Answer on the Spot
Research type
Research Study
Full title
Answer on the Spot: Were this Child’s Fractures Due to Low Vitamin D or Abuse? (A Study to Determine the Stability of Vitamin D in Stored Guthrie Dry Blood Spot Cards)
IRAS ID
228087
Contact name
Amaka Offiah
Contact email
Sponsor organisation
Sheffield Childrens NHS Foundation Trust
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Doctors are as wary of returning a child to an abusive environment as they are of removing one from a loving environment. There is no single test that confirms a diagnosis of abuse, therefore in an infant presenting with unexplained fractures, although physical abuse may be the cause, all possible innocent explanations/underlying disease must be excluded before abuse can be diagnosed.
One such underlying condition is rickets, a disease of growing bones that makes them more likely to fracture, even under normal day-to-day handling. The diagnosis of rickets is based on x-ray findings and low blood levels of calcium, phosphorous and vitamin D and high blood levels of parathyroid hormone.
Diagnosis is complicated by the fact that while low vitamin D is associated with rickets, a low vitamin D doesn’t necessarily mean rickets. This has not stopped some researchers/clinicians from attributing unexplained fractures in a child to low vitamin D. In at least one case, a legal verdict of child abuse has been overturned based on the finding of a low vitamin D level three years after a blood sample was taken from a child who had unexplained fractures at 6-weeks old. The defence argued that the child had low vitamin D at the time and requested that the blood stored on the spot card from the baby’s heel prick test (performed on all babies around Day 5 after birth) be measured. The spot card vitamin D was low and the initial guilty verdict overturned.
Given that there is evidence in adults to suggest that spot card vitamin D decreases over time, this sets a dangerous precedent. As far as we know, tests of vitamin D stability have not been performed from the heel prick spot card of babies, which is the aim of this project.REC name
Yorkshire & The Humber - South Yorkshire Research Ethics Committee
REC reference
17/YH/0219
Date of REC Opinion
1 Aug 2017
REC opinion
Favourable Opinion