Abstract
Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n = 55; approximately 800–1000 IU from combined sources) or monitored therapy (n = 54; with an option of dose modification). 25-hydroxyvitamin D [25(OH)D] concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52 ± 2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20–80 ng/mL) at 52 weeks of PCA (p = 0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.
Highlights
Vitamin D plays an important role in skeletal health [1], and its receptors are in most tissues
In the premature infants’ population, vitamin D deficiency (VDD) can lead to bone disease, which is described as rickets of prematurity, osteopenia of prematurity, or metabolic bone disease (MBD) [9]
One protocol deviation was registered in the control group, wherein the infant received incorrect vitamin D dosing and was excluded from the analysis
Summary
Vitamin D plays an important role in skeletal health [1], and its receptors are in most tissues. Neonatal vitamin D storage depends on 50–70% of the maternal 25-hydroxyvitamin D [25(OH)D] levels received by newborns [7]. Preterm infants are vulnerable to vitamin D deficiency (VDD) because of maternal vitamin D supply deprivation and exposure to additional risk factors, such as long-term parenteral nutrition use, intolerance to human milk fortifiers and formulas, and neonatal cholestasis [8]. In the premature infants’ population, VDD can lead to bone disease, which is described as rickets of prematurity, osteopenia of prematurity, or metabolic bone disease (MBD) [9]. High vitamin D supplementation among low-birth-weight infants with immature renal filtration can lead to vitamin D toxicity with hypercalcemia or hypercalciuria and cause serious illness [10,11]
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