Skip to main content

Advertisement

Log in

Vitamin D status in critically ill children

  • Pediatric Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Background

Hypovitaminosis D is an independent risk factor for cardiovascular disease, muscle weakness, impaired metabolism, immune dysfunction, and compromised lung function. Hypovitaminosis D is common in critically ill adults and has been associated with adverse outcomes. The prevalence of hypovitaminosis D and its significance in critically ill children are unclear.

Methods

We performed a prospective study to determine the prevalence of hypovitaminosis D in 316 critically ill children, and examined its association with physiological and biochemical variables, length of pediatric intensive care unit (PICU) stay, and hospital mortality.

Results

The prevalence of hypovitaminosis D [25(OH)D3 <50 nmol/L] was 34.5 %. Hypovitaminosis D was more common in postoperative cardiac patients than in general medical ICU patients (40.5 versus 22.6 %, p = 0.002), and the cardiac patients had a higher inotrope score [2.5 (1.9–3.3) versus 1.4 (1.1–1.9), p = 0.006]. Additionally, ionized calcium within the first 24 h was lower in patients with 25(OH)D3 <50 nmol/L [1.07 (0.99–1.14) mmol/L] compared with patients with normal vitamin D3 [1.17 (1.14–1.19) mmol/L, p = 0.02]. Hypovitaminosis D was not associated with longer PICU stay or increased hospital mortality.

Conclusions

Hypovitaminosis D is common in critically ill children, and is associated with higher inotropes in the postoperative cardiac population, but not with PICU length of stay or hospital survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Norman AW (2008) From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr 88:491S–499S

    Article  PubMed  CAS  Google Scholar 

  2. Cantorna MT, Zhu Y, Froicu M, Wittke A (2004) Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr 80:1717S–1720S

    PubMed  CAS  Google Scholar 

  3. Holick MF (2006) Resurrection of vitamin D deficiency and rickets. J Clin Invest 116:2062–2072

    Article  PubMed  CAS  Google Scholar 

  4. Van den Berghe G (2003) Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab 88:4623–4632

    Article  PubMed  Google Scholar 

  5. Mansbach JM, Ginde AA, Amargo CA Jr (2008) Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D. Pediatrics 12:1404–1410

    Google Scholar 

  6. Hayes CE, Hashold FE, Spach KM, Pederson LB (2004) The immunological functions of the vitamin D endocrine system. Cell Mol Biol 49:277–300

    Google Scholar 

  7. Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343–351

    Article  PubMed  CAS  Google Scholar 

  8. Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, Boehm BO, Dobnig H (2008) Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab 93:3927–3935

    Article  PubMed  CAS  Google Scholar 

  9. Zosky GR, Berry LJ, Elliot JG, James AL, Gorman S, Hart PH (2011) Vitamin D deficiency causes deficits in lung function and alters lung structure. Am J Respir Crit Care Med 183:1336–1343

    Article  PubMed  Google Scholar 

  10. Makariou S, Liberopoulos EN, Elisaf M, Challa A (2011) Novel roles of vitamin D in disease: what is new in 2011? Eur J Intern Med 22:355–362

    Article  PubMed  CAS  Google Scholar 

  11. Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, Kinkeldei J, Boehm BO, Weihrauch G, Maerz W (2008) Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med 168:1340–1349

    Article  PubMed  CAS  Google Scholar 

  12. Deluca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80:1689S–1696S

    PubMed  CAS  Google Scholar 

  13. Holick MF (1990) The use and interpretation of assays for vitamin D and its metabolites. J Nutr 120(Suppl 11):1464–1469

    PubMed  CAS  Google Scholar 

  14. Lee P, Nair P, Eisman JA, Center JR (2009) Vitamin D deficiency in the intensive care unit: an invisible accomplice to morbidity and mortality? Intensive Care Med 35:2028–2032

    Article  PubMed  CAS  Google Scholar 

  15. Lee P, Eisman JA, Center JR (2009) Vitamin D deficiency in critically ill patients. N Engl J Med 360:1912–1914

    Article  PubMed  CAS  Google Scholar 

  16. Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, Christopher KB (2011) Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med 39:671–677

    Article  PubMed  CAS  Google Scholar 

  17. Slater A, Shann F, Pearson G (2003) Paediatric index of mortality (PIM) study group. PIM2: a revised version of the paediatric index of mortality. Intensive Care Med 29:278–285

    PubMed  Google Scholar 

  18. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118

    Article  PubMed  Google Scholar 

  19. Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR, Walsh AZ, Chang AC, Castaneda AR, Newburger JW (1995) Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 92:2226–2235

    Article  PubMed  CAS  Google Scholar 

  20. Rovner AJ, O’Brien KO (2008) Hypovitaminosis D among healthy children in the United States: a review of the current evidence. Arch Pediatr Adolesc Med 162:513–519

    Article  PubMed  Google Scholar 

  21. Dong Y, Pollock N, Stallmann-Jorgensen IS, Gutin B, Lan L, Chen TC, Keeton D, Petty K, Holick MF, Zhu H (2010) Low 25-hydroxyvitamin D Levels in adolescents: race, season, adiposity, physical activity, and fitness. Pediatrics 125:1104–1111

    Article  PubMed  Google Scholar 

  22. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28

    PubMed  CAS  Google Scholar 

  23. Lucidarme O, Messai E, Mazzoni T, Arcade M, du Cheyron D (2010) Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med 36:1609–1611

    Article  PubMed  Google Scholar 

  24. Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, Perez-Rossello J, Cox JE (2008) Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med 162:505–512

    Article  PubMed  Google Scholar 

  25. Jones G, Blizzard C, Riley MD, Parameswaran V, Greenaway TM, Dwyer T (1999) Vitamin D levels in prepubertal children in Southern Tasmania: prevalence and determinants. Eur J Clin Nutr 53:824–829

    Article  PubMed  CAS  Google Scholar 

  26. Rovner AJ, O’Brien KO (2008) Hypovitaminosis D among healthy children in the United States: a review of the current evidence. Arch Pediatr Adolesc Med 162:513–519

    Article  PubMed  Google Scholar 

  27. Jones G, Dwyer T, Hynes KL, Parameswaran V, Greenaway TM (2005) Vitamin D insufficiency in adolescent males in Southern Tasmania: prevalence, determinants, and relationship to bone turnover markers. Osteoporos Int 1:636–641

    Article  Google Scholar 

  28. Harkness LS, Cromer BA (2005) Vitamin D deficiency in adolescent females. J Adolesc Health 37:75

    Article  PubMed  Google Scholar 

  29. Greenway A, Zacharin M (2003) Vitamin D status of chronically ill or disabled children in Victoria. J Paediatr Child Health 39:543–547

    Article  PubMed  CAS  Google Scholar 

  30. Cecchi A, Bonizzoli M, Douar S (2011) Vitamin D deficiency in septic patients at ICU admission is not a mortality predictor. Minerva [Epub ahead of print]

  31. Hewison M (2010) Vitamin D and the immune system: new perspectives on an old theme. Endocrinol Metab Clin North Am 39:365–379

    Article  PubMed  CAS  Google Scholar 

  32. Hewison M (2010) Vitamin D and the intracrinology of innate immunity. Mol Cell Endocrinol 321:103–111

    Article  PubMed  CAS  Google Scholar 

  33. Nguyen M, Trubert CL, Rizk-Rabin M, Rehan VK, Besancon F, Cayre YE, Garabedian M (2004) 1,25-Dihydroxyvitamin D3 and fetal lung maturation: immunogold detection of VDR expression in pneumocytes type II cells and effect on fructose 1,6 bisphosphatase. J Steroid Biochem Mol Biol 89:93–97

    Article  PubMed  Google Scholar 

  34. Black PN (2005) Relationship between serum 25-hydroxyvitamin D and pulmonary function in the third national health and nutrition examination survey. Chest 128:3792–3798

    Article  PubMed  CAS  Google Scholar 

  35. Ginde AA, Mansbach JM, Camargo CA (2009) Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the third national health and nutrition examination survey. Arch Intern Med 169:384–390

    Article  PubMed  CAS  Google Scholar 

  36. Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V (2009) Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med 7:28

    Article  PubMed  Google Scholar 

  37. Karatekin G, Kaya A, Salihoğlu Ö, Balci H, Nuhoğlu A (2009) Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 63:473–477

    Article  PubMed  CAS  Google Scholar 

  38. Wayse V, Yousafzai A, Mogale K, Filteau S (2004) Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 58:563–567

    Article  PubMed  CAS  Google Scholar 

  39. Muhe L, Lulseged S, Mason KE, Simoes EA (1997) Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet 349:1801–1804

    Article  PubMed  CAS  Google Scholar 

  40. Uysal S, Kalayci AG, Baysal K (1999) Cardiac functions in children with vitamin D deficiency rickets. Pediatr Cardiol 20:283–286

    Article  PubMed  CAS  Google Scholar 

  41. Maiya S, Sullivan I, Allgrove J, Yates R, Malone M, Brain C, Archer N, Mok Q, Daubeney P, Tulloh R, Burch M (2008) Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure. Heart 94:581–584

    Article  PubMed  CAS  Google Scholar 

  42. Tishkoff DX, Nibbelink KA, Holmberg KH, Dandu L, Simpson RU (2008) Functional vitamin D receptor in the t-tubules of cardiac myocytes. Endocrinology 149:558–564

    Article  PubMed  CAS  Google Scholar 

  43. Xiang W, Kong J, Chen S, Cao LP, Qiao G, Zheng W, Liu W, Li X, Gardner DG, Li YC (2005) Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin-angiotensin systems. Am J Physiol Endocrinol Metab 288:E125–E132

    Article  PubMed  CAS  Google Scholar 

  44. Misra M, Pacaud D, Petryk A, Colett-Solberg PF, Kappy M (2008) Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 122:398–417

    Article  PubMed  Google Scholar 

  45. Roth HJ, Schmidt-Gayk H, Weber H, Miederau C (2008) Accuracy and clinical implications of seven 25-hydroxyvitamin D methods compared with liquid chromatography-tandem mass spectrometry as a reference. Ann Clin Biochem 45:153–159

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lara S. Shekerdemian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rippel, C., South, M., Butt, W.W. et al. Vitamin D status in critically ill children. Intensive Care Med 38, 2055–2062 (2012). https://doi.org/10.1007/s00134-012-2718-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-012-2718-6

Keywords

Navigation