Comparison of Daily Dose of 400 and 600 Units of Vitamin D in the Prevention of Osteopenia of Prematurity in Infants with a Gestational Age of Less Than and Equal to 32 Weeks

Behzad Barekatain, Shima Hamidipour, Zohreh Badiei, Maryam Farghadani

Abstract


Background: The use of vitamin D in premature infants is one of the important preventive factors for osteopenia of prematurity, but there are conflicting results on the appropriate doses, so this study aimed to compare the doses of 400 and 600 units of vitamin D in the prevention of osteopenia of prematurity in infants with a gestational age  ≤32  weeks. Methods: This clinical trial study was conducted on 108 premature infants divided into two groups of 54 with a gestational age of  ≤32  weeks born between 2020 and 2021 in Shahid Beheshti and Al‑Zahrai hospitals in Isfahan. In the first group, daily vitamin D was 400 units from the 7th day of birth, and in the second group, it was 600 units. At the age of 5 weeks, levels of calcium, phosphorus, alkaline phosphatase (ALP), and vitamin D were evaluated. If the ALP level was above 1000, wrist radiography was requested. Also, the baby was examined for clinical symptoms of rickets at the age of 5 weeks. The data were analyzed by Statistical Package for the Social Sciences (SPSS) software version 26, and a P value <0.05 was considered significant. Results: In this study, there was no significant difference between the levels of ALP in the two groups (P = 0.596), but the level of vitamin D was significantly higher in the 600 units of vitamin D group (P < 0.001). The level of calcium was higher in the 400 units of vitamin D group, but this difference was slightly significant  (P = 0.062). The level of phosphorus in the 600 units of vitamin D group was higher than in the 400 units of vitamin D group, and the difference was slightly significant  (P = 0.062). Conclusions: This study showed that daily doses of 600 and 400 units of vitamin D in infants with a gestational age of ≤32 weeks had no effect on the incidence of clinical symptoms and radiological findings of rickets at the age of 5 weeks.

Keywords


Alkaline phosphatase; calcium; osteopenia of prematurity; phosphorus; vitamin D

Full Text:

PDF

References


Martin RJ, Fanaroff AA, Walsh MC. Disorders of calcium, phosphorus and magnesium metabolism. In: Neonatal Perinatal Medicine Diseases of the Fetus and Infant. 11th ed. Philadelphia: Mosby Elsevier; 2020. p. 1622 40.

Feliicia Faienza M. Metabolic bone disease of prematurity: Diagnosis and management. Front Pediatr 2019;7:143.

Kliegman RM, Jenson HB, Behrman RH. Nelson Textbook of Pediatrics. 21th ed. Philadelphia; 2020. p. 1996 2943.

Maria Pacifici G. Effects of Vitamin D in neonates and young infants. Int J Pediatr 2016;4:1273 85.

Backstorm MC. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatric 2009;89:867 73.

Abrams SA. In utero physiology: Role in nutrient delivery and fetal development for calcium, phosphorus and vitamin D. 2007;85:604S607S. Available from: Academic.oup.com. [Last accessed on 2023 May 20].

Perez Lopez FR. Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: A systematic review and meta analysis of randomized controlled trials. Fertil Steril 2015;103:1278 88.

Song SJ, Si S, Liu J, Chen X, Zhou L, Jia G, et al. Vitamin D status in Chinese pregnant women and their newborns in Beijing and their relationships on birth size. Public Health Nutr 2013;16:687 92.

Morley R, Carlin JB, Pasco JA, Wark JD. Maternal 25 hydroxy vitamin D and parathyroid hormone concentrations and offspring birth size. J Clin Endocrinol Metab 2006;91:906 12.

Abrams SA; Committee on Nutrition. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics 2013;131:e1676–83.

Zipitis CS, Akobeng AK. Vitamin D supplementation in early childhood and risk of type 1 diabetes: A systematic review and meta analysis. Arch Dis Child 2008;93:512 7.

Nguyen TM, Guillozo H, Marin L, Tordet C, Koite S, Garabedian M. Evidence for a vitamin D paracrine system regulating maturation of developing rat lung epithelium. Am J Physiol 1996;27:L392 9. doi: 10.1152/ajplung. 1996.271.3.L392.

Bronner F, Salle B L. Calcium absorption in preterm infants: Results of 103 metabolic balance studies. Am J Clin Nutr 1992;56:1037 44.

Abrams SA. Vitamin D in preterm and full term infants. Ann Nutr Metab 2020;76(suppl 2):6 14

Mazahery H, Von Hurst PR. Factors affecting 25 hydroxy vitamin D concentration in response to vitamin D supplementation. Nutrients 2015;7:5111 42.

Cho SY, Park HK, Lee HJ. Efficacy and safety of early supplementation with 800 IU of vitamin D in very preterm infants followed by underlying levels of vitamin D at birth. Ital J Pediatr 2017;43:459.

Jobe AH. Vitamin D for extremely preterm infants. J Pediatr 2016;174:3 8.

Haschke F, Schilling R, Pietschnig B. Calcium, phosphorus and vitamin D administration in infancy. Monastsschr Kinderheilkd 1992;140 (9s):S13 6.

Agostoni C, Buono Core G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: Commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010;50:85–91.

Cross BK, Vasquez E. Osteopenia of prematurity prevention & treatment. IJNP 1999;4:1 9.

Vachharajani AJ, Mathur AM, Rao R. Metabolic bone disease of prematurity. Neo Rev 2009;10:e402 11. 22. American Academy of Pediatrics. Statement of endorsement: Dietary reference intakes for calcium and vitamin D. Pediatrics 2012;130:e1424.

World Health Organization. Guidelines on optimal feeding of low birth weight infants in low and middle income countries. Updated 2011. [Last accessed on 2014 Nov 03].

Holick MF, Binkley NC, Bischoff Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30.

Misra M, Pacaud D, Petryk A, Collett Solberg PF, Kappy M; Drug and therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: Review of current knowledge and recommendations. Pediatrics 2008;122:398–417.

Food and Nutrition Board; Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington D.C: National Academy Press; 2000. p. 1 9.

Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142–52.

Anderson Berry A, Thoene M, Wagner J, Lyden E, Jones G, Kaufmann M, et al. Randomized trial of two doses of vitamin D3 in preterm infants< 32 weeks: Dose impact on achieving desired serum 25(OH) D3 in a NICU population. PLoS One 2017;12:e0185950.

Alizadeh Taheri P, Sajjadian N, Beyrami B. Prophylactic effect of low dose vitamin D in osteopenia of prematurity. Acta Med Iran 2014;52:9 15.

Yang Y, Li Z, Yan G, Jie Q, Rui C. Effect of different doses of vitamin D supplementation on preterm infants An updated meta analysis. J Matern Fetal Neonatal Med 2018;31:3065 74.

Alizadeh P, Naderi F, Sotoudeh K. A Randomized clinical trial on prophylactic effects of vitamin D on different indices of ostopenia of prematurity. Iran J Public Health 2006;35:58 63.

Sivert WL. Joint compression therapy in the prevention of osteopenia of prematurity: Current research and future considerations. SOPHIA; 2014. p. 1 9.

Backström MC, Mäki R, Kuusela AL, Sievänen H, Koivisto AM, Ikonen RS, et al. Randomised controlled trial of Vit D supplementation on bonedensity and biochemical indices in preterm infants. Arch Dis Child Fetal Neonatal ED 1999;80:F161 6.