The Return of Congenital Rickets, Are We Missing Occult Cases?
Congenital rickets is the term given to fetus born with clinical features of rickets, but those born with biochemical evidence of rickets without obvious clinical features still can be considered occult congenital rickets. Some of the affected babies with this disease have the intrauterine rachitic environment, but a calcium trans-placental pump prevents the fetus from having clinical features of rickets. They may present with hypocalcemia few days after birth or later with more florid features of rickets. Congenital rickets cases born with florid features reported over the last 40 years are few and can be divided into two groups. The first due to severe maternal osteomalacia in which their bones were so decalcified to have enough calcium to be pumped to their fetus. Another group in which newborn babies were hypocalcemic due to other maternal diseases as malabsorption, celiac disease, pre-eclampsia, and prematurity. All inherited rickets cases per se, or as part of other syndromes can be considered congenital rickets. Most cases seen in our region are due to maternal vitamin D deficiency with symptoms becoming obvious when the infants are breastfed, or may present with hypocalcemic convulsions or craniotabes. This is a review of congenital rickets with the aim of shedding light on this potentially acute disease that needs more attention and awareness in the neonatal period to avoid rare serious complications as cardiomyopathy or myelofibrosis and the complications of hypocalcemic convulsions. Congenital rickets cases seen simulate a tip of an ice-burg and its prevention is an important issue, especially with the tremendous urbanization with tall buildings living in sun-deprived flats as the commonest type of residence leading to the increasing incidence of maternal osteomalacia and rickets.
KeywordsCongenital rickets Fetal rickets Inherited rickets Osteomalacia Hypocalcemia vitamin D
Dr. Kkhalid Khoshhal for reading the manuscript and for helpful comments and daughter Aminah Elidrissy for her secretarial help.
Conflict of Interest
Abdelwahab T. H. Elidrissy declares there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
- 12.Maxwell JP, Pi HT, Lin HAC, Kuo CC (1938) Further studies in adult rickets (osteomalacia) and fetal rickets. Proc R Soc Med 32:287Google Scholar
- 16.Steichen JJ, Koo WW (1992) Mineral nutrition and bone mineralization in full-term infants. Monatsschr Kinderheilkd 140(9):21–27Google Scholar
- 23.Moncrieff MW, Lunt HR, Arthur LJ (1973) Nutritional rickets at puberty. Arch. 48(3):221–224Google Scholar
- 27.Blond MH, Gold F, Pierre F, Berger C, Guerois M, Queru MS, Ramponi N (1997) Nutritional fetal rickets. A case report. J Gynecol Obstet Biol Report (Paris) 26(8):834–846Google Scholar
- 39.Elidrissy ATH (2013) Maternal vitamin D triggering rickets in their breastfeeding infants a current study and literature review. J Res Nurs Midwifery 2(2):30–39Google Scholar
- 47.Marcombes F, Cheron G, Garabedian M, Fékété CN, Chomette G, Lenoir G, Royer P (1986) Congenital hyperparathyroidism. 3 Cases. Ann Med Interne (Paris) 137(5):401–405Google Scholar
- 58.Zeidan S, Bamford M (1984) Congenital rickets with maternal pre-eclampsia. R Soc Med 77(5):426–427Google Scholar
- 60.Elidrissy ATH (1986) Nutritional status of children with rickets in riyadh. Ann Saudi Med 6:101–110Google Scholar
- 61.Elidrissy ATH, Sandokj AM, Al-Magamsi MSF, Al-Hawsawi ZM, Al-Hujaili AS, Babiker NH, YousifAM AM (2012) Nutritional rickets in Almadinah Almunawwarah: presentation and associated factors. J Taibah Univ Med Sci 7(1):35–40Google Scholar