الفهرس 
Introduction and aim of work
Prevelence of nutritional ricketsOnly 14 pages are availabe for public view
 |  | from | 120 |  |  |
| | | from | 120 | | |
Abstract
Normal bone growth and mineralization depends on the availability of adequate calcium and phosphate. Deficient mineralization can result in rickets and or osteomalacia . In rickets, there is deficient mineralization at the growth plate.(Pitt,1991)
Vitamin D is a prohormone that is essential for normal absorption of calcium from the gut, and deficiency of vitamin D is usually more common than either isolated calcium or phosphorus deficiency and is the commonest cause of rickets (Rauch,2003).
A child with rickets is more likely to develop infections such as pneumonia and gastroenteritis (Cesur,et al ,2013) .These can be very serious in young children. Children with rickets may also be more likely to develop bone fracture (Winzenberg , et al ,2013).
Prevalence of nutritional rickets is rising in the developing as well as the developed countries due to changing lifestyles and globalization(Wagneret al ,2008)
Aim of the study:
Vitamin D deficiency rickets is of high morbidity but studies to evaluate the management of those patient are limited .
The present study aimed to evaluate the management of vitamin D deficiency rickets among children attending Assiut University Children Hospital during the period from the 1st of February to the 31st of July Using American Academy of Pediatric guidelines (2008) as a reference standard.
The study included 100 patient with vitamin D deficiency rickets , 18 cases of them complicated with tetany ,the age of them ranged from 3-30 month , 49 of cases were males and 51 were females.
Data of the study showed that the management regimens used to diagnose and treat vitamin D deficiency rickets in Assiut University Children Hospital partially followed the reference standard of the study.
- Most data of the history were fulfilled and showed that:
1- Data of the age and sex were recorded in 100% of cases .
2- Data of risk factors( preterm infant , exclusive breast feeding > 6 month ,formula fed infant without vitamin D supplementation,unbalanced diet , dark skin and excessive wraping ) were fullfilled in most cases , but data of previous vitamin D administration was not recorded in 79% of studied 100 cases
- Most of data about anthropometric measures(length, weight ,head circumference and anterior fontanel )were recorded well ,but mid arm circumference are not recorded in 15 % of studied 100 cases.
-As regard the developmental milestone , most items were fulfilled well,but number of teeth were not recorded in 21 % of studied 100 cases data.
-Most data of the examination were fulfilled but examination of Marfan sign not recorded in 18% of cases and back examination for deformity was not fullfilled in 16% of studied 100 cases.
-Data showed that 100% of studied 100 cases are asked about hypocalcemic manifestations.
-Recorded data showed that serum calcium level was not done in 30% of 100 studied cases. Serum phosphorus and alkaline phosphatase were not done in 68% of 100 studied cases at first examination.
-Data showed that all patient received vitamin D, either oral or IM,the dose and duration of vitamin D that given by oral route were not administered properly in 10 % and 7% of patients respectively,and 9 cases not received maintainence dose after therapeutic dose.
6 out of 72 cases received IM vitamin D with improper dose .13 cases not received maintainence dose .
- As regard monitoring at one month, data showed that 33 of 100 studied cases were not advised for monitoring and 67of cases were advised to be re evaluated after one month . 16 out of 67 came to be re-examined ,X ray was done for 14 cases ,calcium was measured for 12 cases and phosphorus and alkaline phosphatase for 9 cases
- As regard monitoring at three months data showed that 33% of 100 studied cases were not advised for monitoring .
Tetany :
Data showed that all cases with tetany(18 cases) received IV calcium with proper dose and did heart monitoring .but 1 out of 18 cases did not received maintainence calcium after IV dose.