Comparison between daily supplementation doses of 200 versus 400 IU of vitamin D in infants

The daily supplementation of vitamin D is mandatory for infants. However, there are still conflicting opinions about the exact daily dose. Thus, we aimed to evaluate a daily supplementation dose of 200 IU is sufficient and compared the supplementation doses of 200 and 400 IU per day. One hundred and sixty-nine infants were randomly assigned to two groups (group1, 200 IU/day; group 2, 400 IU/day) and there were 75 infants in group 1 and 64 were in group 2 with a total number of 139. The median levels of 25-hydroxyvitamin D3 were significantly increased in group 2 at the age of 4 months (group 1, 39.60 mcg/L; group 2, 56.55 mcg/L; p?<?0.0001). We clearly demonstrated that at the age of 4 months, none of the infants on the group 2 had a serum level of 25-hydroxyvitamin D3 less than 30 mcg/L. However, 21.3 % of the infants in group 1 had a level below 30 mcg/L. Thus, in order to avoid vitamin D deficiency and rickets, we recommend supplementation dose of vitamin D at 400 IU/day as a safe and effective dose.     

Fok-I polymorphism of vitamin D receptor gene and the presence of renal dysfunction in patients with β-thalassemia major

Recent evidence supports the presence of renal dysfunction even among young patients with β-thalassemia major. However, the possible genetic contribution has never been investigated. The aim of this study was to correlate the presence of Fok-I polymorphism of the vitamin D receptor gene with abnormal levels of early markers of renal impairment in children and young adults with thalassemia. Thirty-four patients (19 male and 15 female) with β-thalassemia major on conventional treatment, with a mean decimal age of 14.62 ± 5.47 years (range: 5-22 years), were included in the study. Markers of renal function were determined in serum and in urine and patients were genotyped for Fok-I gene polymorphism. Genotype frequencies were similar to those previously reported for other populations: 47.06% of the patients were homozygous for the F allele, 41.18% were heterozygous, and 11.76% were homozygous for the f allele. A considerable number of patients demonstrated impaired renal function with increased serum cystatin C levels (29.41%), glomerular dysfunction with proteinuria (68%), as well as significant tubulopathy with hypercalciuria (73.08%), and increased levels of urinary β(2)-microglobulin (29.41%). When patients were stratified according to Fok-I polymorphism, a significantly higher prevalence of abnormally increased serum levels of cystatin C was observed in patients being homozygous for the f allele (75%) compared with those being heterozygous (Ff) or homozygous for the F allele (14.29% and 31.25%, respectively, P = .02). Further studies are needed to confirm these preliminary results and elucidate the possible mechanisms involved.     

Can 3 oral 2 mg doses of vitamin K effectively prevent late vitamin K deficiency bleeding?

A 1 mg dose of vitamin K given intramuscularly at birth prevents almost all cases of late VKDB, whereas even two oral doses of 1 mg vitamin K given in the first week and a third given in week 5 to 6 are less effective. Is efficacy improved by increasing the dose to 3 2 2 mg? For active surveillance of VKDB, monthly postcards which include a nothing-to-report option, were sent to all heads of pediatric hospitals in Germany from January 1995 to December 1998. All reports were validated according to a standard case definition for late VKDB by means of a questionnaire. The incidence of VKDB with three oral doses of 2 mg vitamin K is compared to previously published rates for VKDB on 3 oral 1 mg oral doses, which had been ascertained with the same surveillance scheme. The number of cases of VKDB (excluding the failure-of-management cases) in children aged 8 days to 12 completed weeks during the 4 year period was 23. 14 had intracranial hemorrhage, 22 had been exclusively breastfed, and in 20 cholestasis was detected after the bleeding episode. 14/23 had been given all recommended 2 mg doses for vitamin K prophylaxis. Until 1996 all had been given the cremophor vitamin K preparation, whereas in 1997 to 1998 two children with late VKBD had received the new mixed micellar (MM) preparation, first licensed in July 1996. The incidence of VKBD per 100,000 live births during the 1995 to 1998 period was 0.72, including children given no vitamin K prophylaxis, and 0.44 for children who had received all age-related recommended vitamin K doses. These incidence rates are significantly lower than those previously published for the 3 2 1 mg dose regimen in Germany (1.8 cases of late VKDB per 100,000 live births in children who had received all recommended vitamin K doses). Not all cases of late VKDB, however, are prevented by the 3 2 2 mg dose regimen, even if the new mixed micellar preparation is given instead of the cremophor preparation.     

The carotene and vitamin A contents of mother’s milk at Batavia

Indian Journal of Pediatrics -     

Maternal vitamin A deficiency and neonatal microphthalmia: complications of biliopancreatic diversion?

Biliopancreatic diversion (BPD) for morbid obesity carries a serious risk of nutritional deficiencies that might impair embryogenesis. Consequently, attention should be given to the potential of risk to the fetus of BPD in women of childbearing age. We present the case of a pregnant woman who had undergone BPD 8 years previously, with documented vitamin A deficiency, who gave birth to a child with bilateral microphthalmia. Infectious and genetic causes of microphthalmia were excluded. A search of the literature revealed that vitamin A deficiency may cause a disruption of ocular development. We conclude that nutritional deficiencies may cause a spectrum of fetal malformations. As the effect of BPD relies on malabsorption, fetal risk should be considered before BPD is offered to morbid obese women of childbearing age.     

Childhood asthma and vitamin D deficiency in Turkey: is there cause and effect relationship between them?

Background

Epidemiological studies show that vitamin D deficiency and insufficiency are common worldwide and associated with many diseases including asthma. Our aim was to evaluate vitamin D insufficiency and its clinical consequences.

Methods

This cross-sectional study was carried out on 170 children consisted of 85 who were asthmatic and 85 who were not, aged 2 to 14 years in Tekirdag, Turkey, from September 2009 to May 2010. Children’s basal serum D vitamin levels were determined, and their eating habits, vitamin D intake, exposure to sunlight and use of health services during the previous year were investigated. The severity of asthma and levels of asthma control were assessed according to the Global Initiative for Asthma guidelines.

Results

The difference between mean vitamin D levels in the asthmatic group (mean +/- SD) 16.6 +/- 8.5 ng/mL and the healthy control group (mean +/- SD) 28.2 +/- 19.5 ng/mL was found to be statistically significant (p?<?0.001). Children in the asthma group had less exposure to sunlight and ate a diet less rich in vitamin D (p?<?0.001). A significant difference was observed between the groups regarding the frequency of respiratory tract infections leading to emergency unit admissions and number of hospitalizations (p?<?0.001). It was also shown that a decrease in vitamin D level increased the severity of asthma (p?<?0.001) and decreased the frequency of controlled asthma (p?=?0.010).

Conclusion

This study has demonstrated the correlation between plasma 25 (OH) D levels and childhood asthma. Evidently, this relationship being influenced by multiple factors other than vitamin D, further studies should be conducted to explore the interrelation between all such factors.

     

Plasma vitamin A levels in the very low birthweight infant — relationship to respiratory outcome

Objective: To examine the association between plasma vitamin A levels and outcome measures in very low birthweight (VLBW) infants, including meta-analysis of all observational studies. Design: A prospective observational longitudinal study of plasma vitamin A levels measured in the cord blood; maternal blood in the first 48 h after delivery; and the infants' blood at 48 h, 7 days and 28 days of age and correlated with antenatal and postnatal events. A meta-analysis of all published observational studies on the association of vitamin A with respiratory outcome in the VLBW infant was undertaken. Patients: Fifty-seven infants (88% of all eligible) VLBW infants (<1500 g) admitted from January through October 1993 to one of two regional neonatal intensive care units in the South Island of New Zealand. Results: Exposure to antenatal steroids led to a significant increase in infant cord plasma vitamin A levels (P=0.003), but no influence on infant plasma vitamin A levels at any other time. Exposure to postnatal steroids produced a significant rise in infant plasma vitamin A levels between 7 and 28 days (P=0.008). After controlling for gestational age, antenatal and postnatal steroid exposure, low vitamin A levels at 48 h increased the risk of developing chronic lung disease (odds ratio for 50 μg/l decrease: 2.04, 95% CI 1.19–5.77) and bronchopulmonary dysplasia (odds ratio 1.96, 95% CI 1.14–6.87). On combining our results in meta-analysis with those of other published prospective observational studies, infants with chronic lung disease had lower plasma vitamin A levels at all times. Conclusions: Our results support an association between low plasma vitamin A levels and adverse outcome in the VLBW infant.