Tragic death of baby highlights need for vitamin D public health policy change

June 26, 2018

UK vitamin D supplementation policy needs to change to protect the health and lives of babies, pregnant women and dark skinned individuals, say University of Birmingham researchers as they today highlighted the death of a baby and serious ill health of two others due to a vitamin D deficiency.

The death of six-month-old Noah Thahane, who died following complications of heart failure caused by severe Vitamin D deficiency, was entirely preventable, conclude Dr Wolfgang Högler and PhD doctoral researcher Dr Suma Uday in research published today in BMC Pediatrics.

Högler and Uday argue that current UK recommendations for infants and children are overly complex and outdated. They are calling for updated and simplified guidance to include supplementation of all babies from birth, regardless of whether they are formula or breast fed.

They are also calling on the UK government to introduce mandatory monitoring of babies and pregnant women to ensure they are taking vitamin D supplements.

And the authors suggest that studies should explore the feasibility of introducing a rickets prevention programme which would see children receiving oral bolus Vitamin D supplements alongside routine immunisations at GP surgeries, with a similar strategy for pregnant women at antenatal visits.

Högler and Uday's research outlines the cases of three babies aged five to six months, including Noah, all born in England to mothers of Black, Asian and Minority Ethnic (BAME) origin who developed low-calcium heart failure and rickets as a direct consequence of vitamin D deficiency. The researchers also found that five of the nine family members of these three babies also had bone disease caused by vitamin D deficiency.

Vitamin D is essential for skeletal growth and bone health, and deficiency can result in rickets, soft bones and seizures or heart failure as a result of a lack of calcium. Those particularly at risk are the BAME groups, which make up at least 14% of the UK population.

Dubbed the 'English disease' during the Industrial Revolution, Rickets was eradicated from the UK during the Second World War but has returned to England and other western countries through immigration of high-risk populations.

Dietary sources of vitamin D are limited. The main natural source is through exposure of skin to sunlight. However, dark skin produces far less vitamin D than white skin, and, from October to April in the UK there is no ambient ultraviolet sunlight of the appropriate wavelength for skin synthesis of vitamin D. National surveys suggest that around a fifth of adults and up to 24% of children may have low vitamin D status.[1] Deficiency rates are even higher in the BAME part of the population who are under-represented in National Diet and Nutritional Surveys.

Dr Wolfgang Högler, a Reader in Paediatric Endocrinology at the University of Birmingham's Institute of Metabolism and Systems Research and a consultant endocrinologist at Birmingham Children's Hospital, said: "These three cases have in common that their risk and need for supplementation went unrecognised, adherence to supplementation was not monitored, and that clinical symptoms were relatively silent until severe complications manifested.

"The extent of disease, only unveiled by X-rays, tests and post-mortem investigations, went unnoticed.

"The complications in these babies were fully preventable and represent only the tip of the iceberg of widespread deficiency in risk groups. They expose a public health failure to address vitamin D deficiency as an important health problem with potentially devastating consequences."

PhD Doctoral researcher and global challenges scholar Dr Suma Uday, also of the University of Birmingham and Birmingham Children's Hospital, said that importantly, while vitamin D deficiency is most common in BAME groups, it also occurs in other 'risk groups' - including all babies and pregnant women, people who practice whole body clothing, people with restricted diets lacking in calcium, and elderly people who spend more time indoors.

She adds: "We call for renewed public health emphasis on strategies for vitamin D supplementation through food fortification and robust, accountable supplementation programmes, incorporating mandatory monitoring of adherence during routine antenatal and child surveillance visits.

"The government's failure to adjust its prevention programmes to changing demographics is endangering the health and life of UK residents with dark skin, of whom infants are the most vulnerable.

"Establishing accountability through the implementation of monitored antenatal and infant supplementation programmes and mandatory food fortification is overdue."

Noah's mum Beverley Thahane said her son, of African descent, had been suffering seizures that doctors had been unable to explain, and then in January 2017 - aged just six month - he suffered a cardiac arrest at home and tragically doctors were unable to save him.

Following his death, it was Dr Högler's team that identified that Noah had undiagnosed severe nutritional rickets and all complications were ultimately caused by severe Vitamin D deficiency.

Hospital Clerical Officer Beverley, 37, of Shropshire, said: "I was utterly heartbroken when Noah died and horrified to learn that Noah's death could have been entirely prevented.

"I had not been informed of the need for infant vitamin D supplementation, or that we were at greater risk due to having dark skin, and I had no idea how catastrophic the effects of a vitamin deficiency can be.

"I hope that sharing my story will help in the fight to change public health policy and we can prevent another child from needlessly dying."

In separate research published in Endocrine Connections last September, Högler and Uday found that the UK has the lowest adherence to infant vitamin D supplementation in Europe and highlights that hypocalcemic seizures, heart failure and rickets occur nearly exclusively in the BAME group. Their work also showed that the supplementation of all babies and its monitoring increases adherence.

In a further review by Högler and Uday, published in Archives of Disease in Childhood in April, the researchers also emphasize that, given the low uptake of supplements, the long-term solution to vitamin D deficiency is mandatory fortification of the vitamin in food, which has been successfully implemented in countries such as Canada.

Dr Högler adds: "Quite in contrast to their continental European counterparts, paediatric Accident and Emergency doctors in the UK frequently encounter dark-skinned infants with hypocalcaemic seizures, and rickets during winter and spring.

"Our research highlights the critical role of the UK government in the causation and prevention of what was once called, and still is, the 'English disease'.

"The cases we have highlighted are not collections of tragic medical rarities. Infants presenting with complications of hypocalcaemia such as seizures, dilated cardiomyopathy, cardiac death and overt rickets only represent the tip of the iceberg of a public health crisis."


CASE ONE: Noah Thahane, of African descent, was just six months old when he suffered a cardiac arrest at home. Tragically, doctors were unable to save him and a post-mortem examination found he had severe nutritional rickets and complications associated with a Vitamin D deficiency. While his mother had received antenatal multivitamin supplementation and attended all post-natal child surveillance and vaccination appointments, she was not informed of the need for infant vitamin D supplementation.

CASE TWO: A six month old boy from Somalian heritage, was taken to hospital following respiratory arrest and seizure. He was found to have low calcium, severe heart failure and rickets due to severe vitamin D deficiency. He required prolonged hospitalisation to manage his heart failure, which recovered slowly over three months. His mother had been provided with one bottle of vitamin D for him at birth but was not informed to continue supplementation, and adherence was not assessed. She and three of the infant's four siblings, aged between three and nine, were found to be vitamin D deficient.

CASE THREE: A five-month old British Pakistani girl presented to the hospital with a cough, difficulty in breathing and poor feeding. She was diagnosed with a respiratory infection, however further investigations undertaken due to her low weight for her age revealed low calcium, heart failure and rickets. She received treatment and improved. Nobody had informed her mother, who was also vitamin D deficient, of the need for vitamin D supplementation during pregnancy and infancy.
For more information please contact Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, on +44 (0)121 414 6681. Alternatively, contact the Press Office out of hours on +44 (0)7789 921165.

Notes to editors:

  • The University of Birmingham is ranked amongst the world's top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.

  • Uday et al (2018). 'Cardiac, bone and growth plate manifestations in hypocalcemic infants: Revealing the hidden body of the vitamin D deficiency iceberg'. BMC Pediatrics. DOI: 10.1186/s12887-018-1159-y.

  • This research was also carried out in collaboration with Hanusch Hospital in Austria, Hadassah Medical Center in Israel, and Mayo Clinic in the US.

  • Uday et al (2018). 'Prevention of rickets and osteomalacia in the UK: political action overdue'. Archives of Disease in Childhood. DOI: 10.1136/archdischild-2018-314826.

  • Uday et al (2017). 'Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence'. Endocrine Connections. DOI: 10.1530/EC-17-0193

    What are the current UK guidelines around Vitamin D supplementation?

    1. To protect bone and muscle health, everyone needs vitamin D equivalent to an average daily intake of 10 micrograms, Public Health England (PHE) advised the government in July 2016. PHE recommends that babies are exclusively breastfed until around six months of age. As a precaution, all babies under one year should have a daily 8.5 to 10 microgram vitamin D supplement to ensure they get enough. Children who have more than 500ml of infant formula a day do not need any additional vitamin D as formula is already fortified.

    2. The Department of Health recommends that all children aged six months to five years are given vitamin supplements containing vitamins A, C and D every day. It's also recommended that babies who are being breastfed are given a daily vitamin D supplement from birth, whether or not you're taking a supplement containing vitamin D yourself.

    3. This advice is based on the recommendations of the Scientific Advisory Committee on Nutrition (SACN) following its review of the evidence on vitamin D and health.

    4. The National Institute for Health and Care Excellence (NICE) guidelines are here

    5. The global consensus guidelines for the prevention of rickets are here

    6. Babies who are having more than 500ml (about a pint) of infant formula a day shouldn't be given vitamin supplements. This is because formula is fortified with vitamin D and other nutrients.


    [1] NICE guidelines, published in 2014:

    University of Birmingham

    Related Heart Failure Articles from Brightsurf:

    Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
    Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

    Machining the heart: New predictor for helping to beat chronic heart failure
    Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

    Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
    A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

    Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
    In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

    Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
    A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

    Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
    A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

    Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
    The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

    Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
    Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

    How the enzyme lipoxygenase drives heart failure after heart attacks
    Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

    Novel heart pump shows superior outcomes in advanced heart failure
    Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

    Read More: Heart Failure News and Heart Failure Current Events
  • is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to