Premature infants (30 weeks) who got 800-1000 IU of vitamin D were much healthier

Created May 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 [email protected]

Department of Neonatology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India

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Reminder – premature birth is reduced by having enough vitamin D DURING pregnancyReminder - 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 2014Infant-Child category starts with{include}{include}Healthy pregnancies need lots of vitamin D has the following summary{include}

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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.

Tags: Infant-Child Intervention