A third of premature neonates displayed inadequate 25‐hydroxyvitamin D levels before being discharged from a French neonatal intensive care unit

Is 25OH Vitamin D Excess before 36 Weeks Corrected Age an Independent Risk Factor for Bronchopulmonary Dysplasia or Death?

“…As reported herein, a high frequency of excessive 25(OH)D levels with high enteral intakes of vitamin D has been reported [15][16][17] and the recommendations from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition have been updated with a decreased recommended intake during enteral nutrition (400-700 IU daily) and an increased recommended intake during parenteral nutrition [29,30].…”

“…This threshold is reinforced by the results of a case series study that identified 16 preterm infants referred to nephrology clinics for symptomatic hypervitaminosis D with 25(OH)D concentrations between 119 and 350 nmol/L [11]. In two previous studies, higher concentrations were associated with a high frequency of hypercalciuria [15,16]. However, it remains possible that the effect of excessive 25(OH)D concentration on lung development necessitates concentrations above 120 nmol/L, although the results of the post hoc analysis with concentrations above 150 nmol/L do not support this hypothesis.…”

“…Furthermore, in a model of bronchopulmonary dysplasia, neonatal pups exposed to oxygen receiving high doses of 1,25-di-Hydroxyvitamin D (1,25(OH) 2 D) from the first day of life exhibited higher mortality and an altered lung histology (increased mean linear intercept, a decreased angiogenesis, and increased proinflammatory factors) when compared with animals receiving low doses [14]. Recent studies have demonstrated a high frequency of excessive levels of 25(OH)D in preterm infants with supplementation recommended at that time [15][16][17]. Our hypothesis was that these excessive 25(OH)D levels in very and extremely preterm infants may be deleterious to pulmonary development and may therefore be implicated in the pathogenesis of BPD.…”

Diagnosis and management of mineral and bone disorders in infants with CKD: clinical practice points from the ESPN CKD-MBD and Dialysis working groups and the Pediatric Renal Nutrition Taskforce

“…Preterm infants are prone to vitamin D deficiency due to incomplete transplacental transfer during the third trimester, low body stores, low vitamin D in parenteral nutrition, decreased absorption, and negligible sun exposure during hospital stay [ 50 ], in addition to the classical risk factors of vitamin D deficiency in newborns such as use of breast milk, ethnicity, and/or vitamin D deficiency in the mother. Thus, an earlier assessment of 25(OH)D levels should be performed in the first 2 weeks of life, because of the high proportion of native vitamin D deficiency at birth, both in term and especially in preterm infants [ 50 ], but also because with standard vitamin D supplementation preterm infants may display 25(OH)D under- or over-dosing at term-corrected age [ 51 ]. Some studies in preterm infants without CKD have shown the importance of an early monitoring of 25(OH)D levels so as to adapt supplementation [ 52 ].…”

“…Low neonatal levels of vitamin D have been associated with increased risks of respiratory distress syndrome, neonatal sepsis, bronchopulmonary dysplasia and necrotising enterocolitis, and overdoses have been associated with other risks. Another paper by Mathilde et al discusses the development and testing of a protocol that has helped to deliver vitamin D more accurately in preterm infants 8 …”