Context: Craniotabes in otherwise normal neonates has been regarded as physiological and left untreated.

Objective: To investigate the role of vitamin D deficiency in the development of craniotabes in normal neonates.

Design and Setting: Newborn screening of craniotabes was conducted at a single largest obstetrical facility in Kyoto, Japan. Follow up study at one month was conducted at Kyoto University Hospital.

Subjects: A total of 1120 consecutive normal Japanese neonates born in May, 2006 through April, 2007.

Main outcome measures: The incidence of craniotabes was scored each month. Neonates with craniotabes were followed up at one month with measurements of serum calcium, phosphorus, alkaline phosphatase (ALP), intact PTH, 25-OH vitamin D (25-OHD), urinary calcium, phosphate, creatinine, and hand X rays.

Results: Craniotabes was present in 246 (22.0%) neonates and the incidence had obvious seasonal variations, highest in April-May and lowest in November. At one month, infants with craniotabes had significantly higher serum ALP compared with normal neonates; 6.9% of them had elevated intact PTH over 60 pg/ml and 37.3% had 25-OHD less than 10 ng/ml. When separately analyzed according to the method of feeding, 56.9% of breast-fed infants showed 25-OHD less than 10 ng/ml while none of formula/mixed-fed infants did, and breast-fed infants had significantly higher serum PTH and ALP compared with formula/mixed-fed infants.

Summary: These results suggest that craniotabes in normal neonates is associated with vitamin D deficiency in utero, and the deficiency persists at one month in many of them especially when breast-fed.