Effect of Maternal Supplementation With Two Different Doses of Vitamin D During Lactation on Vitamin D Status, Anthropometry and Bone Mass of Infants: A Randomized Controlled Trial.

BACKGROUND: There is a high prevalence of vitamin D deficiency (VDD) in exclusively breast-fed infants in the absence of appropriate vitamin D supplementation. OBJECTIVE: To evaluate the efficacy of two doses of maternal vitamin D supplementation on vitamin D levels of mother-infant pairs and to assess its effect on growth parameters (weight, length and head circumference) and bone mass of infants. STUDY DESIGN: Randomized controlled trial. PARTICIPANTS: Lactating mother-infant pairs (n=220). INTERVENTION: Maternal oral vitamin D supplementation in two doses (group 1: 1,20,000 IU/month and group 2: 12,000 IU/month) for 12 months. MAIN OUTCOMES: Main outcomes: Maternal and infant serum 25OHD levels, and infants' growth and bone mass. RESULTS: There was high prevalence of VDD at baseline in mothers (94%) as well as infants (98.5%), which was reduced to 43.1% in (mothers) and 46.5% in infants after 12 months. Significantly higher median (IQR) serum 25OHD levels (ng/mL) were observed among mothers in group 1 compared to group 2 [46 (17-159) vs 18 (6-64); P<0.01] and in infants [36.5 (15-160) vs 17 (7-32); P<0.01]. No significant association was observed between growth parameters or bone mass and serum 25OHD levels of mother or infant between the two groups. Four mothers (3.6%) and two infants (1.8%) in group I had serum 25OHD>100 ng/mL, but without hypercalciuria or hypercalcemia. CONCLUSION: Bolus vitamin D supplementation in the dose of 1,20,000 IU/month was more efficacious in improving maternal and infant vitamin D status at 12 months, as compared to 12,000 IU/month.

Correlation of Serum Vitamin D Levels in Lactating Mothers and Their Infants.

BACKGROUND: Although Vitamin D deficiency is highly prevalent in Indians, data on Vitamin D eficiency in lactating mothers and exclusively breast fed infants is inadequate. OBJECTIVE: This study was done to evaluate the prevalence of Vitamin D deficiency in lactating mothers and their infants and to find out any correlation between them. MATERIALS AND METHODS: This hospital based, cross sectional study included 200 healthy infants between 1-30 days and their mothers. Serum sample was collected from both for Ca, inorganic phosphate (IP), alkaline phosphatase (ALP), and 25(OH)D. RESULTS: Mean serum 25(OH)D level of mothers was 11.33 ± 5.86 ng/ml with a range of 2-37 ng/ml. Hypovitaminosis D was defined as serum 25(OH)D level <10 ng/ml. Almost 94 (47%) of mothers were having hypovitaminosis D. Mean serum 25(OH)D level of infants was 11.92 ± 7.89 ng/dl with a range of 2.5-68 ng/dl. Ninety (45%) infants were having hypovitaminosis D. There was a moderate positive correlation between individual mothers' and infants' serum 25(OH)D values (Pearson coefficient = 0.516, P < 0.001). Using logistic regression, it was found that infants born to mothers with hypovitaminosis D carry a 4.47 times more risk of developing hypovitaminosis D as compared to infants born to mothers with normal serum 25(OH)D (Odds ratio = 4.47, P < 0.001). CONCLUSION: This study shows a high prevalence of Vitamin D deficiency in lactating mothers and their breastfeeding infants with a positive correlation between them. These results provide a justification for adequate Vitamin D supplementation of all exclusively breastfeeding infants and highlight the urgent need to improve maternal Vitamin D status.

Correlation of Tissue Transglutaminase with Modified Marsh Grading in Celiac Disease: A Prospective Cohort Study.

OBJECTIVE: To find out correlation between serum anti-tissue transglutaminase immunoglobulin-A (tTGA) levels and Marsh grading on duodenal histopathology in Celiac disease (CD). METHODS: In a prospective cohort study, a total of 52 symptomatic patients between age group of 2-18 y were enroled. All enroled patients were subjected to upper GI endoscopy by an experienced endoscopist. Two biopsies each from the bulb (D1) and second part (D2) of the duodenum were taken and Marsh grading was performed by a single experienced pathologist. Serum tTGA levels were also performed to find out correlation between serum tTGA levels and Marsh grading. RESULTS: The mean age of the patients was 8.21 ± 3.45 y (Range: 2-16 y). Anemia was the most common non-gastrointestinal (GI) sign and was present in 73% of the cases. However the authors could not find out any significant association between Marsh grading and hemoglobin levels (r = 0.32, p > 0.05). Serum tTGA levels were found to be positively correlated with Marsh grading (Spearmen correlation coefficient ρ = 0.74, p 0.000). Significant differences were found in tTGA levels between different Marsh gradings (ANOVA test) (p 0.000). Receiver-operator curve (ROC) analysis cut-off value of serum tTGA for predicting villous atrophy was 178.8 (nine times of cut-off value) with sensitivity of 100% and specificity of 85.7%. CONCLUSIONS: Serum tTGA levels can be used to predict villous atrophy and biopsy may be avoided in strongly suspected cases with more than 9 times of cut-offs.

Clinical profile of hemophilia patients in Jodhpur Region.

BACKGROUND: Hemophilia is widely distributed all over the world, but little is known about its clinical profile in resource-limited regions. An insight into its clinical spectrum will help in the formulation of policies to improve the situation in these areas. AIMS: To study the clinical profile of hemophiliacs (age <18 years) in Jodhpur region and screen them for transfusion-transmitted infections. MATERIALS AND METHODS: A cross-sectional study conducted in the Department of Pediatrics, Umaid Hospital, Dr. S. N. Medical College, Jodhpur, over a period of 12 months. RESULT: Out of a total of 56 cases enrolled, 51 (91%) cases were diagnosed as hemophilia A while 5 (9%) were diagnosed as hemophilia B. Positive family history was found in 26 (46%) cases. According to their factor levels, 25 (44%) cases had severe disease, 20 (36%) had moderate disease, and 11 (20%) had mild disease. The mean age of onset of symptoms and diagnosis was 1.73 ± 1.43 and 3.87 ± 3.84 years, respectively. First clinical presentation was posttraumatic bleed in 20 (36%), gum bleeds in 17 (30%), epistaxis in 4 (7%), joint bleeds in 4 (7%), skin bleeds in 4 (7%), and circumcision bleed in 3 (5%) cases. Knee joint was the predominant joint affected by hemarthrosis in 38 (68%), followed by ankle in 29 (52%), elbow in 20 (36%), and hip joint in 7 (13%) cases. All patients had a negative screening test for transfusion-transmitted infections. CONCLUSION: Occurrence of posttraumatic bleeds and gum bleeds in an otherwise normal child should warn the clinician for evaluation of hemophilia.

Premature birth and insulin resistance in infancy: A prospective cohort study.

OBJECTIVE: This study was done to determine the role of prematurity and other variables to predict insulin sensitivity in infancy. SUBJECTS AND METHODS: In this prospective study, 36 preterm appropriate for gestational age (AGA), 11 preterm small for gestational age (SGA), and 17 term SGA included as study cohort and 36 term AGA as control cohort. Detailed anthropometry assessment was performed at birth, 3, 6, and 9 months and at 9 months, fasting plasma glucose and serum insulin was done. Insulin resistance was determined by using homeostasis model assessment version 2. RESULTS: It is found that preterm AGA (mean difference 0.617, 95% confidence interval [CI]; 0.43-0.80, P = 0.0001), preterm SGA (mean difference 0.764, 95% CI; 0.44-1.09, P = 0.0001), and term AGA (mean difference 0.725, 95% CI; 0.49-0.96, P = 0.0001) group had significantly higher insulin resistance than control. There was no significant difference in between preterm SGA and preterm AGA (mean difference 0.147 95% CI; -0.13-0.42, P = 0.927). In multiple regression models, SGA status (ß =0.505) was more significant predictor of insulin resistance index than gestational age (ß = -0.481), weight-for-length (ß =0.315), and ponderal index (ß = -0.194). CONCLUSION: Preterm birth is a risk factor for the future development of insulin resistance which may develop as early as infancy.

Screening for Thalassemia Carrier Status in Pregnancy and Pre-Natal Diagnosis.

This hospital-based study reports the results of antenatal screening for thalassemia in pregnant women visiting a hospital in Jodhpur, Rajasthan, India. Eighty-eight (5.9%) of 1500 women screened for thalassemia had thalassemia trait. Twenty at-risk couples were identified and two fetuses were detected to be having thalassemia major.

Breast feeding and insulin levels in low birth weight neonates: a randomized study.

OBJECTIVE: To evaluate the influence of early infancy feeding practices on fasting insulin levels, as marker of insulin resistance, in low birthweight neonates. METHODS: Eighty successive low birth weight (<2.5 kg) neonates <10 days of age born at >38 wk of gestation at this tertiary care centre, were successively invited for participation in the study; parents of 52 (65%) consented to participate. Group 1 children (n=26) were randomized to receive only breast feeding and Group 2 (n=26) received fortified breast feeding with a commercially available human milk fortifier. Routine anthropometry and evaluation of health status was performed. The babies were followed-up every 15 day up to three months. 4-hour fasting glucose and insulin levels were measured at baseline and at 3 month. Statistical analyses were performed using t-test and Mann-Whitney test. RESULTS: In excusively breast-fed Group 1 neonates vs Group 2 the mean birthweight was similar (1.99+/-0.23 vs 1.87+/-0.30 kg). There was no difference in body length, head circumference and chest circumference. Mean hemoglobin levels, fasting glucose (63.9+/-9.8 vs 64.3+/-8.0 mg/dl) and fasting insulin levels (1.44+/-1.19 vs 1.73+/-1.38 microU/ml), were also similar. At three month follow-up in Group 1 children receiving exclusive breast feeding, there was significantly lower weight as compared to Group 2 (3.40+/-0.3 vs 4.75+/-0.5 kg, p<0.01). This was associated with significantly lower fasting glucose (79.0+/-9.4 vs 85.6+/-8.4 mg/dl) and fasting insulin levels (6.95+/-4.27 vs 15.73+/-3.29 microU/ml) (p<0.001). The difference persisted even after adjustment for weight gain in Group 2 (weight adjusted insulin 11.26+/-3.3 microU/ml; p<0.001). CONCLUSIONS: Low birthweight neonates fed fortified breast milk had greater fasting insulin levels compared to those with exclusive breast feeding, at three month of age. The difference persisted after adjustment for excessive gain in fortified milk fed neonates and, suggests adverse glucometabolic programming.

Kangaroo Mother Care (KMC) in LBW infants--a western Rajasthan experience.

OBJECTIVE: This study was taken to study the various beneficial effects of KMC in LBW babies. METHODS: 50 LBW babies (birth weight> 2 kg) two who delivered at Umaid Hospital, RIMCH Jodhpur included in this study and they have given KMC 4-6 hours/day in 3-4 settings. Maternal & Neonatal characteristics and complications prospectively recorded. RESULTS: Of 50 LBW babies enrolled, M:F ratio was 1.5:1 and mean birth weight was 1.487 +/- 0.175 kg. The mean age at which KMC started was 4+/-1.738 days. The mean weight gain was 29 +/- 3.52 g, mean age of discharge 23.6 +/- 3.52 days and mean duration of hospital stay was 15.5 +/- 11.3 days. CONCLUSION: KMC is effective and safe in stable preterm infants and as effective on traditional care with incubators. KMC because of its simplicity may have a place in home care of LBW babies.

Brainstem evoked response audiometry (BAER) in neonates with hyperbilirubinemia.

OBJECTIVES: To evaluate Brainstem Evoked Response Audiometry (BAER) as an objective testing of hearing assessment in icteric babies and correlate the abnormalities with serum bilirubin levels. METHODS: BAER recordings were taken in 30 icteric ferm neonates at birth, at peak of serum bilirubin levels and on a follow-up visit at 2-4 months of age. RESULTS: Mean latency of waves and interwave intervals on the BAER records were prolonged in icteric babies compared to the control group suggesting early bilirubin encephalopathy. Abnormal records were obtained in 73.3% cases and the abnormality persisted in the follow-up tracings of 23.3% of the study group. CONCLUSION: BAER is a sample, reliable and effective technique for determining auditory functions in the neonates especially changes of early bilirubin toxicity.

Keratomalacia in a neonate secondary to maternal vitamin A deficiency.

A 40-day-old male child was admitted with complaints of not opening eyes from 2-3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neonates, although in children it is reported form developing countries.