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Abnormalities of the rib growth plate and the periphysis of previously healthy infants and toddlers dying suddenly and unexpectedly
  1. Elisa Groff1,
  2. Suma Uday2,3,
  3. Rita Zapata Vazquez4,
  4. Khairul Zainun1,
  5. Marta C Cohen1,5
  1. 1 Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
  2. 2 Department of Paediatric Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospitals NHS Foundation Trust, Birmingham, UK
  3. 3 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
  4. 4 UIICE, Universidad Autonoma de Yucatan, Merida, Yucatán, Mexico
  5. 5 Oncology and Metabolism, The University of Sheffield, Sheffield, UK
  1. Correspondence to Professor Marta C Cohen, Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield S10 2TH, UK; Marta.Cohen{at}


Aims Histological examination of the rib is of critical value in perinatal pathology and points to the health of the child preceding death. The rib is considered ideal because it is the most rapidly growing long bone in infants and demonstrates growth arrest at onset of the insult. We aimed to identify: (1) changes in the perichondrial ring (PR) in the rib of infants and children up to 16 months of age dying suddenly at our institution and (2) any association with presence of histological changes of vitamin D deficiency (VDD)/metabolic bone disease (MBD) in the growth plate.

Methods Retrospective review of the PR histology and comparison with the presence or absence of histological features of VDD in the growth plate of 167 cases. The cases were anonymised and divided in six age/gender categories.

Results Periphyseal abnormalities were only seen in 38% of the cases; of whom 33% had established and 67% had mild changes. Only 14.5% of cases with established histological appearance of VDD at the growth plate had significant PR abnormality; of whom majority (83%) were ≤3 months of age and none ≥9 months old, reflecting a temporal relation with birth and beyond the perinatal period.

Conclusion The histological changes in the PR are significantly associated with histological changes of VDD/MBD at the rib growth plate with an OR of 3.04.

  • bone and bones
  • vitamin D
  • autopsy

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • EG and SU are joint first authors.

  • Handling editor Dhirendra Govender.

  • Contributors All authors had substantially contributed to the conception of the work, the acquisition, analysis and interpretation of data.All author approved the reviewed version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.