Echocardiographic features of children presenting with rickets at Kenyatta National Hospital

Abstract

Background: The prevalence of rickets has remained high in our setup probably due to inadequate nutrition and insufficient exposure to sunlight. Rachitic children have significant morbidity and mortality, often due to severe pneumonia and heart failure. Objective: To determine the prevalence, pattern and biochemical correlates of echocardiographic abnormalities in children with rickets at KNH. Methodology: This was a Descriptive Cross sectional study conducted at KNH paediatrics wards. Children aged between 3 months and 36 months admitted with rickets were recruited to the study. All the study patients had serum calcium, phosphorus and alkaline phosphatase levels measured and Echocardiography done to determine the presence of cardiac abnormalities. Results: A total of one hundred and seventy five patients were evaluated. There were 87 / males (50%) and 88 females (50%). Their age range was 3 months to 18 months with a median of7 months. Abnormal echocardiographic findings were present in 103 (59%) patients. Of these, left ventricular systolic dysfunction was found in 78 (45%), pulmonary hypertension in 35 (20%), diastolic dysfunction in 33 (19%) and pericardial effusion in 8 (4.5%) patients. Left ventricular systolic dysfunction was significantly correlated with low calcium levels, p-value <0.001, odds ratio 4.1 and 95% confidence interval (2.2- 7.8). There was no difference between children with pneumonia and those without pneumonia with regards to echocardiographic abnormalities. Conclusion: The study revealed a high prevalence of echocardiographic abnormalities in children with rickets (59%). Left ventricular systolic dysfunction was the most common finding (45%); it was significantly associated with severe rickets and hypocalcaemia. Recommendations: Echocardiographic evaluation should be done on patients with rickets, particularly those with severe rickets and severe hypocalcaemia so that appropriate treatment can be instituted for cardiac dysfunction if present