Dose-Response Effects of Early Vitamin D Supplementation on Neurodevelopmental and Respiratory Outcomes of Extremely Preterm Infants at 2 Years of Age: A Randomized Trial
Neonatology 2018;113:256-262 . (DOI:10.1159/000484399)
Would have had far better outcome if supplement before birth
Would have had far better outcome if has used more (1000, 1200 IU)
Would have had far better outcome if had raised Vitamin D levels in a week instead of 3 months
Increasing the vitamin D level during pregnancy cuts the risk of preterm birth in half
- Extreme preterm infants need a total of 1,000 IU of vitamin D daily – RCT April 2016
- Preemies need 1,000 IU of vitamin D – RCT Sept 2017
- Preemies getting 800 IU of vitamin D were 3X less likely to have low bone density 4 weeks later – RCT Oct 2017
- Premature infants (30 weeks) who got 800-1000 IU of vitamin D were much healthier – March 2017 Premies in this study were not extreme preterm
- Preterm birth rates increased in 15 European countries – Oct 2013
- Infant-Child category listing has
588 items along with related searches
Download the PDF from VitaminDWiki
NDI = Neurodevelopmental impairment
Salas A.A. · Woodfin T. · Phillips V. · Peralta-Carcelen M. · Carlo W.A. · Ambalavanan N.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
Corresponding Author Ariel A. Salas, MD, MSPH asalas at peds.uab.edu
Department of Pediatrics, University of Alabama at Birmingham
Women and Infants Center Suite 9380, 1700 6th Ave South Birmingham, AL 35233 (USA)
Background: Many extremely preterm infants have low vitamin D concentrations at birth, but early childhood outcomes after vitamin D supplementation have not been reported. Objective: To determine a dose-response relationship between increasing doses of enteral vitamin D in the first 28 days after birth and cognitive scores at 2 years of age.
Methods: In this phase II double-blind dose-response randomized trial, infants with gestational ages between 23 and 27 weeks were randomly assigned to receive placebo or a vitamin D dose of 200 or 800 IU/day from day 1 of enteral feeding to postnatal day 28. The primary outcome of this follow-up study was Bayley III cognitive score at 22-26 months of age.
Results: Seventy of 80 survivors had a follow-up evaluation at 2 years of age (88%). There were no significant differences in cognitive scores between supplementation groups (p = 0.47). Cognitive scores did not differ between the higher vitamin D dose group and the placebo group (median difference favoring the 800 IU group: +5 points; 95% CI: −5 to 15; p = 0.23). The linear trend between increasing doses of vitamin D and reduction of neurodevelopmental impairment (placebo group: 54%; 200 IU group: 43%; 800 IU group: 30%; p = 0.08) or language impairment (placebo group: 64%; 200 IU group: 57%; 800 IU group: 45%; p = 0.15) was not statistically significant. Respiratory outcomes at 2 years of age (need for supplemental oxygen or asthma medications) did not differ between groups.
Conclusion: In extremely preterm infants, early vitamin D supplementation did not significantly improve cognitive scores. Though underpowered for clinically meaningful differences in early childhood outcomes, this trial may help determine dosing for further investigation of vitamin D supplementation.
© 2018 S. Karger AG, Basel
- Fort P, Salas AA, Nicola T, Craig CM, Carlo WA, Ambalavanan N: A comparison of 3 vitamin D dosing regimens in extremely preterm infants: a randomized controlled trial. J Pediatr 2016;174:132-138.e1.
- McCarthy RA, McKenna MJ, Oyefeso O, Uduma O, Murray BF, Brady JJ, Kilbane MT, Murphy JF, Twomey A, O'Donnell CP, Murphy NP, Molloy EJ: Vitamin D nutritional status in preterm infants and response to supplementation. Br J Nutr 2013;110:156-163.
- Burris HH, Van Marter LJ, McElrath TF, Tabatabai P, Litonjua AA, Weiss ST, Christou H: Vitamin D status among preterm and full-term infants at birth. Pediatr Res 2014;75:75-80.
- Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition: Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142-1152.
- Taylor SN, Hollis BW, Wagner CL: Vitamin D needs of preterm infants. Neoreviews 2009;10:e590-e599.
- Thandrayen K, Pettifor JM: Maternal vitamin D status: implications for the development of infantile nutritional rickets. Endocrinol Metab Clin North Am 2010;39:303-320.
- Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, Domellof M, Embleton ND, Fusch C, Genzel-Boroviczeny O, Goulet O, Kalhan SC, Kolacek S, Koletzko B, Lapillonne A, Mihatsch W, Moreno L, Neu J, Poindexter B, Puntis J, Putet G, Rigo J, Riskin A, Salle B, Sauer P, Shamir R, Szajewska H, Thureen P, Turck D, van Goudoever JB, Ziegler EE; ESPGHAN Committee on Nutrition: Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010;50:85-91.
- Kovacs CS: Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies. Am J Clin Nutr 2008;88:520S-528S.
- Abrams SA, Committee on N: Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics 2013;131:e1676-e1683.
- Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG, Taylor SN, Morella K, Lawrence RA, Hulsey TC: Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics 2015;136:625-634.
- Holick MF: Vitamin D deficiency. N Engl J Med 2007;357:266-281.
- Backstrom MC, Maki R, Kuusela AL, Sievanen H, Koivisto AM, Ikonen RS, Kouri T, Maki M: Randomised controlled trial of vitamin D supplementation on bone density and biochemical indices in preterm infants. Arch Dis Child Fetal Neonatal Ed 1999;80:F161-F166.
- Zosky GR, Hart PH, Whitehouse AJ, Kusel MM, Ang W, Foong RE, Chen L, Holt PG, Sly PD, Hall GL: Vitamin D deficiency at 16-20 weeks' gestation is associated with impaired lung function and asthma at 6 years of age. Ann Am Thorac Soc 2014;11:571-577.
- Walker VP, Modlin RL: The vitamin D connection to pediatric infections and immune function. Pediatr Res 2009;65:106R-113R.
- Zhu P, Tong SL, Hao JH, Tao RX, Huang K, Hu WB, Zhou QF, Jiang XM, Tao FB: Cord blood vitamin D and neurocognitive development are nonlinearly related in toddlers. J Nutr 2015;145:1232-1238.
- Eyles D, Brown J, Mackay-Sim A, McGrath J, Feron F: Vitamin D3 and brain development. Neuroscience 2003;118:641-653.
- Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Kusel MM, Hart PH: Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics 2012;129:485-493.
- Pet MA, Brouwer-Brolsma EM: The impact of maternal vitamin D status on offspring brain development and function: a systematic review. Adv Nutr 2016;7:665-678.
- Natarajan CK, Sankar MJ, Agarwal R, Pratap OT, Jain V, Gupta N, Gupta AK, Deorari AK, Paul VK, Sreenivas V: Trial of daily vitamin D supplementation in preterm infants. Pediatrics 2014;133:e628-e634.
- Hanson C, Jones G, Lyden E, Kaufmann M, Armas L, Anderson-Berry A:. Clin Nutr 2016;35:835-841.
- Vaucher YE, Peralta-Carcelen M, Finer NN, Carlo WA, Gantz MG, Walsh MC, Laptook AR, Yoder BA, Faix RG, Das A, Schibler K, Rich W, Newman NS, Vohr BR, Yolton K, Heyne RJ, Wilson-Costello DE, Evans PW, Goldstein RF, Acarregui MJ, Adams-Chapman I, Pappas A, Hintz SR, Poindexter B, Dusick AM, McGowan EC, Ehrenkranz RA, Bodnar A, Bauer CR, Fuller J, O'Shea TM, Myers GJ, Higgins RD; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network: Neurodevelopmental outcomes in the early CPAP and pulse oximetry trial. N Engl J Med 2012;367:2495-2504.
- Kyriacou DN: The enduring evolution of the p value. JAMA 2016;315:1113-1115.
- Siafarikas A, Piazena H, Feister U, Bulsara MK, Meffert H, Hesse V: Randomised controlled trial analysing supplementation with 250 versus 500 units of vitamin D3, sun exposure and surrounding factors in breastfed infants. Arch Dis Child 2011;96:91-95.
- Gallo S, Comeau K, Vanstone C, Agellon S, Sharma A, Jones G, L'Abbe M, Khamessan A, Rodd C, Weiler H: Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: a randomized trial. JAMA 2013;309:1785-1792.
- Holmlund-Suila E, Viljakainen H, Hytinantti T, Lamberg-Allardt C, Andersson S, Makitie O: High-dose vitamin D intervention in infants - effects on vitamin D status, calcium homeostasis, and bone strength. J Clin Endocrinol Metab 2012;97:4139-4147.
- Morales E, Guxens M, Llop S, Rodriguez-Bernal CL, Tardon A, Riano I, Ibarluzea J, Lertxundi N, Espada M, Rodriguez A, Sunyer J, Project I: Circulating 25-hydroxyvitamin D3 in pregnancy and infant neuropsychological development. Pediatrics 2012;130:e913-e920.
- Strom M, Halldorsson TI, Hansen S, Granstrom C, Maslova E, Petersen SB, Cohen AS, Olsen SF: Vitamin D measured in maternal serum and offspring neurodevelopmental outcomes: a prospective study with long-term follow-up. Ann Nutr Metab 2014;64:254-261.
- Gale CR, Robinson SM, Harvey NC, Javaid MK, Jiang B, Martyn CN, Godfrey KM, Cooper C; Princess Anne Hospital Study Group: Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr 2008;62:68-77.
- Gould JF, Anderson AJ, Yelland LN, Smithers LG, Skeaff CM, Zhou SJ, Gibson RA, Makrides M: Association of cord blood vitamin D with early childhood growth and neurodevelopment. J Paediatr Child Health 2017;53:75-83.
- Keim SA, Bodnar LM, Klebanoff MA: Maternal and cord blood 25(OH)-vitamin D concentrations in relation to child development and behaviour. Paediatr Perinat Epidemiol 2014;28:434-444.
There have actually been
1004 visitors to this page since it was originally made