The Darker Side of Brightness - Vitamin D deficiency in Pregnancy and Childhood with Inadequate Treatment Options in Wellington, New Zealand
Newtown Union Health Service, 14 Hall Avenue, Newtown, Wellington, New Zealand.
Background: Working in a high needs community with a large refugee population living at 41degrees South, in 2004 we diagnosed 3 children with rickets within a month. This resulted in a research project within our practice, where we identified and treated vitamin D deficiency in pregnancy to try and prevent rickets in our community. Due to the unavailability of subsidized daily doses of vitamin D and the unaffordability of vitamin D testing in New Zealand we have established a less than ideal process for treating and preventing vitamin D deficiency in our identified high risk women and children, using monthly doses of 50.000IU Cal-D forte for women and vitadol-C (multivitamin) for breast feeding babies. We have decreased the incidence of rickets in our community but with limited subsidised treatment options in a poor and at risk community we are still concerned about the impact of vitamin D deficiency on our vulnerable children.
Method: Identified as high risk low vitamin D community we engaged with Massey University's research into vitamin D deficiency in preschool children in NZ. 47 children had their vitamin D levels measured within our practice in August and September 2012. Primary and secondary medical service contacts were compared between those children who had a vitamin D level <25nmol/L and those >25nmol/L over a 2 year period.
Results: Vitamin D levels ranged from 6-84 nmol/L. 19 (40%) children had levels <25nmol/L.
African and Pacific children had the lowest levels measured although there were Middle Eastern, Maori, European and Asian children with levels <25nmol/L.
- Children with levels <25nmol/L had on average 19 health professional contacts over the 2 years whilst
- children with levels >25nmol/L had 12 contacts over the same time period.
Most of these contacts were for respiratory tract infections. Failure to thrive is identified. Although no children were taking vitamin supplements at the time of the study, the average vitamin D level in African children who had ever been prescribed vitadol-C was 34nmol/L whilst those who had never been prescribed vitadol-C was 16nmol/L.
Conclusion: We have decreased the incidence of rickets in our community and raised awareness of the need for vitamin D supplementation in at risk communities in NZ. However this window-shot identifies ongoing cross cultural vitamin D deficiency in our community. Dissection: Should we spend resources on testing vitamin D level or treat universally? How hard should we fight for improved affordable access to daily vitamin D supplementation? Is second or third best practice OK?
Poster presentation at Vitamin D conference in England - April 23-25 2014
This study used a vitamin D cutpoint (above/below) of 10 ng.
40% of the children had less than 10 ng!
That same 40% of children had health professional contact more often ( 19 vs 12 visits)
Most studies use a much higher cutpoint of 30 ng
- Infant-Child catgory listing with assocated searches
- Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013
- Vitamin D Deficiency is a Strong Predictor (4X) of Asthma in Children – Oct 2012
- Acute lower respiratory infection 5X more frequent with low vitamin D intake – June 2012
- Post-mortem analysis of children in London Hospital – only 1 child had adequate level of vitamin D – July 2014
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- 96 percent of ear, nose, throat children had less than 30 ng of vitamin D – Jan 2013