A COMPARATIVE STUDY OF INJECTABLE AND ORAL VITAMIN D IN MANAGING PEDIATRIC RICKETS

Abstract

Objective:
The primary aim was to compare the effectiveness of injectable versus oral Vitamin D (Cholecalciferol) in normalizing serum calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D levels in children with rickets. Secondary objectives focused on assessing the resolution of clinical symptoms and radiological improvements in children aged 6 months to 5 years.

Methods:
This prospective study was conducted at Department of Paediatrics, KMDC & Abbasi Shaheed Hospital Karachi, Pakistan in the duration from August, 2023 to January, 2024. A total of 120 children diagnosed with nutritional rickets were randomly divided into two groups. One group received a single 600,000 IU dose of injectable Vitamin D, while the other was given an equivalent oral dose spread over six weeks. The primary outcomes were the normalization of serum calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D levels at 12 weeks post-treatment. Secondary outcomes included clinical symptom resolution and radiological improvement. Data were analyzed using SPSS version 25.0, with a p-value of <0.05 considered significant.

Results:
Both groups showed significant improvement in biochemical markers. The injectable group exhibited a higher mean increase in 25-hydroxyvitamin D levels (22.8 ± 5.1 ng/mL) compared to the oral group (18.3 ± 4.8 ng/mL), with a statistically significant difference (p<0.001). The injectable group also had a marginally higher, although not statistically significant, resolution of clinical symptoms and radiological improvements compared to the oral group.

Conclusion:
Injectable Vitamin D proved more effective in rapidly normalizing biochemical markers in children with rickets. Both treatments, however, were effective in resolving clinical symptoms. These findings indicate that while injectable Vitamin D may be preferable for rapid biochemical correction, oral supplementation remains a viable alternative, especially where adherence can be ensured. These results are particularly relevant for clinical practice in resource-limited settings.