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Premature infants (30 weeks) who got 800-1000 IU of vitamin D were much healthier – March 2017

Vitamin D deficiency and morbidity among preterm infants in a developing country

International Journal of Contemporary Pediatrics, 2017 Mar;4(2):499-502, http://dx.doi.org/10.18203/2349-3291.iicp20170697
Nitin Srinivasan, Jayasree Chandramathi, Aswin S. Prabhu, Sasidharan Ponthenkandath psasidha at gmail.com
Department of Neonatology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India


Reminder – premature birth is reduced by having enough vitamin D DURING pregnancy
Reminder - do not have to wait till premie can feed - Injection and UV lighting both can boost the infant vitamin D level

Infant-Child category starts with

Having a good level of vitamin D cuts in half the amount of:

Need even more IUs of vitamin D to get a good level if;

  • Have little vitamin D: premie, twin, mother did not get much sun access
  • Get little vitamin D: dark skin, little access to sun
  • Vitamin D is consumed faster than normal due to sickness
  • Older (need at least 100 IU/kilogram, far more if obese)
  • Not get any vitamin D from formula (breast fed) or (fortified) milk
    Note – formula does not even provide 400 IU of vitamin D daily

Infants-Children need Vitamin D

Healthy pregnancies need lots of vitamin D has the following summary

0. Chance of not conceiving3.4 times Observe
1. Miscarriage 2.5 times Observe
2. Pre-eclampsia 3.6 timesRCT
3. Gestational Diabetes 3 times RCT
4. Good 2nd trimester sleep quality 3.5 times Observe
5. Premature birth 2 times RCT
6. C-section - unplanned 1.6 timesObserve
     Stillbirth - OMEGA-3 4 timesRCT - Omega-3
7. Depression AFTER pregnancy 1.4 times RCT
8. Small for Gestational Age 1.6 times meta-analysis
9. Infant height, weight, head size
     within normal limits
10. Childhood Wheezing 1.3 times RCT
11. Additional child is Autistic 4 times Intervention
12.Young adult Multiple Sclerosis 1.9 timesObserve
13. Preeclampsia in young adult 3.5 timesRCT
14. Good motor skills @ age 31.4 times Observe
15. Childhood Mite allergy 5 times RCT
16. Childhood Respiratory Tract visits 2.5 times RCT

RCT = Randomized Controlled Trial

 Download the PDF from VitaminDWiki

Background: The association of serum vitamin D levels to clinical outcome in VLBW infants has not been studied. Our objective was to measure the cord blood levels, and the dose response for two doses of vitamin D in preterm infants and correlate the relationship of vitamin D levels to the clinical outcome.

Methods: We prospectively obtained cord blood levels in 80 preterm infants under 34 weeks gestation (mean gestation age 29±2 weeks and BW: 1210±350 gms). Infants were supplemented with 400 IU or 800-1000 IU vitamin D daily. Serun vitamin D levels were obtained at 2 - 3 weeks after supplementation and levels were correlated to clinical outcome.

Results: The mean cord blood vitamin D level was 12±8.5 ng/ml. Babies who developed sepsis and compared to those who did not develop these morbidities, ROP had vitamin D levels: 13.5±6 (ng/ml) versus 30.5±10 (ng/ml) (p < 0.01) and 15.7±11 (ng/ml) versus 34±18 (ng/ml) (p <0.03) respectively. Supplementation with 400 IU vitamin D resulted in levels of 17±8.6 (ng/ml) and infants given 800-1000 IU vitamin D had levels 46±17(ng/ml) (p <0.001).

Conclusions: These data suggest that cord blood vitamin D levels are low in preterm infants and 800-1000 IU vitamin D supplementation is advisable to achieve levels >30 ng/ml. Infants with low levels of vitamin D have higher incidence of sepsis, and ROP.

Summary by Grassroots Health May 2017

A study recently published by Srinivasan et al. looked at 25(OH)D serum levels of 80 preterm infants (gestation less than 34 weeks). Objectives of the study were to determine the vitamin D levels in the cord blood of these infants, randomly assign each infant to either 400 IU daily or 800-1000 IU daily supplementation, and then to correlate the serum vitamin D levels to neonatal morbidity and outcome of sepsis, retinopathy of prematurity (ROP), and delayed retinal maturation.

Within this group of premature infants:

  • Late onset sepsis was present in 48 infants (60%)
    Those who developed sepsis had 25(OH)D levels of 14±6 ng/ml
    compared to infants who did not develop sepsis, 31±10 ng/ml (P <0.01)
  • ROP was present in 30 infants (37.5%)
    Those who developed ROP had 25(OH)D levels of 16±11 ng/ml
    compared to infants who did not develop ROP, 34±18 ng/ml (P <0.03)
  • Retinal maturation was delayed beyond 40 weeks in 34 infants (42.5%)
    Those whose retinal maturation was delayed beyond 40 weeks had 25(OH)D levels postnatally of 12±6 ng/ml,
    compared to infants who did not have delayed retinal maturation, 26±7 ng/ml (P <0.02)

The paper concludes that the American Academy of Pediatrics' guidelines for supplementation in infants of 400 IU is insufficient, and most infants require 800 - 1000 IU vitamin D soon after birth to maintain physiological vitamin D levels of ≥ 30 ng/ml, especially if they are exclusively breast fed.

Attached files

ID Name Comment Uploaded Size Downloads
7967 Preterm India.jpg admin 05 May, 2017 21:34 25.12 Kb 1043
7966 Preterm India.pdf PDF 2017 admin 05 May, 2017 21:27 535.21 Kb 852