Vitamin D Deficiency in Pediatric Critical Care

Background: Despite the well-recognized effect of vitamin D in metabolism and homeostasis, there is now growing interest in its probable association with pneumonia. This study aims to supply vitamin D3 (Cholecalciferol) (100,000 IU) to pneumonic children to minimize the duration of illness and improve their outcome. Methods: A double-blinded, randomized, placebo-controlled trial was conducted in a Pediatric Cairo University affiliated hospital. An intervention arm (93 children) and a control arm (98 children), who had pneumonia with an insufficient or deficient level of vitamin D and whose parental permission was obtained, were enrolled in the trial. All children were treated with antibiotics according to WHO guidelines. Children were given a single injection of 1 mL of 100,000 IU of vitamin D3 or placebo. Clinical data were recorded every eight hours for all children. Outcomes were assessed 7 days after vitamin D injection. The primary outcome variable was the change in serum level of 25(OH)D, while the secondary outcomes were the medical state of the assigned cases (improvement or death) and duration between enrollment and hospital discharge for improved cases. Results: In the supplementation group, the percentage of patients who suffered either deficient (38.7%) or insufficient levels (61.3%) of 25 (OH)D at day one had significantly decreased in the seventh day to (11.8%) and (52.7%), respectively. Kaplan--Meier plots highlighted that the median time to recover of the placebo group was significantly longer than that of the supplementation group (Log Rank P value < .001). Conclusion: VDD was detected in pediatric critical care children. In pneumonic children with high VDD, it is illustrated that Vitamin D supplementation is accompanied by lowered mortality risk and pSOFA scores, reduced time to recover, and improved PaO 2 /FiO 2 . Trial registration: Trial Identifier number: NCT04244474. Registered on 27 January 2020- Retrospectively registered at ClinicalTrials.gov https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JXO&selectaction=Edit&uid=U0004UO8&ts=152&cx=9cceq6

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“…In other words, hypovitaminosis D did not show higher prediction of risk scores for mortality. [ 31 , 32 ]…”

Section: Discussionmentioning

confidence: 99%

Vitamin D supplementation and improvement of pneumonic children at a tertiary pediatric hospital in Egypt

et al. 2021

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“…The serum 25(OH)D was analyzed using liquid chromatography-tandem mass spectrometry (18). The pretreatment method of liquid-liquid extraction was used in the project, including a quality control.…”

Section: Measurement Methods and Range Of Reference Valuesmentioning

confidence: 99%

“…The prevalence of vitamin D deficiency in healthy children has also increased (9)(10)(11)(12)(13); however, most of the studies did not include younger children. There have although been several studies surveyed vitamin D levels in critically ill children (14)(15)(16)(17)(18)(19), but these findings are often different and even contradictory. To date, the status and the effect of vitamin D deficiency on the outcome in critically ill children is still unclear, and the opinions on the importance of vitamin D deficiency in critically ill children remains controversial.…”

Section: Introductionmentioning

confidence: 99%

25-Hydroxy Vitamin D Deficiency Is Associated With Cardiovascular Sequential Organ Failure Assessment and Pediatric Risk of Mortality III Scores in Critically Ill Children

Dang

Liu

et al. 2020

Front. Pediatr.

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Aim: Investigate 25-hydroxy vitamin D (25(OH)D) levels and the correlation with cardiovascular sequential organ failure assessment (CV-SOFA) and pediatric risk of mortality III (PRISM-III) scores in critically ill children.Methods: This prospective observational cohort study was conducted on consecutive critical ill children aged 1 month to 14 years old in 1 year. The blood sample was collected upon PICU admission. 25(OH)D deficiency was defined as<20 ng/mL. We performed univariate and multivariate analyses to evaluate associations with CV-SOFA and PRISM-III scores and other important outcomes.Results: 296 critically ill children were enrolled in the study. The mean serum 25(OH)D level was 22.5 (IQR 16.3-31.8) ng/mL. The prevalence of 25(OH)D deficiency was 39.2% in critically ill children. 25(OH)D levels were significantly decreased in septic shock and associated with CV-SOFA and PRISM-III scores. In multivariate analysis, vitamin D deficiency is associated with CV-SOFA and PRISM-III scores.Conclusion: 25(OH)D deficiency is prevalent in critically ill children at PICU admission and seems to be associated with higher CV-SOFA and PRISM-III scores. Our study provides additional data for 25 (OH) D statuses that impact the outcomes of critically ill children.

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“…Critical disorders and some interventions (surgery, fluids, extracorporeal membrane oxygenation, cardiopulmonary bypass, plasma exchange) may markedly reduce 25(OH)D level. Hepatic, parathyroid, and organ dysfunctions (reduced hydroxylation) and increased tissue demand during catabolism, reduced endogenous production, and malabsorption due to intestinal edema also play a role in reduced 25(OH)D level [8].…”

Section: Introductionmentioning

confidence: 99%

Serum vitamin D status in pediatric critical care

2022

Ann Clin Anal Med

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Aim: Vitamin D deficiency (VDD) is a huge public health problem affecting people of all ages, races, and genders. Studies performed in pediatric intensive care units (PICUs) found a prevalence of VDD between 30% and 70%, and it was shown that VDD was related to a more severe disease course and a longer PICU stay. The aim of our study was to investigate the prevalence of VDD at PICU admission and its relationship between disease type, severity, and prognosis. Material and Method: The medical records of pediatric patients aged 1 month-17 years who were admitted to PICU between March 2017 and March 2018 were retrospectively reviewed. The patients' pediatric mortality risk score (PRISM), 25-hydroxyvitamin D(25(OH)vitD) level at admission, serum calcium (Ca), phosphorus (P), magnesium (Mg), and alkaline phosphatase (ALP) levels were recorded. Blood 25(OH)VitD level ≤20 ng/mL was defined as VDD. Patients with low 25(OH)VitD levels (≤20 ng/mL) were grouped as 'Group-1', those without (>20 ng/mL) were grouped as 'Group-2'. Results: Among the patients, 55 (56.7%) had VDD. The mean 25(OH)D level was 12.7 ng/ml in Group 1 and 27.8 ng/ml in Group 2. Patients in Group 1 had a greater age, body weight, and height, but BMI (body mass index) was not significantly different between both groups. The two groups also did not differ significantly with respect to race, gender, admission season, underlying disease, PRISM score, sepsis rate, vasoactive agent need, mechanical ventilation support, number of days on mechanical ventilation, number of days of PICU stay, and mortality rate. Discussion: As the prevalence of VDD is high among pediatric critical care patients, it is important to perform screening and administer effective replacement therapy to these patients. We believe that assessment of the relationship between vitamin D and disease duration, severity, and prognosis, and determining optimal vitamin D dose, administration route, and safety profile through prospective controlled studies could affect morbidity and mortality rates.

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Vitamin D Deficiency in Pediatric Critical Care

Cited by 6 publications

References 116 publications

Vitamin D supplementation and improvement of pneumonic children at a tertiary pediatric hospital in Egypt

Vitamin D supplementation and improvement of pneumonic children at a tertiary pediatric hospital in Egypt

25-Hydroxy Vitamin D Deficiency Is Associated With Cardiovascular Sequential Organ Failure Assessment and Pediatric Risk of Mortality III Scores in Critically Ill Children

Serum vitamin D status in pediatric critical care

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