ESPE Abstracts

Background: Nutritional rickets (NR) is the most common growing bone disease, and vitamin D deficiency (VDD) may predispose to other diseases (diabetes mellitus, cancer, and multiple sclerosis). Maternal VDD and exclusive breastfeeding without supplementation are the most frecuent causes of NR in the neonate. VDD is still a problem in Europe. There are few reports of maternal hypovitaminosis D and rickets in bottle-fed infants during early infancy. We report a case of Nutritional Rickets in a bottle-fed baby at 2 months of age.

Case report: A 2-month-old boy referred for irritability, episodes of hypertonia, cianosis and eye movements of 20–30 s of duration. Mother born in Philippines (1 year in Europe). Normal delivery at term. Adecuate pregnancy follow-up. BW 2660 g. Little sun exposure. She took vitamins. Bottle feeding since the 1st month of life, with intake of vitamin D 200 UI daily. Physical exam: BW, BL, and HC p25. Dry skin, sparse, fine hair, craniotabes, hyperexcitability, hypertonia, wide fontanel, enlargement of wrists, and frontal bossing. Blood test: (CaT 6.8 mg/dl (8.2–10.8), I.Calcio 0.79 mmol/l (1.12–1.23), and normal phosphoremia. Hyperparatiroidism (PTH: 329 pg/ml) and 25-OH-vitamin D (9.08 ng/ml). Hypocalciuria. X-ray: ‘radiolucent’ line in distal ulnar region, expansion and irregularity of the metaphyseal margin, brush-like appearance, cupping of distal region of femur, tibia, fíbula, radius, ulna and proximal of tibia and fibula, and general osteopenia. We started endovenous calcium and vitamin D3. Serum calcium is normal at the 4th day. Recuperation physical and radiological. Maternal blood test: calcium 10.3 mg/dl (8.5–10.5), phosphorus 3.1 mg/dl (2.6–4.8), intact PTH 86 pg/ml (10.0–65.0), and 25-OH-vitamin D 14.2 ng/ml. She started also treatment with vitamin D 800 UI+1000 mg calcium.

Conclusion: Control of calcium levels and vitamin D intake in the pregnant woman should be an important objective during pregnancy, to avoid clinical and radiologic anomalies in the neonate.