69J / 207 – A CASE SERIES OF PAEDIATRIC RACHITIC LUNG DISEASE IN THE UNITED
KINGDOM.
Thia LP 1,2,4, Still L 1, Kiriella K 2, Carr SB 2, Spencer DA 3, Bush A 4, Gupta A 3,4
1
Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children, London.
of Paediatric Respiratory Medicine, Royal London Hospital, London.
3 Department of Respiratory Paediatrics, Freeman Hospital, Newcastle Upon Tyne.
4 Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London.
2 Department
Introduction:
The incidence of vitamin D deficient rickets in the UK is increasing. Vitamin D deficiency rachitic lung
disease is associated with skeletal chest wall deformity and pulmonary changes.
Description of 3 cases:
The first case involved a 6 month old term Afro- Caribbean girl with three severe respiratory tract
infections requiring ventilation. She had a small bell shaped chest, rachitic rosary and bilateral swollen
wrists. Nutritional vitamin D deficiency was confirmed. She was exclusively breast fed by a mother with
darkly pigmented skin, who was also vitamin D deficient. This infant was commenced on vitamin D/
calcium supplements and nocturnal non invasive ventilation for poor respiratory reserve. With
treatment, her respiratory and clinical conditions improved. The second case was an ex- premature 15
month old Angolan boy with recurrent lower respiratory tract infections. Vitamin D deficiency rickets
and iron deficiency anaemia were confirmed and treated. Within a year of treatment, he improved. The
final case involved a 16 month old Asian boy with severe dietary restriction due to eczema, who
presented with breathing difficulties, recurrent cough and faltering growth. He also had vitamin D
deficient rachitic lung disease. He was exclusively breast fed in the first year of life and had a very
restricted diet with limited source of calcium. He was oxygen dependent but was eventually weaned off
through prolonged calcium and vitamin D supplementation.
Discussion:
Physical changes in the skeletal chest wall due to rickets can reduce lung volume and compliance.
This may lead to impaired mucociliary clearance, pulmonary atelactasis, diffuse fibrosis, respiratory
failure and even cor pulmonale. Vitamin D deficiency also predisposes to pulmonary infections by
impairing both the humoral and cellular immunity. At risk groups included children born to mothers of
ethnic minorities, who were exclusively breastfed for prolonged periods without receiving any oral
vitamin supplementation and those with restricted dietary intake. It is important that the prevention of
nutritional rickets though health education and routine calcium and vitamin D supplementation are
implemented.
Conclusion:
Early recognition of vitamin D deficiency rickets as a cause of recurrent chest infections and lung
disease in at risk children, could lead to prompt treatment and reduction in morbidity and mortality
associated with rachitic lung disease.