Prabu, V (2012) Study on Prevalence of Hypovitaminosis D in Exclusively Breastfed Babies in an Urban Referral Centre. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Exclusive breast-feeding is recommended up to 6 months of age with all its beneficial effects on child survival(1). Globally as many as 1.45 million lives are lost due to suboptimal breast-feeding in developing countries. WHO analysis of childhood deaths has listed suboptimal breast-feeding as one of the most powerful shared risk factors and estimated that 1.3 million deaths can be prevented in 42 high mortality countries by increasing the level of breast-feeding amongst infants.The increase in the practice of breast feeding associated with the belief that “breast is best” and that breast milk does not require supplementation because it is a babys “perfect food” may lead to decreased 25-hydroxy vitamin D (25-OHD) intake from other sources and thereby causing rickets(1). The prevalence of hypovitaminosis D in exclusively breast fed infants to be 82 ,52 and 20 % from UAE(5),Pakistan(6) and China(7) respectively but there is a paucity of data from India regarding the same. AIM OF THE STUDY: To determine the prevalence of subclinical hypovitaminosis D among exclusively breast fed babies. DISCUSSION: 1. In our study 83% of exclusively breast fed babies are vitamin D deficient similar to report by Atiq et al. A male preponderance was noticed in our study, the reason for which is not clear. 2. In our study all exclusively breast fed babies with hypocalcemia and vitamin D deficiency had inadequate exposure to sunlight as reported by Gunsel Kutluk et al(39). 3. Since vitamin D is principally derived from the action of sunlight on exposed skin, inadequate exposure to sunlight, leads to hypovitaminosis D which must be made up from dietary sources. In exclusive breast fed babies the content of breast milk vitamin D also low, so vitamin D deficiency is aggravated(39). Deficiency must be present for many months before clinical rickets becomes obvious. In our study, all babies with vitamin D deficiency as evidenced by low levels of 25 OH vitamin D3 but clinical features of rickets were absent in all of them. 4. Babies on exclusive breast feeding with vitamin D deficiency may have normal levels of calcium or low level of calcium. depends upon the stage of deficiency as similar to earlier report by Vanthana Jain et al(46). 5. Vitamin D deficiency in exclusive breast fed babies may present with hypocalcemia seizures as similar to earlier report by SBS, et al(1). 6. Nutritional rickets still remains one of the most common health problems in children in developing countries and in some regions of developed counties too, with increasing incidence in the latter(39). 7. It is unfortunate that this natural source of vitamin D is not being utilized in tropical countries like India where Nature is kind enough to provide sunlight. Gessner et al recommended adequate exposure to sunlight to maintain serum 25-hydroxy Vitamin D concentration above the lower limit of the normal range(16). 8. Exclusive breastfeeding is recommended upto 6 months with all its beneficial effects on child survival. However reports of biochemical evidence of vitamin D deficiency in breastfed infants both in developing and developed countries have been periodically appearing in medical literature. SUMMARY AND CONCLUSIONS: 1. Vitamin D deficiency in exclusive breastfed babies not only present in the developed countries, but also in developing countries like India where abundant sunshine exposure is present. 2. High prevalence of subclinical hypovitaminosis D is present among exclusive breastfed babies. 3. Vitamin D deficiency in exclusive breastfed babies can manifest as hypocalcemic seizures, if supplementation of Vitamin D is not done in them in the setting of decreased exposure to sunlight. 4. Rickets is the late manifestation of vitamin D deficiency usually after 6 months of age. It should be diagnosed in early stages before 6 months of age by assaying 25OH vitamin D3 in exclusive breastfed babies. 5. Recent studies concluded that adequate intake of vitamin D in exclusive breastfed babies cannot be met with human milk as the sole source of vitamin D. Adequate level of vitamin D in pregnancy will give adequate levels in newborn for 8 to 12 weeks only. Also vitamin D content of breast milk is low (12-60 IU/L) and RDA of vitamin D in exclusive breast babies is 200 to 400 IU/day. If exclusive breastfed babies not supplemented with vitamin D within 2 to 3 months of age, the risk of developing vitamin D deficiency rickets by 6 months of age is very high.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Hypovitaminosis D ; Exclusively Breastfed Babies ; Urban Referral Centre |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 16 Apr 2018 06:08 |
| Last Modified: | 16 Apr 2018 06:08 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7002 |
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