The UK Royal College of Paediatrics and Child Health guidance on breastfeeding has been warmly welcomed in both the medical and lay spheres | Archives of Disease in Childhood
Breastfeeding has undoubted benefits and should be singularly promoted and encouraged. However, in their position statement, the college omits to mention the importance of vitamin D supplementation for breastfed children and lactating women in the UK. This is an important measure to support women and children and ensure their health during this period. Hypovitaminosis D is exceedingly common in the UK with rates as high as 20% for adults and 8%–24% for children depending on gender and age
Full reference: Uzoigwe, C.E. & Ali, O. (2017) Breastfeeding and vitamin D. Archives of Disease in Childhood Published Online First: 14 September 2017.
Oral nutritional supplements (ONS) are substances taken by mouth as an addition to the child’s usual diet | Paediatrics and Child Health
They can benefit a child who does not manage to ingest and absorb sufficient nutrients to grow and develop in the usual way. ONS can be used in the management of a wide range of medical conditions such as neurodevelopmental disorders with associated dysphagia, intestinal inflammatory disorders e.g. Crohn’s disease and non-IgE slow onset food allergies (when a protein hydrolysate or amino-acid based ONS is usually needed) major organ failure or in areas of food insecurity to avoid starvation. Appropriate use at the earliest opportunity may preclude or postpone the need to insert an artificial feeding device. Once on treatment children need to be reviewed at least 6-monthly by a dietitian as well as a paediatrician.
Marshall, I. et al. BMC Pediatrics. Published online: 8 December 2016
Background: Occurrence and consequence of cord blood (CB) vitamin D insufficiency/deficiency has not been adequately explored despite rising concern regarding this topic in pediatrics. This study was designed to determine the rate, maternal risk factors, and clinical outcomes in infants in association with vitamin D insufficient/deficient status at birth.
Conclusions: The likelihood for an infant to be born with vitamin D deficiency/insufficiency is relatively high and is related mainly to younger maternal age, gravidity, and non-White race/ethnicity. Our findings raise a question regarding the adequacy of the AAP recommended vitamin D supplementation requirements without knowing the infant’s vitamin D status at birth.
Lindqvist, P.G. et al. BMJ Open. Published online: 22 September 2016
Objective: Vitamin D deficiency causes not only skeletal problems but also muscle weakness, including heart muscle. If the fetal heart is also affected, it might be more susceptible to fetal distress and birth asphyxia. In this pilot study, we hypothesised that low maternal vitamin D levels are over-represented in pregnancies with fetal distress/birth asphyxia.
Design and setting: A population-based nested case–control study.
Patients: Banked sera of 2496 women from the 12th week of pregnancy.
Outcome measures: Vitamin D levels were analysed using a direct competitive chemiluminescence immunoassay. Vitamin D levels in early gestation in women delivered by emergency caesarean section due to suspected fetal distress were compared to those in controls. Birth asphyxia was defined as Apgar <7 at 5 min and/or umbilical cord pH≤7.15.
Results: Vitamin D levels were significantly lower in mothers delivered by emergency caesarean section due to suspected fetal distress (n=53, 43.6±18 nmol/L) compared to controls (n=120, 48.6±19 nmol/L, p=0.04). Birth asphyxia was more common in women with vitamin D deficiency (n=95) in early pregnancy (OR 2.4, 95% CI 1.1 to 5.7).
Conclusions: Low vitamin D levels in early pregnancy may be associated with emergency caesarean section due to suspected fetal distress and birth asphyxia. If our findings are supported by further studies, preferably on severe birth asphyxia, vitamin D supplementation/sun exposure in pregnancy may lower the risk of subsequent birth asphyxia.
Ware, L. Evidently Cochrane. Published online: 6 September 2016
It seems to me that vitamin D – also known as the ‘sunshine vitamin’ – is very much in the limelight (or should that be sunlight?) right now. Its role in maintaining a healthy skeleton is well known but it may have other important actions. Low levels of vitamin D have been linked to an increased risk of asthma attacks in children and adults with asthma. It is thought that vitamin D has anti-inflammatory and antimicrobial functions in the lungs, which may explain why it could be beneficial.
The recent systematic review from the Cochrane Airways Group found nine double-blind randomised placebo-controlled trials of vitamin D in children and adults with asthma, which evaluated the risk of having an asthma attack and/or the level of symptom control. Two studies were in adults and involved 658 participants; seven studies were in children with 435 participants. The studies were conducted in Canada, India, Japan, Poland, UK and USA. Most of the participants had mild to moderate asthma and continued their regular asthma medication for the duration of the trial. The studies lasted from six to twelve months.
High quality evidence showed that giving vitamin D reduced the average number of asthma attacks and the risk of Emergency Department attendances and hospital admissions. These results can be represented diagrammatically :
There was no evidence to indicate that vitamin D brought about an improvement in lung function tests or in day-to-day symptoms. It was safe at the doses given.
Cebey-López, M. et al. Journal of pediatric gastroenterology and nutrition, vol. 62, no. 3, p. 479-485, 1536-4801 (March 2016)
Vitamin D is known to have modulatory actions in the immune system. Its influence on the severity of lower tract acute respiratory infections (LT-ARIs) is unclear. The aim of the present study was to evaluate the role of vitamin D on LT-ARI in paediatric patients. Children admitted to hospital with LT-ARI were prospectively recruited through the GENDRES network (March 2009-May 2013).
The 25-hydroxyvitamin D (25-OHD) levels were measured by immunoassay. The severity of the illness was evaluated according to clinical scales, length of hospital stay, ventilatory requirements, and pediatric intensive care unit admission. A total of 347 patients with a median (interquartile range) age of 8.4 (2.6-21.1) months were included. The mean (SD) 25-OHD levels in our series were 27.1 (11.3) ng/mL. In this study, a cutoff value of ≥30 ng/mL was considered optimal vitamin status.
Patients with 25-OHD levels <20 ng/mL were at a higher risk of showing severe signs of respiratory difficulties (OR 5.065, 95% confidence interval 1.998-12.842; P = 0.001) than patients with normal values, and had a 117% higher risk of oxygen necessity and 217% higher risk of ventilatory requirement than those patients with normal values. An inverse correlation was found between 25-OHD levels and the severity in the evaluated scales. 25-OHD levels did not influence PICU admission rate or length of hospital stay. 25-OHD levels of children admitted because of a LT-ARI are <30 ng/mL. Lower levels of 25-OHD were found to be correlated with severity of the disease.
The possible role of abnormal 25-OHD levels as a facilitator or consequence of the infection needs further evaluation.