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Vitamin D Deficiency In a Pediatric Intensive Care Unit

Sunday, October 21, 2012
Room 210 (Morial Convention Center)
Kristen Nelson-McMillan, MD, Pediatrics and Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, David Procaccini, PharmD, BCPS, Pediatric Pharmacy, Johns Hopkins Hospital, Baltimore, MD and Laura Davis, MS, RD, LD, CNSC, Pediatric Nutrition, Johns Hopkins Hospital, Baltimore, MD

Purpose: Vitamin D is essential for calcium metabolism and bone health, but is also necessary for normal function of the immune and cardiovascular systems. Data from the National Health and Nutrition Examination Survey (NHANES) 2001-2004 revealed 70% of the U.S. pediatric population is either vitamin D deficient or insufficient. We conducted a pilot study in our combined medical-surgical pediatric intensive care unit (PICU) to delineate the prevalence of vitamin D deficiency, as well as the conditions leading to admission and dietary intake prior to admission.

Methods: Over a three month period, 25-OH-vitamin D (25OH) levels were obtained from 30 patients admitted to our PICU. Demographics, admitting diagnosis, underlying medical conditions, route of feeding and type of diet were obtained for each patient. Vitamin D deficiency was defined as a 25OHD level less than 20 ng/mL and insufficiency was defined as a level less than 30 ng/mL.      

Results: Of the 30 patients in our pilot study, 37% were African-American, 30% Caucasian, 17% Hispanic and 13% other races. Overall, 50% were female and 50% were male. 73% (22/30) of patients were either vitamin D deficient or insufficient, with 100% of African Americans, 70% of Caucasians, 40% of Hispanics and 75% of other races being so classified. 50% (5/10) of the patients with respiratory insufficiency or failure as their admitting diagnosis were vitamin D deficient or insufficient, while 100% (8/8) of the patients with heart disease as their admitting diagnosis were either deficient or insufficient (including congenital heart disease patients admitted post-operatively and patients with acquired heart disease admitted for management of heart failure).  Of the patients in this study with normal vitamin D levels, 88% (7/8) were fed either vitamin-D fortified formula by mouth or enteral tube prior to admission. Of the patients in this study with vitamin D deficiency or insufficiency, 95% (21/22) were either breast fed infants or patients consuming regular diets. Only 7% (2/30) of patients were supplemented with vitamin D as part of a daily regimen prior to admission, with one of these patients being vitamin D deficient despite receiving the recommended daily intake.

Conclusions: Inadequate vitamin D levels were prevalent in this pilot study in our multidisciplinary PICU, particularly in patients with cardiovascular and respiratory disease. Patients consuming regular US diets and/or breast milk without vitamin D supplementation were much more likely to have vitamin D deficiency than those fed with vitamin-D fortified formulas. We have begun enrolling all patients in our PICU with respiratory and/or cardiovascular disease in a prospective, observational study to further address the prevalence of this deficiency and further define associated risk factors.