ICCBH2017 Poster Presentations (1) (209 abstracts)
Nutritional rickets presenting to secondary care in children (<16 years) -- A UK surveillance study
Priscilla Julies 1 , Karina Pall 2 , Richard Lynn 2 , Alistair Calder 8 , Zulf Mughal 3 , Nicholas Shaw 4 , Ciara McDonnell 6 , Helen McDevitt 5 & Mitchell Blair 7
1Royal Free Hospital, London, UK; 2British Paediatric Surveillance Unit, London, UK; 3Royal Manchester Children’s Hospital, Manchester, UK; 4Birmingham Children’s Hospital, Birmingham, UK; 5Royal Hospital for Sick Children Glasgow, Glasgow, UK; 6Children’s University Hospital, Dublin, Ireland; 7Northwick Park Hospital, London, UK; 8Great Ormond Street Hospital, London, UK.
Objectives: Rickets is a disease of growing children with potentially serious short and long-term complications. The United Kingdom (UK) national incidence of Nutritional Rickets(NR) is unknown and thought to be increasing. This study aims to describe the incidence, presentation and clinical management of children with NR in the UK and Republic of Ireland.
Methods: Data is being collected prospectively monthly between March 2015 and March 2017 from 3500 paediatricians using British Paediatric Surveillance Unit reporting methodology.
Results: During 22 months of surveillance, 89 cases met the case definition. Table 1 shows demographic and clinical findings. There was little difference by sex. Most were young children, of African and South Asian ethnicity and on solids with dairy. At the time of diagnosis 84% of children were not receiving vitamin D supplements. Cows milk protein allergy and/or multiple food allergies (10%; 9/89) and iron deficiency (7%; 6/89) were the commonest associated conditions. Bony (wrist swelling, bowed legs) and radiological abnormalities were the commonest presentation. Eight children (9.2%) had associated fractures. All confirmed radiological cases had either high parathyroid hormone and/or low phosphate. One child died of dilated cardiomyopathy. There is huge variability in management practices of Vitamin D deficiency amongst clinicians.
| Sex (n=89) | n | % |
| Male | 46 | 52 |
| Female | 42 | 48 |
| Ethnicity (n=89) | ||
| African | 27 | 30 |
| Arab | 2 | 2 |
| Caribbean | 6 | 7 |
| South Asian | 32 | 35 |
| Other Asian background | 3 | 3 |
| Other Black/African/Caribbean background | 7 | 8 |
| Other White background | 5 | 6 |
| Other mixed/multiple ethnic background | 5 | 6 |
| Not known | 3 | 3 |
| Age at Presentation (n=89) | ||
| <1 year | 22 | 20 |
| 1–5 years | 61 | 69 |
| 5–15 years | 8 | 9 |
| Feeding practices (n=84) | ||
| Exclusively breastfeeding | 15 | 18 |
| Exclusively formula fed | 1 | 1 |
| Mixed | 8 | 10 |
| Solids (with dairy n=50) | 60 | 71 |
| 42 | 84 | |
| Clinical Presentation (n=89) | ||
| Bony Sign (in 8, the only abnormality) | 69 | 85 |
| Radiological Abnormalities | 65 | 73 |
| Neuromuscular Abnormalities | 40 | 45 |
| Incidental Blood test or X-ray | 13 | 15 |
Conclusions: Interim findings are that NR continues to affect children in the UK with serious sequelae. Uptake of vitamin D supplementation remains low and constitutes a failure of current public health guidance and policy. We recommend performing both radiological and biochemical tests for accurate case ascertainment. This surveillance of NR will provide robust and current data to inform UK national policy on management of this preventable condition.
Disclosure: The authors declared no competing interests.
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