Aim: Audit was undertaken to study patient profile, prevalence, treatment choice and interrelation between biochemical markers in vitamin D deficient children.
Methods: Retrospective review of case notes for patients who had vitamin D measured over the period 5/2005 and 5/2010.
Results: Study included 150 randomly selected patients from a total of 336. 99 (66%) were found to be deficient in vitamin D, 52 females and 47 males. Peak age at presentation was 711 years, 30% and 1218 years 24%. Forty-seven percent were of Asian origin, 19% Caucasians, 19% Black and 14% others/unknown. Audited vitamin D test indications included signs of clinical rickets, failure to thrive, gut related pathology (CMPI, atopy related restriction diet, and short gut) and HIV infection. Twenty-five percent were incidental findings. Among the deficient cases 29 had normal/low parathormone and 45 had normal ALP, cCa2+ and phosphate with no proportional difference in different ethnic groups. 87/99 were treated, the treatment choice varied 34 received cholecalciferol, 21 ergocalciferol, 20 - 1 alfacalcidol, 6 dalavit and in 6 treatment was unclear. 24 cases also received calcium supplementation. Follow up and repeat investigations varied in timing.
Conclusion: This audit clearly demonstrates that vitaminD deficiency remains a problem. It continues to be an issue in ethnic minority and clinical high risk groups. Biochemical markers are not always reliable in detecting low vitamin D stores. We are seeing an increase in the request of vitamin D measurements in asymptomatic children. This has led to confusion in the need to treat, treatment choice, follow up and blood tests in these children. With the evolving knowledge about vitamin D role in other disease processes should we investigate more children or recommend maintenance treatment in all children and only investigate the at risk group?
This audit has helped our unit to look at its practise and make some local recommendations in the management of vitamin D deficiency.
09 - 11 Nov 2011
British Society for Paediatric Endocrinology and Diabetes