Vitamin D deficiency common in critically ill children

Robin Wulffson MD's picture
Vitamin D, critically ill child, PICU, immunity, infection resistance
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According to a new study, low Vitamin D levels increases the risk of a serious childhood illness. Researchers affiliated with the Children’s Hospital Boston, Harvard medical School, and the University of South Carolina published their findings online on August 6 in the journal Pediatrics.

The authors noted that Vitamin D influences cardiovascular and immune function. Therefore, they designed a study to determine the prevalence of Vitamin D deficiency in critically ill children and identify factors influencing admission Vitamin D (25-hydroxy Vitamin D (25(OH)D) levels. They theorized that levels would be lower with increased illness severity and in children with serious infections.

The study group was comprised of 511 severely or critically ill children admitted to the pediatric intensive care unit (PICU) from November 2009 through November 2010. Blood was collected near PICU admission and analyzed for 25(OH)D concentration by using Diasorin radioimmunoassay.

The median 25(OH)D level was 22.5 ng/mL; 40.1% of the children were 25(OH)D deficient (level less than 20 ng/mL). They found that the following factors were involved in Vitamin D deficiency: summer season, Vitamin D supplementation, and formula intake were protective; 25(OH)D levels were not lower in the 238 children (46.6%) admitted with a life-threatening infection, unless they had septic shock (51 children (10.0%) had septic shock). After adjusting for factors associated with deficiency, lower levels were associated with higher admission day illness severity.

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The authors concluded that they found a high rate of vitamin D deficiency in critically ill children. They wrote: “Given the roles of Vitamin D in bone development and immunity, we recommend screening of those critically ill children with risk factors for Vitamin D deficiency and implementation of effective repletion strategies.”

The skin can produce Vitamin D with sunlight (ultraviolet B) exposure. It also is available in many vitamin supplements. Safety research supports an upper limit of a daily Vitamin D dose of about 250 micrograms (10,000 IU of vitamin D3). A number of foods are high in Vitamin D. Examples are:

  • Pure Cod liver oil
  • Salmon, mackerel, sardines, or tuna
  • Milk, nonfat, reduced fat, and whole, Vitamin D fortified
  • Margarine, fortified
  • Pudding, prepared from mix and made with Vitamin D fortified milk
  • Cereals fortified with Vitamin D
  • Eggs
  • Beef liver
  • Swiss cheese

The following are risk factors for Vitamin D deficiency:

  • Your ethnic background is 50% or more African, Indian, Southeast Asian, Hispanic, or Arabic. You are obese (BMI of 30 or higher).
  • You were breast-fed as an infant. Breast milk usually has little or no Vitamin D.
  • You are easily tired or suffer frequent aches and pains.
  • You live outside the 35th parallel north or south of the equator. (add 3 points)
  • You rarely (less than three times a week) spend time outdoors between 11 a.m. and 4 p.m.
  • You apply sunscreen of SPF 8 or higher before you go outdoors.
  • You are age 50 or older.

A simple blood test can check for Vitamin D deficiency.

Reference: Pediatrics

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