Vitamin D Deficiency Linked to Pediatric Deaths

Vitamin D is essential for absorbing calcium and for calcium metabolism. In newborns and young children, vitamin D deficiency, especially when accompanied by hypocalcemia, can cause unexpected death. Studies suggest that there is also a correlation between vitamin D deficiency, early childhood asthma, and children with multiple infections. Finally, lack of vitamin D may cause bone fractures. Receiving the right levels of calcium begins in the womb and continues through birth and development, so the mother’s intake is as important as the child’s after birth.

The article “Does Low Vitamin D Have a Role in Pediatric Morbidity and Mortality? An Observational Study of Vitamin D in a Cohort of 52 Postmortem Examinations,” in the journal Pediatric and Developmental Pathology presents data from 2009 to 2012, examining 183 cases of death in children between the ages of 2 days to 10 years.¹ Vitamin D status was known and examined in 51 of these cases. Along with blood samples, X-rays were also taken to examine for fractures. Cases were classified into 4 categories: vitamin D deficiency (VDD), vitamin D insufficiency (VDI), vitamin D suboptimal (VDS), and vitamin D adequate or normal (VDN).

Seventeen children were seen to be VDD, 24 VDI, 10 VDS, and in one case had VDN. Vitamin D is critical in absorbing calcium and also maintaining the equilibrium between calcium and phosphorus. VDD is directly associated with rickets, which is the failure of growing bone and cartilage to mineralize. This condition can cause premature death in small children. In this study, 3 of the 17 children with VDD had rickets. Having high levels of vitamin D during pregnancy is critical to promote healthy fetal skeletal growth to ensure a healthy beginning. After birth, the major source of vitamin D is through solar skin exposure, so getting an adequate amount of time outdoors is essential. There are cases of nutritional rickets, but testing is available.

According to the authors, testing for VDD is easy to measure and should be performed on all children presenting with multiple fractures. Unfortunately, this type of injury is commonly confused with child abuse, and sometimes goes undiagnosed or unreported. However, the potential risk of VDD can cause apnea, hypocalcemic seizures, tetany, delayed motor milestones, skeletal deformities, fractures, and it can also lead to an increased risk of other childhood disorders, such as type I diabetes and bronchial asthma, frequent lower respiratory infections, and tuberculosis. So if there is cause for concern, testing is absolutely critical.

Notes

1. Scheimberg I, Perry L. Does low vitamin D have a role in pediatric morbidity and mortality? An observational study of vitamin d in a cohort of 52 postmortem examinations. Pediatr Dev Pathol. 17(6):455–464. Available at http://www.pedpath.org/doi/full/10.2350/14-05-1491-OA.1.

Pediatric and Developmental Pathology is the premier journal dealing with the pathology of disease from conception through adolescence. It covers the spectrum of disorders developing in utero (including embryology, placentology, and teratology), gestational and perinatal diseases, and all diseases of childhood. For more information about the journal or society, please visit http://www.pedpath.org.