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Post-mortem analysis of children in London Hospital – only 1 child had adequate level of vitamin D – July 2014

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.

Pediatr Dev Pathol. 2014 Jul 14. [Epub ahead of print]
Scheimberg I1, Perry L. 1a The Royal London Hospital.

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.

PMID: 25019937


See also VitaminDWiki

Vitamin D deficiency is the cause of most rickets
Rate of rickets is usually < 0.1% of births, unless dark skin or breastfed
Rate of rickets has greatly increased with the drop in vitamin D levels during the past 40 years
400 IU can prevent/treat most rickets (Turkey gave vitamin D to EVERY child)
More than 400 IU may be needed
A low serum level of vitamin D does not indicate rickets
Rate of rickets in some countries varies from 10% to 70% (typically poor health overall)
Rickets was identified 400 years ago and treatments were determined 100 years ago
Rickets is strongly associated with severe breathing problems (weak ribs)
Bowed legs is not the primary indication of rickets (3 other indications of rickets are seen more often)
Vitamin D and Rickets consensus took 80 years

Rickets category has 114 items
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