Emine ÇAMTOSUN, Ayşehan AKINCI, Nurullah ÇELİK, İsmail DÜNDAR

Nutrisyonel Raşitizmde D Vitamini Profilaksisi Programının Sürdürülebilirliğinin Önemi Üzerine Bir Araştırma

Giriş-Amaç: Türkiye’de, çocuklarda D vitamini eksikliğinin ve nutrisyonel raşitizmin (NR) önlenmesi amacıyla 2005 yılında başlatılan proje ile bebeklere ilk 12 ay ücretsiz D vitamini sağlanmış ve sonuçta üç yaş altı raşitizm sıklığında belirgin azalma görülmüştür. Ancak günümüzde halen NR vakaları saptanmakta ve bu vakaların D vitamini profilaksisi kullanmadığı görülmektedir. Materyal-Metod: Bu çalışmada Ocak 2013-Nisan 2018 tarihleri arasında Malatya’da iki Çocuk Endokrin ünitesinde tanı alan üç yaş altı 36 olgu başvuru şikayetleri, fizik muayene, laboratuvar ve görüntüleme bulguları ve aldıkları tedaviler ile sunulmuştur. Bulgular: Olguların %25’i (9/36) son dört ayda tanı almıştır. Olguların tümünde D vitamini düzeyi ≤12,4 ng/mL’dir, ortalama 3,8±2,5 ng/mL. D vitamini profilaksisi sorgulanan 30 hastadan 16’sı hiç profilaksi almamış, 14’ü ise düzensiz almıştır. Sonuç: Kliniğimize başvuran NR vakalarının son yıllarda artması profilaksi programının başlangıçtaki kadar sıkı takip edilmediğine işaret ediyor olabilir. D vitamini profilaksisinin öneminin ve etkinliğinin hekimlerimizce kavranması, programın sıkı bir şekilde takip edilmesi, ailelerin uygun bir şekilde bilgilendirilerek programa dahil edilmesi ile program canlandırılacak ve etkinliği artırılacaktır.

Research on the Importance of the Sustainability of The Vitamin D Prophylaxis Program in Nutritional Rickets

Introduction-Objective: In Turkey, the babies were provided with free vitamin D within their first 12 months through the project launched in 2005 for the purpose of preventing children from vitamin D deficiency and nutritional rickets (NR) and consequently, a significant reduction was observed in the prevalence of rickets among children under three years of age. However, NR cases are still present today and it is seen that these patients do not use vitamin D prophylaxis. Material and Method: In this study, 36 cases under three years of age, who have been diagnosed with NR in two Pediatric Endocrine Units in Malatya between January 2013 and April 2018 were presented along with their complaints during admission, the results of physical examination, laboratory test and imaging and the treatments they have received. Findings: 25% of the cases (9/36) have been diagnosed in the last four months. In all cases, the vitamin D level was ≤12,4 ng / mL, with an average of 3,8 ± 2.5 ng / mL. Of the 30 patients, who were asked about having vitamin D prophylaxis, 16 have not received prophylaxis at all and 14 have received irregularly. Conclusion: The increase in the number of NR cases admitted to our clinic in recent years may indicate that the prophylaxis program is not followed as closely as in the beginning. The prophylaxis program would be revitalized and its effectiveness would be improved when our physicians understand the importance and efficacy of vitamin D prophylaxis, the program is strictly followed and the families are properly informed and included in the program.

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