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A female patient, born at 25 weeks’ gestation, had developed cerebral palsy, microcephaly, cystic periventricular leukomalacia, developmental delay and epilepsy. At 3 weeks, she had a significant bowel resection for necrotising enterocolitis, with 65 cm of small bowel remaining. She required total parenteral nutrition for several weeks. During her long recovery in neonatal intensive care, she developed feeding difficulties, diarrhoea and prolonged vomiting when the parenteral nutrition was weaned. She now has an unsafe swallow, severe reflux and is gastrojejunally fed, with exclusive elemental feed (Neocate). Of note, her medication currently includes Abidec®, cholecalciferol, clobazam and omeprazole.
At 16 months of age, she presented to the children’s unit with a large bruise following venepuncture. Humeral X-ray showed a fracture over the bruise site, and further skeletal survey (figures 1–3) showed widespread rachitic changes. Relevant bloods are shown in table 1.
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