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

Abstract

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

Efficacy of Vitamin D Supplements in Treatment of Acute Respiratory Infection: A Meta-Analysis for Randomized Controlled Trials

“…Thus, further larger trials are warranted to confirm our findings on the efficacy of vitamin D for ARIs. Second, five [ 15 , 19 , 25 , 26 , 30 ] out of 18 RCTs were not designed specifically to investigate the efficacy in the treatment of ARIs as primary outcomes. For example, as a primary outcome, Wejse et al [ 15 ] used reduction in a clinical severity score, and Miroliaee et al [ 26 ] used the effect of vitamin D administration on the selected markers (IL-6, C-reactive protein, and plasma level of vitamin D).…”

“… Efficacy of vitamin D supplements in treatment of acute respiratory infections in a meta-analysis of randomized controlled trials ( n = 18) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. RR, relative risk; CI, confidence interval.…”

“…Previous randomized controlled trials (RCTs) have shown inconsistent findings regarding the efficacy of vitamin D supplements in the treatment of ARIs [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Several RCTs reported that vitamin D supplements had a beneficial effect [ 14 , 19 , 21 , 28 , 29 , 30 ], while others reported no effect [ 15 , 16 , 17 , 18 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 31 ].…”

“…Previous randomized controlled trials (RCTs) have shown inconsistent findings regarding the efficacy of vitamin D supplements in the treatment of ARIs [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Several RCTs reported that vitamin D supplements had a beneficial effect [ 14 , 19 , 21 , 28 , 29 , 30 ], while others reported no effect [ 15 , 16 , 17 , 18 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 31 ]. Several meta-analyses have been published on the efficacy of vitamin D supplements in the treatment of pulmonary tuberculosis (TB), pneumonia, and COVID-19 [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

“…Labib et al [30] Egypt Out of 18 trials, 16 trials were funded by public/governmental organizations or ind pendent scientific foundations, while the remaining ones did not report their fundin source. Regarding the source of supplements, six trials were provided by a pharmaceut cal company, two paid for them, and 10 did not mention their funding source.…”