My name is Ian GreyBull and I am a junior in the nursing program at the University of North Dakota. I am writing in regards to the journal article by Shelly R. Kreiter, MD on Nutritional rickets in African American breast-fed infants in the Journal of Pediatrics >>August 2000;137 issue. Before I read this article I was not aware of the >>issue's that surrounded nutritional rickets, especially in the >>African-American population. The aim of this study was to analyze the >>characteristics of infants and children diagnosed with nutritional rickets >>at two medical centers in North Carolina in the 1990's. The study design >>involved physical and radiographic findings, calcium, phosphorus, alkaline >>phosphatase, and 25-hydroxyvitamin D levels of the thirty infants and >>children diagnosed with nutritional rickets at the two medical centers >>were reviewed. Also included was the breast-feeding data that was >>obtained from the North Carolina Women, Infant, and Children Program >>(WIC). The steps or methods the study followed was to review all of the >>patients records between the years 1990 and 1999. And to obtain >>information of all the patients which included age at diagnosis, infant >>feeding, history of vitamin D supplementation, biochemical findings, >>radiographic findings, race/ethnic background, sex, weight and height at >>the time of diagnosis, and results of follow-up studies. The results of >>the study showed that in 1998 and the first half of 1999 57% of the >>patients were diagnosed with nutritional rickets. All were >>African-American, all were breast fed, and those over the age of one had a >>history of poor intake of fortified cow's milk or other diary products. >>Eleven of the children or 37% were diagnosed between November and March, >>the coldest months in North Carolina. Some of the signs and symptoms of >>the patients included skeletal abnormalities and failure to thrive. >>Height and weight measurements were available for some of the patients. >>This reflected <5th percentile in lenght for 65% of the patients and <5th >>percentile in weight for 43% of the patients. For the rest of the >>patients it was even a lower percentile for both length and weight, with >>only two patients with the lenght of >50th percentile.. The results also >>showed decreased levels of 25-hydroxyvitamin D in 19 of 23 patients (83%) >>in whom it was measured. The conclusion indicated the factors that may >>have contributed to the increase in diagnosed nutritional rickets was that >>more African American women were breast feeding, fewer infants were >>receiving vitamin D supplements, and children that were exposed to less >>sunlight. The authors of this study recommend that all dark-skinned >>breast-fed infants and children receive vitamin D supplementation. >> This study was done in a very thorough manner. The study design and >>methods used really strengthen this study. It really showed the reader >>strong evidence on how the researchers came to their conclusions. >>However, this study does have a couple of weaknesses. One of the >>weaknesses is the limited geographical area in which the study was done. >>Only researching North Carolina gives this study a one dimensional view of >>the pattern of nutritional rickets among African American infants and >>children. Another weakness is that some information was not present on >>the mothers of the infants and children in the study. The vitamin D >>status of the mothers and the amount of sunlight exposure of the patients >>(both mother and infants) is the information that should have been >>included in this study. This can impact one's clinical practice because >>of the increase in the number of breast-fed baby's. Whether or not to >>encourage breast feeding in dark skinned infants at risk is a concern. >>And if the mother decides to breast feed you might have to provide >>information on giving the infant adequate amounts of vitamin D supplements >>and sun exposure to help prevent nutritional rickets. A future in-depth >>study should be done throughout the United States involving dark skinned >>infants diagnosed with nutritional rickets. This would give this topic of >>concern more fire power to fight with, concerning the authors current >>recommendations. _________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. Share information about yourself, create your own public profile at http://profiles.msn.com. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html