Aim To estimate the incidence of infantile hypocalcaemia caused by vitamin D deficiency and to improve diagnosis, prevention and treatment.
Methods Retrospective case note review of infants younger than 1000 days of age presenting to two Hospitals in North London with severe hypocalcaemia (serum corrected calcium less than 1.8 mmol/') secondary to vitamin D deficiency (total plasma 25-hydroxyvitamin D less than 12.5nmol/') over an 18 month period. The hospitals serve a population of approximately 18 000 infants younger than 1000 days.
Results 50 infants with severe hypocalcaemia were identified. 16 of these were secondary to vitamin D deficiency. This gives an incidence rate of approximately 6 per 10 000 infants per year. All the vitamin D deficient children were of Asian origin, under 1 year of age, exclusively breastfeeding and had secondary hyperparathyroidism. Of mother-infant pairs, 60% of infants were deficient if they had a deficient mother. The commonest clinical presentation was with afebrile seizures, but nearly 20% had seizures which satisfied criteria for a ‘simple febrile seizure’ and three children presented with clinical and radiological rickets.
Conclusion Vitamin D deficiency continues to be a problem among the population in London. This study should support the move towards wider Vitamin D supplementation, at least among groups at risk of Vitamin D deficiency such as Asian children. Hypocalcaemic seizures may masquerade as ‘simple febrile seizures’ and blood investigations may be warranted, despite the standard paediatric teaching tradition of not referring or investigation typical simple febrile convulsions.
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