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
- Preemies need 1,000 IU of vitamin D – RCT Sept 2017
- Respiratory distress after preterm birth is more likely if low vitamin D – review April 2015
- All preemies with Chronic Lung Disease had low vitamin D levels– July 2015
- Preemies with low Vitamin D are 14 percent more like to have expensive gut problems (necrotizing enterocolitis) – March 2017
- Vitamin D required for breastfed infants – daily or monthly, infant or mother – Jan 2017
- Low vitamin D in Pediatric ICU – 5 times more ill (morbidity) – Spanish Nov 2016
- Preterm birth rate reduced by 43 percent with adequate Vitamin D supplementation – meta-analysis Feb 2017
- Preterm birth has become the leading cause of infant mortality (vitamin D not mentioned) – JAMA June 2016
- Extreme preterm infants need a total of 1,000 IU of vitamin D daily – RCT April 2016
- The more preterm the birth, the lower the vitamin D level (both mothers and infants) – Feb 2014
- Preemies 2.5 X more likely to get hip replacement etc. (low vitamin D) – Nov 2014
- Autism associated with preterm and low birth weight (both associated with low vitamin D) – Nov 2014
Infant-Child category starts with
- No consensus on MINIMUM International Units (IU) for healthy infant of normal weight
- 400 IU Vitamin D is no longer enough
Was OK in the past century, but D levels have been dropping for a great many reasons.
FDA doubles the amount of vitamin D permitted in milk – July 2016 - No consensus: range is 600 to 1600 IU – based on many randomized controlled trials
- Review of 400 IU to 2000 IU daily and higher if non-daily
- Fewer pre-infants were vitamin D deficient when they got 800 IU – RCT Feb 2014
- 1600 IU was the conclusion of three JAMA studies
1000 IU recommended in France and Finland – 2013 - appears to be a good level - 5X less mite allergy after add vitamin D
- Child bone fractures with low vitamin D were 55X more likely to need surgery
- 75 % of SIDS had low vitamin D
- Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- Infants have gotten free 400 IU of vitamin D in Turkey since 2005, More for longer would be even better – Feb 2022
- Preemies should have vitamin D supplements – reaching an agreement – April 2021
- Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021
Having a good level of vitamin D cuts in half the amount of:
- Asthma, Chronic illness, Doctor visits, Allergies, infection
Respiratory Tract Infection, Growing pains, Bed wetting
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
- Sun is great – well known for 1,000’s of years.
US govt (1934) even said infants should be out in the sun - One country recommended 2,000 IU daily for decades – with no known problems
- As with adults, infants and children can have loading doses and rarely need tests
- Daily dose appears to be best, but monthly seems OK
- Vitamin D is typically given to infants in the form of drops
big difference in taste between brands
can also use water-soluable form of vitamin D in milk, food, juice, - Infants have evolved to get a big boost of vitamin D immediately after birth
Colostrum has 3X more vitamin D than breast milk - provided the mother has any vitamin D to spare - 100 IU per kg of infant July 2011, Poland etc.
More than 100 IU/kg is probably better 854 items in the category Infant/Child See also - 34 pages in VitaminDWiki had BREASTFE*in title as of Jan 2022
- "BIRTH DEFECTS" 172 items as of July 2016
- Stunting OR “low birth weight” OR LBW OR preemie OR preemies OR preterm 1940 items as of Oct 2018
- 153 VitaminDWiki pages contained PRETERM or PREEMIE in title as of Nov 2024
- "SUDDEN INFANT DEATH" OR SIDS 214 items as of Dec 2020
- Overview of Rickets and Vitamin D
- Youth category listing has
175 items along with related searches - Down's syndrome and low vitamin D - several studies
- Rett syndrome associated with low vitamin D, treated by Omega-3
Healthy pregnancies need lots of vitamin D has the following summary
Most were taking 2,000 to 7,000 IU daily for >50% of pregnancy
Click on hyperlinks for detailsProblemVit. D
ReducesEvidence 0. Chance of not conceiving 3.4 times Observe 1. Miscarriage 2.5 times Observe 2. Pre-eclampsia 3.6 times RCT 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 times Observe Stillbirth - OMEGA-3 4 times RCT - 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 limitsRCT 10. Childhood Wheezing 1.3 times RCT 11. Additional child is Autistic 4 times Intervention 12.Young adult Multiple Sclerosis 1.9 times Observe 13. Preeclampsia in young adult 3.5 times RCT 14. Good motor skills @ age 3 1.4 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 VitaminDWikiBackground: 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.
Premature infants (30 weeks) who got 800-1000 IU of vitamin D were much healthier – March 2017Printer Friendly Follow this page for updates11958 visitors, last modified 30 Oct, 2019, This page is in the following categories (# of items in each category)Attached files
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