Duplicating the dose of vitamin D for premature babies and very low birth weight can give their small bones a great advantage, offering hope for a stronger start in life.
Study: Effects of supplementation with high dose of vitamin D on bone mineral density in premature infants of very low birth weight. Image credit: RMC42/Shuttersock.com
A study in border in endocrinology investigated the safety and effectiveness of the high doses of vitamin D supplements in premature infants of very low birth weight (VLBW). The researchers stressed that the daily supplementation of 800 IU of vitamin D improves bone mineralization in VLBW premature babies.
The effect of vitamin D deficiency on babies
Premature VLBW babies commonly experience vitamin D deficiency due to limited exposure to u ultraviolet, reduced transplantal transfer, challenges to achieve adequate enteral nutrition and a low fat mass for vitamin D.
Vitamin D is essential for general growth and the development of bone mineral density (DMO) in babies. Previous studies have indicated that the decrease in premature babies increases the risk of several skeletal complications, such as prematurity osteopenia (OOP) and rickets.
Vitamin D improves the absorption of calcium and phosphate by regulating the co-transporters of sodium phosphate (NAPI-iib) and the potential of the transitional recipient 6 (TRPV6) in enterocytes. Experimental research has shown that activated vitamin D is joined by the vitamin D (VDR) receiver in osteoblasts, which triggers Rankl’s expression (Kappa-β nuclear factor receptor activator), a crucial factor in bone remodeling and osteoclast differentiation. In addition, vitamin D regulates osteocalcin and alkaline phosphatase (ALP), essential components for bone mineralization mediated by osteoblasts.
Skeletal complications in babies are commonly diagnosed using clinical evaluations, biochemical trials and radiological images. For example, biochemical tests detect biological markers, such as phosphate, ALP, serum calcium and 25-hydroxivitamin D (25 (OH) d), which indicate skeletal complications. X -rays and double -energy X -ray absorptiometry (Dexa) are standard radiological methods used to evaluate bone health.
Previous studies have highlighted the possibility that the increase in vitamin D intake can improve bone mineralization and reduce the risk of OOP in premature babies. According to European guidelines, 800–1,000 IU/Vitamin D day is more effective, while the United States recommends 400 IU/day for an effective result. The difference in European and American guidelines with respect to the dose of vitamin D creates confusion about the most effective dose and its security profile.
About the study
The current retrospective cohort study compared the effectiveness of the daily doses of vitamin D of 800 and 400 IU in the improvement of the DMO, measured by Dexa, in VLBW babies. A total of 215 VLBW babies were considered, which weighed less than 1500 grams at birth. All babies recruited in this study required UCIN care at the Seoul Hospital of Hanyang University between January 2011 and December 2022.
Babies selected for this study were divided into two groups. A group received 400 IU/day (n = 70; period 1: January 2011 – October 2015) and the other 800 IU/day of vitamin D (n = 145; period 2: November 2015 – December 2022). The liquid cholecalciferol was administered through a nasogastric or orogastric route on the 14th of life if the burial feed was tolerated. This treatment continued up to 36 weeks of postmenstrual age (PMA). Once the baby achieved 100 ml/kg/enteral feeding day, he received a maximum daily vitamin D 900 IU/day through supplements and diet.
Study findings
The basal characteristics of the 400 IU/day groups and 800 IU/day varyed significantly. For example, the 800 IU/day group had a significantly higher maternal age, birth height, birth weight, Apgar scores at 1 and 5 minutes, caesarean section and days of parenteral nutrition (TPN) total. On the contrary, the 400 candidates for the UI/day group exhibited greater use of postnatal corticosteroids and a greater incidence of necrotizing enterocolitis (NEC). An acceptable covariable balance between the groups was estimated by obtaining differences from standardized means (SMD) of less than 0.2, except the TPN days.
High dose treatment of vitamin D exhibited bone mineralization patterns consisting of different skeletal sites. Dexa showed entirely higher whole body with 800 IU after IPTW, significant profits in the left spine and left femur, and a positive (not significant) tendency in the right femur. The significant results of the left femur could be partially attributed to the variability of positioning or measurement in very small premature babies.
Serum 25 (OH) d was only monitored in the 800 IU group; There was no clinical toxicity, and the dosing was stopped by protocol when the levels exceeded 80 ng/ml. Bone densitometry analysis revealed a significantly higher whole BMAD in the 800 IU/day group than the 400 IU/day group, even after the reverse probability of treatment weighting (IPTW).
Dexa radiology images indicated a positive consistent effect of the highest dose vitamin D supplementation in skeletal mineralization, with significant effects on the spine and the left femur and a positive trend in the right femur.
A biochemical safety evaluation based on serum levels 25 (OH) D did not reveal clinical toxicity signs. This finding stressed the security of an 800 IU/day regime in the VLBW population. Bone densitometry analysis revealed that good BMAD newborns had significantly higher bone mineral content (BMC) and DMO compared to other groups. Greater supplementation with vitamin D and greater gestational maturity are crucial to improve bone mineralization in VLBW babies.
Conclusions
The current study stressed that, compared to the standard dose of 400 IU of vitamin D, a higher dose of 800 IU, started at 14 days of life, could significantly increase bone mineralization in premature babies with VLBW. The authors indicated the potential benefits of a greater intake of vitamin D in vulnerable babies.
In the future, a similar investigation that uses a diverse study population of different geographical locations, ethnicities, genetic factors and maternal conditions is essential to validate the current study findings. In addition, the standard reference values for the interpretation of Dexa in premature populations, together with other validated methods, must be developed.
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