Increasing Pediatric Hospitalizations With Severe Vitamin D Deficiency: A Concerning Trend

Abstract

Background: Deficiency of vitamin D can lead to multiple health issues in children. Though it can be asymptomatic in early stages, it can lead to symptomatic illnesses if severe/ prolonged including seizures and rickets. Deficiency can be prevented by adequate dietary vitamin D intake with/without supplementation in those at higher risk. However, there has been a recent reemergence and increase in the incidence of vitamin D deficiency in European nations, noted as early as 2008 and at least upto 2018. Hence, we performed a 10 year retrospective study of severe vitamin D deficiency in hospitalized patients at a Children’s Hospital in USA.Methods: Electronic medical record was searched to identify patients with the following inclusion criteria: admitted at our hospital between 1/1/2010 and 12/31/2019 and had a 25-OH vitamin D (25-OH D) level <13 ng/mL with/without hypocalcemia or had a diagnosis of rickets. The study was approved by our institutional review board and consent was waived. Patient demographics, medical history and data on laboratory results, treatment given were extracted. We then ran a summative analysis of most of the data collected, analyzed trends for the number of admissions per year and the response time of calcium levels.Results: Between 1/1/2010 and 12/31/2019, there were 109 hospital admissions with 25-OH D deficiency with or without hypocalcemia. Median 25-OH D level was 9.7 ng/mL. Admissions per year increased from 2010 to 2019 as follows: 2 in 2010, 5 in 2011, 4 in 2012, 6 in 2013, 6 in 2014, 7 in 2015, 12 in 2016, 13 in 2017, 23 in 2018, 25 in 2019. Median patient age was 27 months (range 0,228). Of those </=1 year (n=39), 13% were preterm, 38% were exclusively breastfed and 44% were formula fed. Ninety percent of these infants were not receiving vitamin D supplementation prior to hospitalization. Of the entire cohort of 109 patients, 63% were males and race distribution was as follows: 13% were White, 77% were Blacks and 10% were others. Seventy percent patients were on state sponsored insurance. About 33% had some diet restrictions/ peculiarities, 40% had a presenting complaint related to hypocalcemia including seizures, while 44% had hypocalcemia but it was not their primary reason for presentation. Seventy eight percent patients had hypocalcemia. Of the patients with initial calcium <7.5 mg/dL (n=64), it took a median of 72 hours (range 7,468) to improve to >/= 7.5 mg/dL.Conclusions: Our hospital has witnessed a significant increase in severe vitamin D deficiency in admitted patients between 2010 and 2019. A large proportion of these were Blacks, on state sponsored insurances and infants not on vitamin D supplementation. Greater than 3/4th of patients had hypocalcemia and over 50% patients had hypocalcemia that required a median of 3 days to correct. This is a concerning trend of an often easily preventable morbidity and another health issue that highlights disparities in our health system.