Vitamin D supplementation in neonates
BMJ Qual Improv Report 2014;3: doi:10.1136/bmjquality.u203171.w1436
Zhe Wu
St Mary's Hospital, Imperial College NHS Trust
Correspondence to: Zhe Wu zjwu87900 at yahoo.co.uk
Received 23 January 2014; Revision requested 12 March 2014; Revised 5 July 2014; Published 26 August 2014
Vitamin D deficiency may lead to the development of rickets. In our paediatrics department in a major London hospital, we audited the number of babies with low vitamin D levels attending our prolonged jaundice clinic. Prior to our newly designed intervention, those babies with low vitamin D levels would be given a letter to encourage collection of supplementation from their GP. The GP would receive a letter which included a 14-page guideline on vitamin D supplementation.
For this project, we included all breastfed babies that attended our prolonged jaundice clinic between August 2012 and December 2012. Those babies that were either vitamin D deficient or insufficient were identified. We then followed up these patients and asked them whether they were being prescribed the correct supplementation after being identified as vitamin deficient. For our intervention, we designed a leaflet to simplify guidelines that was then distributed to mothers and their GPs. Following this intervention, we re-audited the new cohort of patients who received the leaflet between August and November 2013.
The study found 71% of babies to be vitamin D deficient. Moreover, almost two in five mothers had less than the recommended six months of vitamin supplementation during pregnancy. After identifying a deficiency, one would expect that uptake of vitamin supplementation would increase dramatically. However, only four in 10 babies went on to receive the correct dose and preparation of supplements. A marked increase in uptake was seen during the re-audit post intervention, with 71% of babies receiving correct supplementation.
While an increase in government advertising would have contributed to the rise in uptake of vitamin D supplementation, a leaflet proved to be a simple yet effective intervention in improving vitamin uptake in babies. As a result, this was then implemented as part of trust guidelines.
PDF is attached at the bottom of this page
Reasons for non-compliance include
- Too busy for to be bothered with daily supplements (once pill every two weeeks would have done as well)
- Did not understand the instructions written in Englihs (this was in the UK - where many immegrants do not understand English very well)
- There was no interaction available for asking questions- just a printed set of instructions
- The supplements were too hard to obtain, not available at low cost, etc.