All of them present similar clinical and biochemical manifestations of rickets such as findings related to hypocalcemia (irritability, fatigue, muscle cramps, seizures) and rickets (craniotabes, delayed closure of fontanelles, frontal bossing, enlarged wrists, bowed legs, short stature, and bone pain) (Table 1) (1,4).
The first observed findings in bone and joints include deformities such as craniotabes, metaphyseal enlargement, prominence of costochondral joints (rachitic rosary), delayed closure of the anterior fontanel, Harrison's grooves and thoracic anomalies (1,26).
A repeat physical exam and X-rays failed to show any craniotabes
, widened sutures, rachitic rosary, or enlarged wrists.
Clinical signs are stunting of growth, softening of the skull (craniotabes
), prominence of the suture lines (hot-cross bun) and prominence of frontal bones (frontal bossing).
His research on 1,120 newborns found that 22% had, at age five to seven days, craniotabes (softening of the skull bones).
Yorifuji, "Until more research is done on the effects of perinatal vitamin D deficiency, we suggest treating breastfed infants with craniotabes with vitamin D, or preferably, treating all pregnant women with vitamin D."
Symptomatic vitamin D deficiency manifests as craniotabes, rickety rosary, swelling of the ends of long bones, frontal bossing of the skull, hypocalcaemic seizures or tetany and slow motor development.
Clinical signs of rickets (rachitic rosary and craniotabes) were observed in one of these 13 infants whereas radiological features in only two of them.
Vitamin D deficiency, often seen in preterm infants fed only breast milk, is the cause of rickets, which is marked by osteomalacia, bowed legs, craniotabes
, rachitic rosary, anorexia, bone pain, fractures, weakness, and delayed tooth eruption.
* Pronounced craniotabes
, benign congenital thinness on the top and back of the skull in infancy.
High-dose vitamin D therapy indications for all newborns and infants consist of a 25-hydroxy vitamin D [25(OH)D] level <15 ng/mL, an elevated serum alkaline phosphatase levels in addition to a serum 25(OH)D level of <15 ng/mL, and presence of craniotabes
in addition to a serum 25(OH)D level <15 ng/mL.