Vitamin D Status in Neonates Undergoing Cardiac Operations: Relationship to Cardiopulmonary Bypass and Association with Outcomes

Abstract

Objectives To determine the incidence of vitamin D deficiency in neonates with congenital heart disease and whether differences exist by race. In addition, we determined the effect of cardiopulmonary bypass on vitamin D levels, and explored associations between 25-hydroxyvitamin D [25(OH)D] levels and postoperative outcomes. Study design A secondary analysis of a prospective randomized controlled trial in 70 neonates undergoing cardiac surgery was performed. 25(OH)D levels were collected in the operating room prior to skin incision (baseline), at the cessation of cardiopulmonary bypass and 24 hours post-operatively. Associations between these levels and clinical outcomes were explored. Vitamin D deficiency was defined as a 25(OH)D level <20 ng/ml. Results Vitamin D deficiency was present in 84% (59/70); concentrations in African-Americans (n=20) were significantly lower than Caucasian/other (n=50) (10.2 ±4.2ng/ml vs. 16.0 ±5.6ng/ml, p<0.0001). The 24 hour postoperative 25(OH)D level were not different from baseline and correlated with a reduced postoperative inotropic requirement (r=−0.316, p=0.008). Conclusions Vitamin D deficiency is prevalent in neonates with congenital cardiac defects and lower postoperative 25(OH)D levels are associated with the need for increased inotropic support in neonates undergoing cardiac operations. These findings provide support that vitamin D deficiency may play a role in myocardial injury and postoperative recovery and warrants further investigation.

Low Vitamin D Concentration Is Not Associated with Increased Mortality and Morbidity after Cardiac Surgery

“…We know that off the pump technique is more often used in Europe then USA, which have significant effect on vitamin D concentrations. Similarly another study in neonates couldn’t demonstrate difference in outcomes other than vasopressor usage [30]. We were unable to demonstrate any difference in vasopressor usage, which may be result of very different patient populations.…”

Vitamin D Deficiency and Its Response to Supplementation as “Stoss Therapy” in Children with Cyanotic Congenital Heart Disease Undergoing Open Heart Surgery

“…Graham et al 41 in their study observed that CPB did not have any effect on serum vitD levels in neonates postcardiac surgery and 84% of children have vitD deficiency from preoperative period itself. In our study, the control group followed the same pattern as shown by Graham et al 41 whereas the study group followed the pattern found in the studies published by others like Riad Abou et al, 39 McNally et al, 40 and Krishnan et al 42 One interesting finding was noticed in ►Table 6 the presurgery vitD levels of the Graham et al 41 study and the control group of our study corresponded to severe vitD deficiency, and their post CPB levels increased (though statistically insignificant) instead of decreasing contray to the findings from other three studies plus children in our study group where post CPB vitD level decreased significantly. Even though we cannot reach any conclusion as to why the serum vitD levels behave differently to CPB and acute hemodilution at different body levels of deficiency, we propose that it could be related to the multiple factors that control the serum vitD levels such as serum PTH, fibroblast growth factor (FGF) 23 levels, calcium levels, the distribution between the free and bound vitD levels in serum, and so forth.…”

“…42 A recent randomized placebo control trial by Shedeed et al of vitD supplementation in 80 infants with congestive heart failure was reported in which infants receiving vitD supplementation had greater improvements in clinical symptoms and echocardiographic measurements of ventricular size and function. 43 Shedeed et al, 43 McNally et al, 40 and Graham et al 41 noticed a reduced requirement of ionotropic support, fluid requirements, and short duration of mechanical ventilation among those with a higher serum vitD levels postoperatively. On the contrary, Lucidarme et al 18 and Rippel et al 37 did not find any correlation between serum vitD levels and the various prognostic outcomes.…”

“…Many other studies also showed significant decrease in serum vitD levels as a result of CPB effect in the immediate postoperative period. On the contrary, the control group showed rise in the mean value of serum vitD levels in the immediate post CPB period in sample C compared with sample B. Riad et al, 39 McNally et al, 40 Graham et al, 41 and Krishnan et al 42 studied the effect of CPB on serum vitamin D levels which is compared in ►Table 6.…”

Vitamin D Deficiency in Pediatric Critical Care

“…Prior to 2012, little attention was paid to vitamin D status during pediatric critical illness, with only three small studies reporting 25OHD levels on a total of 88 children. 39,74,75 Since 2012 there have been 10 observational studies evaluating vitamin D status in general PICU populations, [76][77][78][79][80][81][82][83][84][85] two focused on postoperative congenital heart disease (CHD), 86,87 and a pilot study of high-dose vitamin D in children with burns. 88 The 10 observational PICU studies originate from six countries and evaluate 2,000 children.…”