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Intermittent High-Dose Vitamin D3 Administration in Neonates with Multiple Comorbidities and Vitamin D Insufficiency
Catalin Cirstoveanu1,2, Iulia Ionita2, Carmina Georgescu2,3
1Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Insights
High-dose vitamin D3 supplementation can normalize vitamin D levels in critically ill neonates. However, intermittent weekly dosing is more effective than a three-week gap for sustained vitamin D sufficiency.
Area of Science:
- Neonatal Intensive Care
- Pediatric Endocrinology
- Nutritional Science
Background:
- Neonates face high risk of vitamin D insufficiency due to inadequate maternal and infant supplementation.
- Vitamin D deficiency is linked to increased disease severity and mortality in critically ill patients.
- Optimal vitamin D3 supplementation regimens for high-risk infants remain undefined.
Purpose of the Study:
- Determine vitamin D insufficiency prevalence in neonates with severe comorbidities.
- Evaluate high-dose vitamin D3 oral administration for achieving normal plasma concentrations without adverse effects.
Main Methods:
- Randomized, prospective trial involving 150 neonates in a Neonatal Intensive Care Unit (NICU).
- Three subgroups received different vitamin D3 products with a dosage of 10,000 IU/kg.
- Oral vitamin D3 administered in three steps: admission, 1 week, and 1 month, targeting ≥40 ng/mL 25-hydroxyvitamin D.
Main Results:
- 68% of neonates achieved optimal vitamin D levels after one month; only 15% at admission.
- A 27% increase in mean vitamin D levels observed after the first high dose.
- Concentrations decreased after one month due to a three-week interval between the last two doses.
Conclusions:
- Intermittent, weekly high-dose vitamin D3 effectively increases and normalizes vitamin D in most critically ill neonates.
- Oral high-dose vitamin D3 administration with a three-week gap leads to decreased vitamin D levels in this population.
Background:
Neonates have an increased risk of vitamin D insufficiency due to the inadequate supplementation of mothers and infants after birth. Insufficiency of vitamin D is frequently detected in critically ill patients and is associated with disease severity and mortality. There is yet to be a consensus on the appropriate regimen of vitamin D3 supplementation in high-risk infants.
Aim:
The main objectives of this study were to determine the prevalence of vitamin D insufficiency in neonates with severe comorbidities and to evaluate whether high-dose vitamin D3 oral administration leads to normal plasmatic concentrations without side effects.
Methods:
The current study was a randomized, prospective trial of 150 patients admitted to the Neonatal Intensive Care Unit (NICU) at Maria Sklodowska Curie Emergency Children's Hospital in Bucharest. Patients were divided into three subgroups based on the chronological order of their admission date. Each subgroup received a different pharmaceutical product of vitamin D3. We administered a dosage of 10,000 IU/kg of vitamin D3 orally in three steps, as follows: at admission, one week after admission, and one month from the first administration, targeting a serum 25-hydroxyvitamin D concentration of at least 40 ng/mL.
Results:
Most neonates (68%) achieved an optimum vitamin D level after one month, even though only 15% of patients had an optimum concentration at admission. After the first high dose of vitamin D3, there was a 27% increase in the mean vitamin D plasmatic level compared to admission levels. However, after one month, the concentrations decreased in all subgroups due to the gap of three weeks between the last two administrations.
Conclusions:
An intermittent, weekly high-dose vitamin D3 oral administration leads to a steadier increase and normalization of vitamin D concentration in most critically ill neonates. However, high-dose vitamin D3 administered orally after three weeks decreases vitamin D levels in this high-risk population.
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