Newborn kraniotabesinin levels of vitamin D in relation to

AIM: Craniotabes is a softening of skull bones that is known to be associated with a variety of pathological conditions, including rickets, hypervitaminosis A, osteogenesis imperfecta, hydrocephalus, or congenital syphilis. On the other hand, craniotabes in otherwise normal newborns has largely been regarded as a physiological condition without the need for treatment .The condition is found in a considerable percentage of otherwise normal neonates, up to 30%, and is usually self-limited, healing within 2–3 months. Previous small-scale studies failed to show lower serum 25-OH vitamin D (25-OHD) in mothers of newborns with craniotabes as compared with that of mothers of newborns without craniotabes but there is now compelling evidence that transient vitamin D deficiency in utero or in infancy could lead to an increased risk of childhood type 1 diabetes or decreased bone mass later in life. Increased risks are also suggested for other disorders such as childhood asthma, lower respiratory tract infections in infancy , or even schizophrenia and rickets. If craniotabes in normal neonates reflects mild vitamin D deficiency in utero, and if the condition persists longer in infancy, it might lead to a variety of health problems later in life. Until the whole picture of perinatal vitamin D deficiency is elucidated, for safety, we suggest treating breast-fed infants with craniotabes with vitamin D. Our aim in this study was to investigate whether craniotabes in otherwise healthy newborns is really physiological and its relationship between vitamin D deficiency and whether it requires treatment or not. METHOD: 150 healthy ,term newborns; being >2000gr and born at Zonguldak Bülent Ecevit University School of Medicine Hospital between April 2012 and April 2013 were taken to this study. During postnatal discharge (1-3. Day) newborns taken to this study were divided into two groups: newborns with craniotabes and newborns without craniotabes. 25(OH) vitamin D levels of all mothers of newborns were studied. At 1 month policlinic controls, all infants were re-evaluated for craniotabes and serum Ca, P, ALP, PTH, 25(OH) vitamin D and urine calcium, urine creatinine samples were taken from all infants. Relationship between resuts and maternal age, number of pregnancies, birth weight, gestational age , the family residence, mother's education level, smoking status, feeding patterns of newborns were assessed. SPSS 13, 0 package program was used to assess the data obtained from the research. FINDINGS: Craniotabes was present in 45 (%30) neonates, and seasonal variations, highest in winter and lowest in summer. In caniotabes group, birth weight was significantly lower than normal group (p=0,002). At 1 month, infants with craniotabes had significantly higher serum PTH compared with normal neonates, but there was no releationship between craniotabes and 25(OH) vitamin D status of mother at birth and of newborn at 1 month. Of mothers of infants with craniotabes, %6,6 showed serum 25(OH) vitamin D less than 10 ng/ml, whereas only %0,95 of mothers of normal infants showed serum 25(OH) vitamin D less than 10 ng/ml. Vitamin D deficiency or insufficiency was observed in 96% of mothers but in 90% of newborns vitamin D levels were within normal limits. When seperatately analyzed according to the method of feeding, breast-fed infants showed significantly lower serum 25 (OH) vitamin D than formula/mixed-fed infants, but there was no relationship between craniotabes and the method of feeding. In our study, %95,3 of newborns took 400 IU vitamin D supplement while only %7 did not. There was no significant difference between craniotabes and vitamin D supplementation. CONCLUSION: The relationship between newborn craniotabes and maternal vitamin D deficiency is not clear but it is clear that much more studies must be done in this regard. Results of our study also show that maternal vitamin D deficiency is still a major problem in our country. Therefore, strengthening of measures to prevent maternal vitamin D deficiency should be extended. Key Words: Newborn; craniotabes; vitamin D deficiency