PT  - JOURNAL ARTICLE
AU  - Priscilla Julies
AU  - Richard M Lynn
AU  - Karina Pall
AU  - Marina Leoni
AU  - Alistair Calder
AU  - Zulf Mughal
AU  - Nick Shaw
AU  - Ciara McDonnell
AU  - Helen McDevitt
AU  - Mitch Blair
TI  - Nutritional rickets under 16 years: UK surveillance results
AID  - 10.1136/archdischild-2019-317934
DP  - 2020 Jun 01
TA  - Archives of Disease in Childhood
PG  - 587--592
VI  - 105
IP  - 6
4099  - http://adc.bmj.com/content/105/6/587.short
4100  - http://adc.bmj.com/content/105/6/587.full
SO  - Arch Dis Child2020 Jun 01; 105
AB  - Objective The UK national incidence of nutritional rickets is unknown. We aimed to describe the incidence, presentation and clinical management of children under 16 years with nutritional rickets in the UK presenting to secondary care.Methods Prospective data were collected monthly between March 2015 and March 2017 from 3500 consultant paediatricians using British Paediatric Surveillance Unit methodology. Clinicians completed online clinical questionnaires for cases fitting the surveillance case definition.Results 125 cases met the case definition, an annual incidence of 0.48 (95% CI 0.37 to 0.62) per 100 000 children under 16 years. 116 children were under 5 years (annual incidence of 1.39 (95% CI 1.05 to 1.81) per 100 000. Boys (70%) were significantly more affected than girls (30%) (OR 2.17, 95% CI 1.25 to 3.78). The majority were of Black (43%) or South Asian (38%) ethnicity. 77.6% of children were not taking vitamin D supplements despite being eligible. Complications included delayed gross motor development (26.4%), fractures (9.6%), hypocalcaemic seizures (8%) and dilated cardiomyopathy (3%). Two children died (1.6%). In eight cases, rickets was confirmed radiologically and biochemically [raised serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) levels ] but were excluded from the incidence analysis for not meeting the case definition of 25-hydroxyvitamin D of <25 nmol/L.Conclusion The incidence of nutritional rickets in the UK is lower than expected. Serious complications and unexpected deaths, particularly in Black and South Asian children under 5 years, occurred. Both vitamin D deficiency and dietary calcium deficiency are role players in pathogenesis. Uptake of vitamin D supplementation remains low.