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Reduced vitamin D levels linked to critical childhood illness

Reduced vitamin D levels linked to critical childhood illness

Tuesday, September 18, 2012. The September 1, 2012 issue of the journal Pediatrics contained a report by Canadian researchers which reveals a greater prevalence of deficient vitamin D levels in children hospitalized with critical illnesses.

J. Dayre McNally, MD, PhD of Children's Hospital of Eastern Ontario Research Institute and colleagues examined serum 25-hydroxyvitamin D levels in 326 critically ill children between the ages of six months and thirteen years who were admitted to the intensive care units of six Canadian hospitals. Seventy-two percent of the children underwent mechanical ventilation, and 27 percent received catecholamine infusions (administered in cases of shock).

Sixty-nine percent of the group had deficient 25-hydroxyvitamin D levels of lower than 50 nanomoles per liter (nmol/L), and insufficient levels between 50 and 75 nmol/L were uncovered in 23 percent. Vitamin D deficiency was associated with lower ionized calcium levels, a greater likeliness of the necessity of catecholamine use, longer intensive care unit (ICU) stays and increased Pediatric Risk of Mortality scores, which are used to evaluate illness severity. Lower vitamin D concentrations were also observed in a greater percentage of those receiving mechanical ventilation. While five deaths occurred among the deficient group during their ICU admissions, no deaths occurred in those who were not deficient in vitamin D.

"This is the first study to report on vitamin D levels in a large group of critically ill children," announced Dr McNally, who is a clinical researcher and intensivist at the Children's Hospital of Eastern Ontario and assistant professor in the Department of Pediatrics at the University of Ottawa. "Although these findings are of concern, we are very encouraged because we've discovered something that is modifiable. There are simple ways to prevent this problem, and it may be possible to rapidly restore vitamin D levels at the time of severe illness."

"This study provides evidence that vitamin D deficiency is both common among critically ill children and associated with greater severity of critical illness," the authors conclude. "Further research will determine whether targeted vitamin D supplementation or rapid restoration will improve outcome."

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Deficient vitamin D levels associated with decreased lung function in asthmatic children treated with steroids

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An article published ahead of print in the American Journal of Respiratory and Critical Care Medicine® on July 13, 2012 reports an association between diminished vitamin D levels and poorer lung function among children with asthma who use inhaled corticosteroids.

Boston researchers evaluated data from 1,024 asthmatic children who participated in the Childhood Asthma Management Program, which examined the effects of an inhaled corticosteroid known as budesonide, nedocromil (another inhaled asthma treatment), or placebo. Blood samples collected at the beginning of the trial were analyzed for serum 25-hydroxyvitamin D. Subjects with 25-hydroxyvitamin D levels of 20 nanograms per milliliter (ng/mL) were classified as deficient, and insufficient levels were defined as those between 20 ng/mL to 30 ng/mL.

"In our study of 1,024 children with mild to moderate persistent asthma, those who were deficient in vitamin D levels showed less improvement in pre-bronchodilator forced expiratory volume in 1 second (FEV1) after one year of treatment with inhaled corticosteroids than children with sufficient levels of vitamin D," reported Ann Chen Wu, MD, MPH, who is an assistant professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. "These results indicate that vitamin D supplementation may enhance the anti-inflammatory properties of corticosteroids in patients with asthma."

"Our study is the first to suggest that vitamin D sufficiency in asthmatic children treated with inhaled corticosteroids is associated with improved lung function," Dr Wu announced. "Accordingly, vitamin D levels should be monitored in patients with persistent asthma being treated with inhaled corticosteroids. If vitamin D levels are low, supplementation with vitamin D should be considered."

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