Frequency of Nutritional Rickets in Breastfed Babies

Munazza  Hayat; Muhammad  Sajid; Naveed  Akbar; Sana  Sarwar; Maria  Iftikhar; Zahid Iqbal Sahi

doi:10.29054/apmc/2020.832

Munazza Hayat Department of Pediatrics, Sir Ganga Ram Hospital Lahore, Lahore-Pakistan
Muhammad Sajid Department of Pediatrics, Sheikh Zayed Medical College, Rahim Yar Khan-Pakistan
Naveed Akbar Department of Pediatrics Fatima Jinnah Medical University, Lahore-Pakistan
Sana Sarwar Department of Pediatrics, Sir Ganga Ram Hospital Lahore, Lahore-Pakistan
Maria Iftikhar Department of Pediatrics, Sir Ganga Ram Hospital Lahore, Lahore-Pakistan
Zahid Iqbal Sahi Department of Pediatrics Fatima Jinnah Medical University, Lahore-Pakistan

DOI: https://doi.org/10.29054/apmc/2020.832

Keywords: Breastfed, Nutritional Rickets, Socioeconomic Status

Abstract

Background: Rickets is associated with biochemical abnormalities, bone deformities, impaired growth, developmental delays, and, late in the course of the disease, seizures. Several factors are thought to play a role in the rising incidence, including increased prevalence of prolonged breast-feeding, maternal vitamin D deficiency, limited sunlight exposure and poor utilization of vitamin D supplements. Objective: To determine the frequency of nutritional rickets in breastfed babies. Study Design: Descriptive Cross-Sectional study. Settings: Department of Pediatrics, Sir Ganga Ram Hospital, Lahore. Duration: From March 03, 2015 to September 02, 2015. Methodology: A total of 200 cases were included in the study. Nutritional rickets was assessed on X-ray wrist and venous blood sample was taken in an aseptic environment for measuring alkaline phosphatase by taking 1 ml of blood and sent to the laboratory to be assessed on semi-automated micro-lab 300. Nutritional rickets was labeled as per operational definition. Results: Mean age of infants was 9.5+2.1 months. Mean gestational was 38.11±1.05 weeks. In these 200 cases 134 (67.0%) were male and 66 (33.0%) female. While assessing the radiological signs of rickets it was noted that frequencies of radiological findings were as follows: metaphyseal fraying of distal radius/ulna 29 (14.5%), metaphyseal cupping of distal radius/ulna 57 (28.5%) and widening of distal end of metaphysis corresponding to thickened wrists or rachitic rosary 52 (26.0%). Clinical findings were: frontal bossing 111 (55.5%), fontanel widening >2.5 cm 74 (37.5%), wrist widening 108 (54.0%) and rachitic rosary 13 (6.5%). Positive biochemical findings were seen in 6 patients (3.0%). Malnutrition was present in 98 infants (49.0%). Conclusion: The study demonstrated Nutritional rickets was present in 36% of the breast-fed infants. Factors like low socioeconomic status and no formal education in this study were clearly associated with effected cases.