Vitamin D Deficiency Linked to Critical Illness in Children

by | Apr 8, 2013 | 2012, Infant and Children's Health, Vitamin D - General

Written by Greg Arnold, DC, CSCS. In a study of 326 critically ill children up to 17 years of age, it was found that low vitamin D blood level was associated with nearly 2 days longer stay in hospital. 

Vitamin D is most notably associated with bone health (1). The current recommendations by the National Institute of Health range from 400 IU per day in children younger than 1 year to 800 IU per for adults over the age of 70 (2). But the role of vitamin D in overall health has now been extended to include proper functioning of multiple organs. Vitamin D deficiency has been associated with cardiovascular disease (3), asthma (4), multiple sclerosis (5), diabetes (6), acute lower respiratory infection (7), and cancer (8).

Recent research has also suggested that vitamin D deficiency could contribute to or prolong critical care stays in hospitals (9). With costs of critical care ranging from $12,000-30,000 per stay (10), any ways to help decrease critical care costs are of primary importance. Now a new study (11) suggests that vitamin D may play a role in critical illness in children. The levels of vitamin D blood levels of less than 30 nmol/L is considered to indicate vitamin D deficiency, leading to rickets in infants. (12) A supplementation of 400 IU daily of vitamin D in breastfed infants, has been shown to maintain serum 25-OH-D concentration at more than 50 nmol/L. (13)

Previous research has shown associations between lower vitamin D levels, higher illness severity scores, and longer stays in the intensive care unit (14, 15). Building on these findings, researchers analyzed 326 critically ill children up to 17 years of age from six different pediatric intensive care units between 2005 and 2008. They found the average vitamin D blood level to be 40 nmol/l.  This is “well below” the recommended 50 nmol/l as suggested by the Institute of Medicine, Canadian Pediatric Society, and American Academy of  Pediatrics. This further broke down to 69% of the patients having vitamin D below 50 nanomoles per liter, 23% having levels between 50-75 nmo/L and 8% above 75 nmol/Liter.

The researchers found vitamin D to be independently associated with a longer stay in the pediatric intensive care unit. Specifically, those with vitamin blood levels <50 nmol/L stayed in the hospital nearly 2 days longer than those >50 nmol/L (p = 0.03).

Finally, the researchers found a link between the Pediatric Risk of Mortality score (16) and vitamin D deficiency. Specifically, every additional point in the Pediatric Risk of Mortality score increased the likelihood of being vitamin D deficient by 8% (p = .005).

They went on to conclude that “vitamin D deficiency is both common among critically ill children and associated with greater severity of critical illness” and that “further research will determine whether targeted vitamin D supplementation or rapid restoration will improve the outcome.”

Source: McNally, J. Dayre, et al. “The association of vitamin D status with pediatric critical illness.” Pediatrics (2012): peds-2011.

© 2012 by the American Academy of Pediatrics

Posted April 8, 2013.

Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com

References:

  1. InstituteofMedicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium andVitamin D.Washington, DC:NationalAcademyPress, 2010.
  2. “Vitamin D Supplement Fact Sheet” from the National Institute of Health’s Office of Dietary Supplements website.
  3. Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168(12):1340–1349.
  4. Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, Zeiger RS, et al. Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol. 2010;126(1):52–8.e5.
  5. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296(23):2832–2838.
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  10. Dasta JF.  Daily cost of an intensive care unit day: the contribution of mechanical ventilation.  Crit Care Med 2005 Jun;33(6):1266-71.
  11. The Association of Vitamin D Status With Pediatric Critical Illness.  Pediatrics 2012; originally. published online August 6, 2012.  DOI: 10.1542/peds.2011-3059.
  12. Vitamin D- Dietary Supplement Fact Sheet.
  13. Wagner C. L., Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents.  Pediatrics, 2008; 122(5): 1142-1152.
  14. Lucidarme O, Messai E, Mazzoni T, Arcade M, du Cheyron D. Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med. 2010;36 (9):1609–1611.
  15. McKinney JD, Bailey BA, Garrett LH, Peiris P, Manning T, Peiris AN. Relationship between vitamin D status and ICU outcomes in veterans. J Am Med Dir Assoc. 2011;12(3):208–211.
  16. Pollack MM.  Pediatric risk of mortality (PRISM) score.  Crit Care Med 1998; 16(11):1110-6.