Congenital heart surgery dropped vitamin D levels by 40 percent – July 2013

Impact of Anesthesia and Surgery for Congenital Heart Disease on the Vitamin D Status of Infants and Children:
A Prospective Longitudinal Study

Anesthesiology: July 2013 - Volume 119 - Issue 1 - p 71-80. doi: 10.1097/ALN.0b013e31828ce817
McNally, J. Dayre M.D., Ph.D.*; Menon, Kusum M.D., M.Sc.†; Chakraborty, Pranesh M.D.‡; Fisher, Lawrence B.Sc., A.R.T.§; Williams, Kathryn A. M.S.‖; Al-Dirbashi, Osama Y. Ph.D.#; Girolamo, Tara B.Sc.N.**; Maharajh, Gyaandeo M.D., C.M.††; Doherty, Dermot R. M.B., B.Ch., B.A.O., M.D.‡‡

Background: Vitamin D is recognized as a pleiotropic hormone important for the functioning of organ systems, including those central to critical illness pathophysiology. Recent studies have reported associations between vitamin D status and outcome among critically ill adults and children. Preoperative vitamin D status, impact of operative techniques, and relationship between immediate postoperative vitamin D levels and clinical course have not been described in the pediatric congenital heart disease (CHD) population. The objective of this study was to describe the impact of CHD surgery on vitamin D status and relationship between postoperative levels and clinical course.

Methods: A prospective cohort study was conducted from 2009 to 2011 at a single tertiary care pediatric hospital. A total of 58 children with CHD were enrolled and blood collected preoperatively, intraoperatively, and postoperatively. Serum 25-hydroxyvitamin D (25OHD) was measured using liquid chromatography–mass spectrometry.

Results: The mean preoperative 25OHD was 58.0 nm (SD, 22.4), with 42% being deficient (<50 nm). Postoperatively, we identified a 40% decline in 25OHD to 34.2 nm (SD, 14.5) with 86% being deficient. Intraoperative measurements determined that initiation of cardiopulmonary bypass coincided with abrupt decline. CHD patients requiring catecholamines had lower postoperative 25OHD (38.2 vs. 26.5 nm, P = 0.007), findings confirmed through multivariate logistic regression. Lower postoperative 25OHD was associated with increased fluid requirements and intubation duration.

Conclusions: Most CHD patients are vitamin-D deficient postoperatively due to low preoperative levels and a significant intraoperative decline.
Interventional studies will be required to determine whether prevention of postoperative vitamin D deficiency improves outcome.

Note the increased medical care/expense needed for children having < 10 ng of vitamin D

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See also VitaminDWiki

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• Vitamin D deficient children stayed in ICU almost 2 days longer – Sept 2012
• Will lots of vitamin D help in ICU – RCT protocol Nov 2012
• With just 200 IU vitamin D in intravenous feeds, deficiency results did the above study mention IV?
• 5 days longer in ICU if low on vitamin D - April 2012
• 1 month after plasma exchange vitamin D levels reduced by 40 percent – Oct 2013
• Congenital Heart problems - vitamin D levels drop even lower after surgery, loading dose probably required - thesis 2015
  Thesis author is one of the authors of the study on this page
• All items in category Trauma and Surgery and Vitamin D 352 items

This study was cited by 43 studies as of Nov 2021

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• Rapid Normalization of Vitamin D Levels: A Meta-Analysis - 2015 - https://doi.org/10.1542/peds.2014-1703
• Vitamin D deficiency in critically ill children: a systematic review and meta-analysis - 2017 PDF