Aoife Carroll

The Association of Vitamin D Status with Acute Respiratory Morbidity in Preterm Infants

OBJECTIVE To assess the association between serum 25-hydroxyvitamin D (25OHD) levels and outcomes in preterm infants (<32 weeks gestation). STUDY DESIGN Serum 25OHD was measured in mothers and their infants within 24 hours of birth, before the start of enteral vitamin D supplementation, and at discharge from the neonatal intensive care unit. We evaluated the associations between vitamin D status and various early preterm outcomes. RESULTS Ninety-four preterm infants and their mothers were included; 92% of the infants had a 25OHD level≤50 nmol/L (20 ng/mL), and 64% had a 25OHD level<30 nmol/L (12 ng/mL). A low 25OHD level (<30 nmol/L) in preterm infants at birth was associated with increased oxygen requirement (P=.008), increased duration of intermittent positive-pressure ventilation during resuscitation at delivery (P=.032), and greater need for assisted ventilation (P=.013). CONCLUSION We observed a high prevalence of low 25OHD (<30 nmol/L), and found an association between vitamin D status and acute respiratory morbidity in preterm infants after birth.

Vitamin D and neonatal immune function.

Abstract Vitamin D deficiency is widespread in the neonatal and paediatric population of northern latitudes, particularly in children of African, Middle Eastern and Asian ethnicity. This is associated with diminished immune function and increases the risk of Th1 autoimmune diseases like type 1 diabetes. Epidermiological studies have also shown a link between vitamin D deficiency in children and a more severe course of illness with lower respiratory tract infection or Respiratory Syncitial Virus (RSV) bronchiolitis. The mechanism by which vitamin D enhances immunity is complex. It acts through the innate immune system by inducing antimicrobial peptides in epithelial cells, neutrophils and macrophages. The role of Vitamin D in neonatal and paediatric immunomodulation requires further study.

Inadequate vitamin D levels are associated with culture positive sepsis and poor outcomes in paediatric intensive care

This study aimed to assess vitamin D status, and its determinants, in paediatric patients with suspected sepsis who were admitted to a paediatric intensive care unit (PICU). We also investigated the association between vitamin D status and clinical outcomes.

Vitamin D Status in Irish Children and Adolescents: Value of Fortification and Supplementation

Background. Vitamin D has important skeletal and extraskeletal roles but those living at northerly latitudes are at risk of suboptimal levels because of reduced sunlight exposure. Aim. To describe the vitamin D status of Irish children and identify factors predictive of vitamin D status. Methods. A prospective cross sectional study was undertaken over a 12 month period. Two hundred and fifty two healthy children attending for minor medical or surgical procedures were recruited. All had 25-hydroxyvitamin D (25OHD), parathyroid hormone and bone profiles measured. Results. The mean (standard deviation) for 25OHD was 51(25) nmol/L (20.4 (10) ng/mL). Forty-five percent had levels >50 nmol/L (20 ng/mL). The following variables were significantly associated with 25OHD levels >50 nmol/L (20 ng/mL): sample drawn in April-September, use of vitamin D supplements, consumption of formula milk, and non-African ethnicity. Conclusion. More than half of the children in this study had 25OHD levels less than 50 nmol/L (20 ng/mL). Vitamin D status was significantly improved by augmented oral vitamin D intake.

Towards evidence based medicine for paediatricians. Question 2. What is the ideal dose of vitamin D supplementation for term neonates

During a well-baby check, a mother asked for the consultants recommendation on the ideal dose and type of vitamin D formulation for her infant. She intends to breastfeed her baby exclusively. Her baby was born at 39 weeks gestation by spontaneous vaginal delivery. In a normal term neonate [patient], what is the optimal dose of vitamin D supplementation [intervention] to prevent vitamin D deficiency and rickets [outcome]? ### Primary sources MEDLINE was searched via PubMed from 1990 to July 2011. The advanced search mode was used with the terms ‘vitamin D’ and ‘neonates’ and ‘supplementation’. ### Secondary sources A search of the Cochrane Library was conducted using the search terms ‘vitamin D’ and ‘infants’. Vitamin D is essential for good bone health and insufficient levels are linked to rickets in children.1 5 A resurgence of vitamin D insufficiency and nutritional rickets has been reported across many countries.1 Studies in infants and children are also exploring the association between vitamin D insufficiency and type 1 diabetes mellitus as well as inflammatory diseases.1 2 There …