Abstract
Introduction: Vitamin D is critical in bone metabolism and calcium homeostasis,as well as an important regulator in metabolic processes, cardiovascular and immune systems. It is crucial for humans to have sufficient vitamin D levels to maintain bone health and improve response to infection. Vitamin D deficiency (VDD) represent a potentially modifiable risk factor for greater illness severity and clinical outcome during critical illness.
The objective of this study is to assess Vitamin D status in critically ill children admitted in PICU and to determine the frequency of VDD amongst them and its association with disease severity and important clinical outcomes.
Methods: It was a prospective observational study conducted over a period of 6 months in the PICU of tertiary care hospital on 100 critically ill children aged 1 month –12 years. Serum Vitamin D levels were estimated within 24 hours of admission to PICU. Severity of illness was assessed using Pediatric Index of Mortality III (PRISM III) score. The need for catecholamines and mechanical ventillation, length of PICU stay and mortality were also recorded.
Results: The prevalence of VDD among critically ill children was 49%.Vitamin D level was significantly lower in VDD group as compared to ‘no deficiency’ group (16.3±2.5 vs 38±5.9, p value 0.01). There was also a trend toward increased disease severity, higher need of catecholamines and mechanical ventillation in VDD group. The length of PICU stay (pvalue0.004) and mortality rate (pvalue0.006) was also significantly higher in VDD group.
Conclusion: VDD is common in critically ill children and associated with greater illness severity, longer PICU stay and higher mortality.
Keywords: Critically ill children, Mortality, PICU, PRISM III, Vitamin D, Vitamin D deficiency
References
- Braegger C, Campoy C, Colomb V, et al. Vitamin D in the healthy european paediatric population. J Pediatr Gastroenterol Nutr 2013;56:692–701.
- Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122: 398–417.
- Kongsbak M, Levring TB, Geisler C, von Essen MR. The vitamin D receptor and T cell function. Front Immunol. 2013;4:148.
- Gordon CM, Feldman HA, Sinclair L, et al. Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med. 2008;162(6):505–512.
- Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531–7.
- Flores M, Macias N, Lozada A, Sanchez LM, Diaz E, Barquera S. Serum 25-hydroxy vitamin D levels among Mexican children ages 2 y to 12 y: a national survey. Nutrition. 2013;29:802–4.
- Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87:1080–6S.
- Rathi N, Rathi A. Vitamin D and child health in the 21st century. Indian Pediatr. 2011;48:619–25.
- Madden K, Feldman HA, Smith EM, Gordon CM, Keisling SM, Sullivan RM, et al. Vitamin D deficiency in critically ill children. Pediatrics. 2012;130:421–8.
- McNally JD, Menon K, Chakraborty P, Fisher L, Williams KA, Al-Dirbashi OY, et al. The association of vitamin D status with pediatric critical illness. Pediatrics. 2012; 130:429–36.
- Rippel C, South M, Butt WW, Shekerdemian LS, et al. Vitamin D status in critically ill children. Intensive Care Med. 2012;38:2055–62.
- Ebenezer K, Job V, Antonisamy B, Dawodu A, Manivachagan MN, Steinhoff M. Serum vitamin D status and outcome among critically ill children admitted to the pediatric intensive care unit in South India. Indian J Pediatr. 2015. doi:10.1007/s12098-015-1833-0.
- Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2–8.
- World Health Organization. Guidelines: Update on the Management of Severe Acute Malnutrition in Infants and Children. Geneva: WHO; 2013
- Rey C, Sánchez‑Arango D, López‑Herce J, Martínez‑Camblor P, García‑Hernández I, Prieto B, et al. Vitamin D deficiency at pediatric intensive care admission. J Pediatr (Rio J) 2014;90:135‑42.
- Ponnarmeni S, Kumar Angurana S, Singhi S, Bansal A, Dayal D, Kaur R, Patial A, Verma Attri S. Vitamin D deficiency in critically ill children with sepsis. Paediatrics and international child health. 2016 Jan 2;36(1):15-21.
- Sankar, J., Lotha, W., Ismail, J. et al. Vitamin D deficiency and length of pediatric intensive care unit stay: a prospective observational study. Ann. Intensive Care 6, 3 (2016) doi:10.1186/s13613-015-0102-8
- Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81
- Padhi R, Panda B, Jagati S, Patra SC. Vitamin D status in adult critically ill patients in Eastern India: an observational retrospective study. Lung India. 2014; 31:212–6.
Corresponding Author
Somrita Chakravarty
Department of Pediatrics, Silchar Medical College and Hospital, Silchar, Assam, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.138
