Vitamin D deficiency in critically ill children: a systematic review and meta-analysis
Critical Care201721:287, https://doi.org/10.1186/s13054-017-1875-y
James Dayre McNally, Nassr Nama, Katie O’Hearn, Margaret Sampson, Karin Amrein, Klevis Iliriani, Lauralyn McIntyre, Dean Fergusson and Kusum Menon
Vitamin D < 20 ng in Pediatric Intensive Care Unit
| Increased Risk | |
| PICU length of stay | 2.0 more days |
| Infection | 2.5 X |
| Mechanical Ventilator | 1.9 X |
| Vasopressor use reduce blood pressure | 2.2 X |
| Mortality | 2.5 X |
items in BOTH of categories: Infant-Child and Trauma/Surgery
- Give ICU children a bolus dose of 10,000 IU of vitamin D per kg – RCT underway Sept 2024
- Sepsis is fought by Vitamin D in 9 ways – Feb 2023
- Fewer drugs needed after cardiac surgery if higher levels of vitamin D (Chinese children) – July 2021
- 3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020
- PICU children with low vitamin D levels have worse health scores (PRISM-III) – Feb 2020
- Vitamin D levels dropped 42 percent immediately after pediatric cardiac surgery – Dec 2019
- Septic children have low Vitamin D (54 studies, ignored Vitamin D Receptor) – meta-analysis April 2019
- Candida infections in PICU reduced by Vitamin D in yogurt – RCT Feb 2019
- Children entering ICU with low vitamin D were 3.5 X more likely to have a poor ICU score– Oct 2018
- Critically ill children with low vitamin D: 2.5 X more likely to die or stay 2 days longer - meta-analysis Nov 2017
- Micronutrients (such as Vitamin D) for critically ill children – review Oct 2017
- Critically ill children – randomized clinical trial to give single doses of up to 400,000 IU of vitamin D – 2019
- Vitamin D deficiency in pediatric critical illness: Time to move on from observational studies – Nov 2016
- Low vitamin D in Pediatric ICU – 5 times more ill (morbidity) – Spanish Nov 2016
- Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
- Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
- Rapid Normalization of Vitamin D in Critically Ill Children (10,000 IU per kg) – clinical trial
- Congenital Heart problems - vitamin D levels drop even lower after surgery, loading dose probably required - thesis 2015
- Infant in ICU much more likely to die if low vitamin D – Nov 2015
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- Hospitalization consumes vitamin D in children – March 2014
- Congenital heart surgery dropped vitamin D levels by 40 percent – July 2013
- Vitamin D deficient children stayed in ICU almost 2 days longer – Sept 2012
- Sepsis is both prevented and treated by Vitamin D - many studies
Restoring Vitamin D in the PICU as soon as possible is vital
Not mentioned by the meta-analysis on this page
- Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
- Critically ill children – randomized clinical trial to give single doses of up to 400,000 IU of vitamin D – 2019
- Rapid Normalization of Vitamin D in Critically Ill Children (10,000 IU per kg) – clinical trial
- Takes a year to restore children and youths to good levels of vitamin D without loading dose - RCT Dec 2016
Not Mentioned: The vitamin D used must be able to quickly get to the cells
Injection and IV are both very quick, and do not need the gut to digest it or even be working
Note: Most IV provide only 200 IU of Vitamin D per day
People with poor guts getting nutrition via IV had poor oral Vitamin D bio-availability – May 2017
Download the PDF from VitaminDWiki
1.8 X more likely to have low Vitamin D (< 20 ng)
1.6 X more likely to die (all countries) if low Vitamin D
Background
Vitamin D deficiency (VDD) has been hypothesized not only to be common but also to represent a potentially modifiable risk factor for greater illness severity and clinical outcome during critical illness. The objective of this systematic review was to determine the frequency of VDD in pediatric critical illness and its association with clinical outcomes.
Methods
MEDLINE, Embase, and CENTRAL were searched through December 12, 2016, with no date or language restrictions. The primary objective was to estimate the prevalence of VDD in the pediatric intensive care unit (PICU) and compare vitamin D status with healthy control populations. Secondary objectives were to evaluate whether VDD is associated with mortality, increased illness severity, PICU interventions, and patient clinical course. Random effects meta-analysis was used to calculate pooled VDD event rate, compare levels with those of control subjects, and evaluate for associations between VDD and clinical outcome.
Results
Among 2700 citations, 17 studies meeting study eligibility were identified. The studies reported a total of 2783 critically ill children and had a median sample size of 120 (range 12–511). The majority of studies used a 25-hydroxyvitamin D [25(OH)D] level less than 50 nmol/L to define VDD, and the pooled VDD prevalence was 54.8 (95% CI 45.4–63.9). Average 25(OH)D levels were significantly lower in PICU patients than in healthy control subjects (pooled difference −17.3 nmol/L, 95% CI −14.0 to −20.6). In a meta-analysis calculation, we found that VDD was associated with increased mortality (OR 1.62, 95% CI 1.11–2.36), illness severity, and need for PICU interventions.
Conclusions
Approximately 50% of critically ill children have VDD at the time of PICU admission, defined as a blood total 25(OH)D concentration under 50 nmol/L. VDD was further determined to be associated with greater illness severity, multiple organ dysfunction, and mortality in the PICU setting. Clinical trials are required to determine if optimization of vitamin D status improves patient outcome.
Trial registration: PROSPERO, CRD42016026617. Registered on 11 January 2016.