A Comparison of 3 Vitamin D Dosing Regimens in Extremely Preterm Infants: A Randomized Controlled Trial

Area of Science:

• Neonatology
• Pediatric Endocrinology
• Nutritional Science

Background:

• Extremely low gestational age newborns frequently present with biochemical vitamin D deficiency at birth.
• Vitamin D sufficiency is crucial for infant health and development.
• Optimal dosing strategies for vitamin D supplementation in this vulnerable population remain under investigation.

Purpose of the Study:

• To ascertain the most effective dose of vitamin D supplementation required to achieve biochemical vitamin D sufficiency in extremely preterm infants.
• To evaluate the impact of different vitamin D doses on serum 25-hydroxy vitamin D concentrations and clinical outcomes.

Main Methods:

• A masked randomized controlled trial involving 100 infants born between 23 0/7 and 27 6/7 weeks gestation.
• Infants were assigned to receive either placebo, 200 IU/d, or 800 IU/d of vitamin D, considering background nutritional support.
• Primary outcomes included serum 25-hydroxy vitamin D levels on day 28 and days alive and off respiratory support.

Main Results:

• At birth, 67% of infants exhibited vitamin D deficiency (serum 25-hydroxy vitamin D <20 ng/mL).
• On day 28, median vitamin D levels were 22 ng/mL (placebo), 39 ng/mL (200 IU), and 84.5 ng/mL (800 IU) (P < .001).
• No significant differences were observed in days alive and off respiratory support across the groups (P = .63).

Conclusions:

• Vitamin D deficiency is prevalent at birth in extremely preterm infants.
• Supplementation with 200 IU/d improves biochemical status, while 800 IU/d prevents deficiency by day 28.
• Further research is needed to determine if correcting biochemical deficiency translates to improved clinical outcomes.