Critically ill children lack vitamin D

Vitamin D insufficiency and deficiency are prevalent in critically ill children. New research has found that 4 in 10 children admitted to the pediatric intensive care unit (PICU) have vitamin D deficiency.

Investigators enrolled 511 patients aged younger than 21 years (median age, 5.3 years) who were admitted to the PICU with a stay of at least 48 hours or who were admitted with probable infection. Children admitted to the cardiac ICU were excluded from the study. Blood was obtained from each patient as close as possible to the PICU admission.

Seven in 10 patients (71.2%) had vitamin D insufficiency, defined as a serum 25-hydroxyvitamin D (25[OH]D) level below 30 ng/mL, and 40.1% were considered vitamin D deficient, defined as a level below 20 ng/mL. Thirty-one percent of the infants and toddlers, 46% of the school-aged children, and 57% of the adolescents were vitamin D deficient.

The 13 patients who died during hospitalization had a median 25(OH)D level of 19.4 ng/mL.

Younger age, white race with non-Hispanic ethnicity, summer season, taking vitamin D supplements, and taking infant formula were independently protective against vitamin D deficiency.

Lower vitamin D blood levels were associated with greater illness severity on the PICU admission day. A lower 25(OH)D level on admission was inversely associated with the Pediatric Risk of Mortality III (PRISM-III) score: each 5-ng/mL decrement in 25(OH)D level increased the risk of moving into the next highest risk PRISM-III quartile by 19%.

Increasing use of vasopressors correlated with worse 25(OH)D levels: each 5-ng/mL decrease in 25(OH)D corresponded to 13% increased odds of additional vasopressor use.

Infection had no significant effect on vitamin D deficiency.

Previously healthy children had lower 25(OH)D levels than those with underlying chronic illness; the researchers speculate that’s because chronically ill children were more likely to be receiving vitamin D supplements.

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