Written by Joyce Smith, BS. Infants with vitamin D supplementation developed their first upper respiratory tract infection later than those without supplementation during the first 6 months of life irrespective of breast or formula feeding.
The leading cause of illness and death worldwide is respriatory tract infections (RTIs) in children under 5 years of age and the highest rates of death occur in the first year of life 1. Hospitalizations due to RTIs are also common in children five years of age or younger; however, infants are hospitalized at a rate 1.3 times higher than the overall rate in young children 2.
Vitamin D deficiencies, often due to insufficient exposure to sunlight, sunscreen protection use, and insufficinet vitamin D intake, have become a global health problem for all age populations. Particularly problematic is the lack of vitamin D among pregnant women and their newborns 3. When breast milk levels of Vitamin D are inadequate 4 and when infants lack sufficient sunlight exposure, Vitamin D supplementation is a requisite for achieving adequate levels 4.
Recent studies have shown a beneficial role of vitamin D supplementation in the prevention of RTIs’ 5; however, current studies on the association of vitamin D supplementation with RTIs in infants are very limited. The lack of studies, coupled with an increased vulnerability of infants to RTIs 6, led Hong and colleagues to investigate Vitamin D’s potential to lower infant RTIs. They conducted a prospective cohort birth study 7 of 2,244 infants in Wuhan, China and followed them from birth to six months of age. Pregnant women, 8-16 weeks gestation, were recruited from 2013-2016 and provided data via telephone interviews and questionnaires at one, three, and six months post-partum to determine infant feedings, any pediatrician-diagnosed respiratory illnesses and hospitalizations, vitamin D supplementation, and whether infants were breast or formula fed.
Of the 2,244 mother-infant pairs, 1,207 (53.8%) were male infants, and 1,124 (50.1%) were born in autumn or winter. A total of 999 (44.5%) infants had RTIs during the first 6 months of age. Of those infants, 215 had RTIS that developed into lower respiratory tract infections and 126 infants were hospitalized for RTIs.
Infants, who received supplementation with vitamin D, had a longer period of time without experiencing a respiratory tract infection episode compared to infants without Vitamin D supplementation. The median time to first RTI episode was 60 days for infants who received no Vitamin D supplementation and longer than 6 months of age for infants with supplementation (p < .001).
Routine vitamin D supplementation was associated with a reduced risk of RTIs, a lower number of RTIs, and a lower rate of hospitalization for RTIs during the first six months of life, with the lowest risk of infection occurring in infants receiving vitamin D supplements five to seven days per week. This inverse association of vitamin D supplementation and incidence of RTIs was independent of whether babies were breast fed or formula fed.
This observational study does not prove causation; however, it does highlight the importance of higher dose vitamin D for the prevention of RTIs in newborns. Future studies to determine the optimal recommendation for routine vitamin D supplementation to prevent RTIs are recommended.
Source: Miao Hong, Ting Xiong, Junmei Huang, Yuanjue Wu, Lixia Lin, Zhen Zhang, Li Huang, Duan Gao, Huanzhuo Wang, Chun Kang, Qin Gao, Xuefeng Yang, Nianhong Yang. Association of vitamin D supplementation with respiratory tract infection in infants. MaternChild Nutr. 2020;e12987. https://doi.org/10.1111/mcn.12987
© 2020 The Authors. : This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Posted April 20, 2020.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
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- Högler W. Complications of vitamin D deficiency from the foetus to the infant: One cause, one prevention, but who’s responsibility? Best Practice & Research Clinical Endocrinology & Metabolism. 2015;29(3):385-398.
- Autier P, Mullie P, Macacu A, et al. Effect of vitamin D supplementation on non-skeletal disorders: a systematic review of meta-analyses and randomised trials. The lancet Diabetes & endocrinology. 2017;5(12):986-1004.
- Hong M, Xiong T, Huang J, et al. Association of vitamin D supplementation with respiratory tract infection in infants. Maternal & Child Nutrition. 2020:e12987.
