12个月组维生素D不足和缺乏率为50.5%(139/275),13-24个月组为39.7%(54/136),25~36个月组为23.6%(17/72),差异具统计学意义;儿童佝偻病主要症状与体征为方颅、肋膈沟,发病率45.7%,其次为单纯神经精神症状及枕秃,发病率21.4%,第三为方颅、肋膈沟合并鸡胸、肋串珠,发病率16.7%;母亲孕期营养状况、出生体重、孕周、双胎、喂养方式、正常添加辅食、合理补充维生素D、光照时间、营养不良、肥胖、晒照皮肤面积、家庭经济状况、居住地、留守儿童、母亲文化程度及反复呼吸道感染等方面比较差异均具有统计学意义.结论 :儿童维生素D缺乏性佝偻病发病率相对较高,该病重在预防,而了解其影响因素对于针对性的早期诊断和干预,降低佝偻病的发生率和严重程度均具有重要临床意义.     

Vitamin D deficiency in mothers of infants with rickets

OBJECTIVE: To identify infants treated for vitamin D deficiency rickets, and to determine the incidence of vitamin D deficiency in their mothers and their mothers' country of origin. DESIGN: A retrospective audit of the medical records of children diagnosed with vitamin D deficiency rickets. Inpatients were identified by discharge diagnoses of vitamin D deficiency or hypocalcaemia and outpatients by pharmacy dispensing of cholecalciferol. SETTING: The Women's and Children's Health Care Network and the Southern Health Care Network (Melbourne, VIC) from June 1994 to February 1999. PATIENTS: 55 children with vitamin D deficiency rickets. RESULTS: Fifty-four of the 55 children were born to mothers with ethnocultural risk factors for vitamin D deficiency. Vitamin D status had been assessed in 31 of the 55 mothers (56%): 25 (81%) had 25-hydroxyvitamin D3 concentrations < or = 25 nmol/L, consistent with osteomalacia. CONCLUSION: Vitamin D deficiency continues to occur in children of migrant families. When infants are diagnosed with vitamin D deficiency, vitamin D levels in their mothers and siblings should also be assessed.     

昆明地区妊娠期妇女、婴幼儿维生素D水平分析及妊娠期空腹血糖水平与维生素D水平的关联性

  目的  通过分析昆明地区妊娠期妇女和婴幼儿血清25羟维生素D（25OHD）群体水平,了解当地此类人群维生素D营养状况,同时探究维生素D与妊娠期糖尿病发生风险,为补充维生素D提供合理性建议。  方法  采集正常孕妇婴幼儿血清25OHD检测结果和血糖水平等数据,通过SPSS19.0进行数据分析。  结果  昆明地区妊娠期妇女与婴幼儿血清25OHD的 3a整体水平为（20.41±8.08）ng/mL、（29.14±8.89）ng/mL、（31.67±9.77）ng/mL。2018年至2020年血清25OHD缺乏比例由7.31%减少至0.09%,不足比例由66.7%减少至7.95%。孕妇血清25OHD与其血糖水平存在负相关性。  结论  昆明地区妊娠期妇女与婴幼儿血清25OHD整体水平逐年上升,各年龄段的血清25OHD水平呈现出婴幼儿略高,维生素D水平一定程度上对血糖水平存在影响,孕妇适当补维生素D,以食物和适当光照为主,维生素D制剂为辅,不仅有利于防治缺钙等相关疾病,而且有助于稳定妊娠期妇女血糖水平。     

Comparison of two regimens of vitamin D supplementation for vitamin D-deficient neonates

INTRODUCTION

Vitamin D deficiency is common in pregnant women, and supplementation of vitamin D is necessary for the infants of these women. This study explored the efficacy of an alternative way of vitamin D supplementation in an area with a high prevalence of vitamin D deficiency in mothers.

METHODS

This was a non-randomised clinical trial conducted in 2010 in Yazd, Iran. Full-term healthy infants born to vitamin D-deficient mothers (n = 82) were divided into the high-dose regimen (HDR; single oral bolus 30,000 IU vitamin D₃, n = 34) and the standard-dose regimen (SDR; 400 IU/day vitamin D₃ within two weeks of life, n = 48) groups. 25-hydroxyvitamin D (25OHD) was measured using chemiluminescent immunoassays, and 25OHD level > 20 ng/mL was deemed sufficient.

RESULTS

Over 90% of infants in the HDR group attained vitamin D sufficiency within one month, while comparable sufficiency was reached in the SDR group only after four months. At two months, the proportion of infants attaining 25OHD > 30 ng/mL was 93.3% and 27.9% in the HDR and SDR groups, respectively (p = 0.003). None of our infants achieved 25OHD levels > 100 ng/mL.

CONCLUSION

For infants born to vitamin D-deficient mothers, oral supplementation of 30,000 IU vitamin D₃ during the first month of life, followed by a routine recommended dose of 400 IU/day, should be considered. The four-month lag for attaining vitamin D sufficiency in 90% of infants in the SDR group may have clinical implications and should be further investigated.     

Vitamin D deficiency in veiled or dark-skinned pregnant women

OBJECTIVES: To determine the vitamin D status of veiled or dark-skinned pregnant women, because of their known increased risk of vitamin D deficiency. DESIGN: An audit of vitamin D status. SETTING: An antenatal clinic in a major metropolitan teaching hospital, Melbourne, Victoria. PARTICIPANTS: Pregnant women attending the clinic who agreed to be screened. MAIN OUTCOME MEASURES: Serum 25-hydroxyvitamin D3 (25OHD3) level at first visit to the antenatal clinic. RESULTS: Of 94 women, 82 were screened. Sixty-six women (80%) had 25OHD3 values below the test reference range (22.5-93.8 nmol/L). CONCLUSIONS: Our findings are a cause for concern, because vitamin D deficient women are at risk of bone disease and their children at risk of neonatal hypocalcaemia and rickets.     

Relationships between radiological and biochemical evidence of rickets in Asian schoolchildren

One hundred Asian schoolchildren provided evidence of the relationships between radiological and biochemical evidence of rickets in a vitamin D-deficient population. In a retrospective study of the X-rays of 56 children the variables serum alkaline phosphatase, inorganic phosphorus and age provided a discriminant function which correctly classified 10 of 11 children with radiological evidence of rickets and 44 of 45 children with negative or marginally abnormal X-rays. When the discriminant function was applied to a prospective study of 44 children, three children with radiological evidence of rickets were correctly classified together with 38 of the remaining 41 children with negative or marginally abnormal X-rays. Serum alkaline phosphatase was the most important variable in the discriminant analysis, followed by serum inorganic phosphorus and age. Low levels of serum 25-hydroxy vitamin D (25-OHD) are of little value in predicting the severity of radiological evidence of rachitic bone disease in a vitamin D-deficient population.     

妊娠妇女血清叶酸、维生素B12水平的测定及其临床意义

目的　研究正常妊娠妇女血清叶酸、维生素B1 2 水平的变化及其临床意义。方法　检测 62例正常妊娠妇女和 3 8例正常非妊娠妇女的血清叶酸、维生素B1 2 水平。结果　妊娠妇女血清叶酸水平明显低于非妊娠妇女 (P<0 .0 1) ,妊娠妇女血清维生素B1 2 水平明显低于非妊娠妇女 (P <0 .0 5 )。结论　妊娠妇女体内缺乏叶酸和维生素B1 2 ,妇女在妊娠期应补充足量的叶酸和维生素B1 2 。     

维生素D受体基因多态性与婴幼儿佝偻病的相关性

目的研究维,圭素D受体fVDR）基因Apal位点多态性与婴幼儿佝偻病的相关性,探讨其遗传易感性,为临床早期诊断治疗提供理论依据。方法采用病例对照研究方法,选择确诊的佝偻病患儿56例和正常婴幼儿76例作为研究对象。应用聚合酶链反应-限制性片段长度多态性分析检测VDR基因ApaI位点的多态性,比较两组之间的VDR基因型频率、等位基因频率以及VDR基因型中相关指标的相关性。结果病例组VDR基斟ApaI位点基因型分布频率AA为14．3％、Aa为46．4％、aa为39．3％,对照组AA为13．3％,Aa为50％,aa为36．8％,两组之间差异无统计学意义;病例组VDR基因ApaI位点等位基因分布频率A为37．5％,a为62．5％,对照组A为38．2％,a为61．8％,两组之间差异无统计学意义;两组之间VDR基因ApaI位点不同基因型之间血清钙水平不同（x2=6．719,P〈0．05）。结论VDR基因ApaI基凶型与血清钙水平有相关性,VDR基因ApaI酶切位点的多态性与婴幼儿佝偻病无相关性。     

高剂量维生素D防治肥胖症孕妇妊娠期糖尿病的作用研究

目的 探讨孕期预防性给予高剂量维生素D (VD)对肥胖症孕妇妊娠期糖尿病的防治作用。 方法 选择2016年6月—2017年6月于温州市中西医结合医院初产、单胎肥胖孕妇118例,随机分为试验组和对照组,每组各59例。试验组于孕16～20周给予维生素D₃注射液30万IU,肌肉注射。对照组于孕16～20周给予VD滴剂胶囊400 IU (1粒),口服,每日1次。比较2组一般资料、25(OH) D₃、甲状旁腺激素(PTH)、血钙(Ca)、血磷(P)、糖化血红蛋白(HbA1c)及BMI等临床相关指标及维生素D缺乏的改善情况、妊娠期糖尿病的发生情况及妊娠结局。 结果 经干预后,试验组25(OH) D₃和血清Ca较治疗前显著升高,PTH浓度显著下降(P<0.01)。试验组在治疗后维生素D缺乏和不足患者的比率均显著下降(P<0.01)。而对照组治疗后缺乏和不足患者的比率虽略有下降,但与治疗前比较,差异不具有统计学意义(P>0.05)。试验组孕妇GDM的发生平均孕周显著晚于对照组(P<0.01),孕妇GDM的发生率均显著低于对照组(P<0.05)。试验组顺产率显著高于对照组、剖宫产率显著低于对照组(P<0.01)。试验组新生儿死胎、新生儿窒息、早产儿、巨大儿的发生率显著低于对照组(P<0.05)。 结论 通过单次负荷剂量治疗可有效改善肥胖孕妇VD缺乏状态,安全性较好,可有效降低肥胖孕妇GDM的发生率,降低剖宫产率,减少不良妊娠结局的发生风险,这可能与VD有效调节了肥胖患者的体脂分布,降低了胰岛素抵抗,减少了妊娠期糖尿病的发生风险有关。      

婴幼儿期反复呼吸道感染与维生素D缺乏性佝偻病的关系

目的探讨婴幼儿期反复呼吸道感染与维生素D缺乏性佝偻病的关系。方法选自2004年6月至2005年5月，本院儿科门诊及住院患者中，年龄≤3岁，符合反复呼吸道感染诊断标准的患者共53例作为观察组，同时选取同期年龄分布与观察组无差别的非反复呼吸道感染患者共86例，作为对照组，作临床评估及BAIP检查，必要时作腕骨X线摄片检查。依据病史，临床表现，结合BALP，判定有无佝偻病及是否为维生素D缺乏亚临床状态。结果观察组中佝偻病患病率明显高于对照组，维生素D缺乏亚临床状态发生率高于对照组，差异有显著性（X^2=15．0315，P〈0．01）。结论婴幼儿期反复呼吸道感染，与维生素D缺乏性佝偻病及维生素D缺乏亚临床状态有关，对于婴幼儿期反复呼吸道感染的患者，在诊治过程中应注意佝偻病的防治。     

Evidence-based guidelines for universal counselling and offering of HIV testing in pregnancy in Canada

OBJECTIVE: To provide Canadian health care workers with evidence-based guidelines for universal counselling about HIV testing and the offering of such testing to all pregnant women. OPTIONS: Universal counselling and offering of HIV testing to all pregnant women versus targeted testing of only pregnant women at high risk for HIV infection. Antiretroviral treatment protocols for HIV-positive mothers and their infants are discussed as the intervention to reduce mother-to-child transmission rates. OUTCOMES: Main outcomes are mother-to-child HIV transmission rates and consequences of HIV testing on the mother and infant. EVIDENCE: Articles published from January 1985 to March 1997 identified through a MEDLINE search; articles published in pertinent medical journals in 1996 and 1997 identified through a manual search; and abstracts presented at international HIV/AIDS conferences. BENEFITS, HARMS AND COSTS: Early diagnosis of HIV infection in a pregnant woman optimizes her medical and psychosocial care, decreases the incidence of mother-to-child transmission and decreases the risk of horizontal transmission to sexual partners. New, third-generation HIV tests have reduced false-positive rates and thus diminished the harm of screening. RECOMMENDATIONS: A screening strategy consisting of universal counselling and offering of HIV testing is recommended for all pregnant women in Canada (grade B recommendation). Targeted testing of only pregnant women at high risk for HIV infection fails to identify a substantial proportion of HIV-positive pregnant women and is therefore not recommended (grade D recommendation). Women who identify themselves as being at high risk and whose initial HIV test result is negative should be counselled about the reduction of high-risk behaviours and retested in 6 months (grade B recommendation). Treatment of seropositive women and infants with zidovudine to prevent mother-to-child transmission is recommended (grade A or B recommendation depending on gestational age and CD4 count). VALIDATION: These guidelines are endorsed by the Canadian Pediatric AIDS Research Group and are in agreement with the recommendations of the Canadian Paediatric Society and the US Public Health Service Task Force.     

Rickets of prematurity: a case report.

A case report is given, and an attempt made to summarize our knowledge about this disorder. An extremely premature infant (birth weight 750 grammes) developed progressive rickets resulting in fractures despite phosphate, calcium and calciferol (vitamin D) supplementation. The patient had mild respiratory distress syndrome but later developed broncopulmonary dysplasia. Initial biochemical evidence of rickets occurred by the 6th week of post-natal life (or 31 weeks post-conceptional age). Although the serum levels of vitamin D or 1-alphahydroxy vitamin D were not determined, it is assumed that the levels of the active metabolite was probably low since clinical, biochemical and radiologic cure of the rickets occurred following its usage.