Abstract
Objective: To compare the levels of vitamin D, calcium, phosphorus and alkaline phosphatase and linear growth parameters in exclusively breast fed term infants with and without supplementation of vitamin D. Design: Interventional study (Non Randomized). Setting: Department of Paediatrics and OBG in a Tertiary care Teaching Hospital, Mysuru. Participants: 60 term Healthy Neonates who were delivered in the hospital. In order to estimate the expected level with an allowable error of 20% and 95% confidence, the required sample size was considered to be a minimum of 28 for each group of only breast fed and breast fed with vitamin D supplementation. Thus we recruited 30 healthy term newborns for each group in our study. Main outcome measures: Study infants were divided into two groups, Group A-Only breast fed; Group B-breast fed with Vitamin D supplementation (800 IU/day for 4 months). The cord blood sample reports and linear growth parameters at birth with results at the end of 4th month+15days between the two groups were compared and statistical analysis was made. Results: This study showed significant improvement in vitamin D, calcium and phosphorus levels at the end of 4 months after supplementing daily 800 IU of vitamin D (cholecalciferol). However, there were no significant change in linear growth parameters between the two groups at the end of 4 months. Conclusion: This study shows the advantage of supplementing vitamin D to all infants at a relatively higher (800IU) but safe dose since birth in preventing rickets and complications of hypocalcemia.
Highlights
There are global efforts to promote breastfeeding as optimal nutrition in early infancy
It was observed that the vitamin D level in only breast fed (Group A) infants was significantly low (p=0.040) at the end of 4 months compared to cord blood levels
Maternal influences on vitamin D status in the exclusively breastfed neonate is more pronounced during the first 2 months of life, but, thereafter, infant vitamin D status is more directly affected by sunshine exposure and vitamin D supplementation [13,14,15]
Summary
There are global efforts to promote breastfeeding as optimal nutrition in early infancy. Vitamin D deficiency and rickets among breast-fed infants who lack adequate sunlight exposure and do not receive vitamin D supplementation are increasingly being reported worldwide. Maternal vitamin D status and human milk vitamin D concentration significantly affect infant vitamin D status and, should be of global concern. The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Routine supplementation starting from newborn period is being increasingly endorsed by various international organizations. Prevention by sensible sunlight exposure, food fortification and routine supplementation are the currently available options for tackling this nutritional deficiency
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