Introduction:The Clinical and radiological manifestations of newborns with severe VDD have not been studied well.Materials and Methods:We studied the clinical, biochemical, and radiological manifestations of 10 full-term (FT) newborns (6: M, 4: F) infant presented to with symptomatic hypocalcemia (seizure) secondary to vitamin D deficiency (VDD) during the first 10 days of life are described. All were exclusively breastfed since birth. All their mothers have low 25 hydroxy vitamin D (25OHD) level <10 ng/mL and were not taking vitamin supplements during pregnancy.Results:FT newborns with hypocalcemia secondary to VDD presented with generalized convulsions (10/10) and craniotabes (8/10), but none had rachitic chest rosaries or joint broadening. Cranial ultrasonographic evaluation was normal. Serum 25OHD concentrations were low in these newborns (13.2 ± 3.8 ng/mL) and their mothers (8.1 ± 1.5 ng/mL). A total of 60% of them had increased parathormone (PTH) concentrations (>60 ng/mL) and 60% had decreased magnesium (Mg) concentrations (<0.7 mmol/L). Their alkaline phosphatase (ALP) concentrations were significantly higher than normal newborns. All other laboratory results (liver function tests, urea and electrolytes, C reactive protein, lumbar puncture, blood culture, and lactate) were normal. In all patients, seizures ceased within 2 days of starting treatment with alphacalcidol and calcium. Radiological manifestations included metaphyseal band of relative lucency (osteopenia), just under the line of provisional calcification, within distal radius (7/10), femur (4/10), and tibia (3/10), mild cupping and haziness of distal radius (2/10).Discussion:Newborns with VDD had significantly lower serum calcium, ALP and PTH and higher phosphate concentrations, compared to older infants with VDD rickets. In newborns with VDD, serum calcium levels were correlated significantly with 25OHD (r = 0.597, P < 0.001), Mg concentrations (r = 0.436, P < 0.001) and negatively with ALP concentrations (r = −0.451, P < 0.001). Serum PTH concentrations were correlated significantly with serum Mg (r = 0.78, P < 0.0001) but not with serum calcium (r = −0.103, P = 0.3) or 25OHD (r = −0.03, P = 0.7) concentrations.Conclusion:The clinical, biochemical, and radiological manifestations of VDD in newborns indicate that they are less adapted to VDD compared to older infants. VD supplementation for mothers and newborns should be considered to avoid short-term complications of VDD in the neonatal period and on the growing infants especially in countries with high prevalence of VDD.

Background: Caring about ELBW newborns at the limit of viability is demanding with a high rate of mortality and long-term morbidity. Society expectations become high and persistent while health care coast inside NICU is very high. Objective: The purpose of this study is to examine the short-term survival (till discharge) of extremely low birth weight (ELBW) newborns at limits of viability 23–26 weeks gestation (WG) age in a large tertiary maternity hospital. Methods: A population-based retrospective study of babies born at 23–26 WG age over 3 years period. Results: Over the study period 2016 to mid-2018, a total of 283 ELBW newborns were delivered in our institute. Of those, 250 were admitted to NICU (88%). The number of newborns who survived till discharge from NICU was 174 (61.5%) while the rate of delivery room death was 33 newborns (11.75%). The survival rates during 2016–2018 period were 35%, 64%, 73%, and 81.4% for 23, 24, 25, and 26 WG respectively. 76 newborns (26.9%) of NICU admissions died before discharge. Most deaths occurred during the first two weeks of life (64%). The main cause of death inside the NICU during the first 2 weeks was respiratory failure, followed by infection. Conclusion: Counseling Parent using local data become more convincing and reflecting local experience. Short term survival rate of ELBW is comparable to those reported in the literature. The first two weeks are very crucial where the mortality rate is highest.