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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
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VitaminDWiki

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

Problem
Vit. D
Reduces
Evidence
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
RCT
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 25.12 Kb 1217
7966 Preterm India.pdf admin 05 May, 2017 535.21 Kb 931