A syndrome of subacute respiratory distress, severe metabolic bone disease affecting the thoracic cage, and mild cholestasis occurred in 4 small preterm infants during the first three months of life and was associated with considerable morbidity. The early radiological features in the chest resembled thos of the Mikity-Wilson syndrome, with which the disorder may be confused. After spontaneous improvement in hepatic function 3 of the infants fully recovered. The fourth died of paralytic ileus. Various nutritional and absorptive abnormalities probably contribute to the pathogenesis of the bone disorder in this syndrome. The best prophylaxis might be to supplement the diet with 25-hydroxyvitamin D rather than native vitamin D.
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