644 - Vitamin D supplementation for Prevention of Vitamin D deficiency in Preterm and Low Birth Weight Infants

Publication Number: 1621.644

Pramod Pharande, Monash Children's Hospital, Melbourne, Clayton, Melbourne, Victoria, Australia; Jennifer L. Middleton, Royal Prince Alfred Hospital, Dulwich Hill, New South Wales, Australia; Chris Cooper, Bristol University, Bristol, England, United Kingdom; Mohan Pammi, Baylor College of Medicine, Bellaire, TX, United States; Mohamed Abdel-Latif, Australian National University, Acton, Australian Capital Territory, Australia

Background: Infants born prematurely or low birth weight (LBW) are at increased risk of vitamin D deficiency, poor bone health and rickets. Uncertainty exists regarding the need, dose and duration of vitamin D supplementation in preterm and LBW infants.

Objective: To evaluate the benefits and harms of vitamin D (daily cumulative dose ≥ 200 IU) for prevention of vitamin D deficiency in preterm and LBW infants.

Design/Methods: We searched CENTRAL, MEDLINE, Embase, and trial registries in February 2024. We included Randomised controlled trials of vitamin D supplementation versus placebo, or higher versus lower dose vitamin D supplementation in preterm ( < 37 weeks gestational age) and LBW infants. Outcomes were vitamin D deficiency, insufficiency, excess, osteopenia of prematurity, bone mineral content, nutritional rickets and hypercalcaemia reported up to discharge / term corrected age for preterm infants, and up to six months' age for LBW infants. We synthesised results for each outcome using meta-analysis where possible using risk ratio (RR), risk difference (RD), mean difference (MD) with 95% confidence intervals (CI).

Results: Thirty studies involving 4787 infants were included.
Vitamin D supplementation versus no supplementation:
In preterm infants, Vitamin D supplementation reduces the risk of vitamin D deficiency (RR 0.29, 95% CI 0.16 to 0.53; 3 studies, 269 infants); and may reduce the risk of vitamin D insufficiency or deficiency (RR 0.53, 95% CI 0.41 to 0.68). In LBW infants, vitamin D supplementation may reduce vitamin D deficiency (RR 0.21, 95% CI 0.13 to 0.34; 453 infants); and may reduce vitamin D insufficiency or deficiency (RR 0.59, 95% CI 0.50 to 0.70).
Higher versus lower dose vitamin D supplementation in preterm infants:
Higher dose of vitamin D reduces vitamin D deficiency (RR 0.13, 95% CI 0.05 to 0.31; 9 studies; 554 infants); and probably reduces vitamin D insufficiency or deficiency (RR 0.28, 95% CI 0.20 to 0.41). However, higher dose probably increases vitamin D excess (RR 5.76, 95% CI 1.09 to 30.3; 4 studies; 357 infants).
Higher dose may result in little to no difference in osteopenia of prematurity (RR 0.92, 95% CI 0.48 to 1.76; 6 studies, 339 infants), but may increase bone mineral content (SMD 0.39, 95% CI 0.03 to 0.75; 4 studies, 124 infants) and probably reduces secondary hyperparathyroidism (RR 0.46, 95% CI 0.31 to 0.67; 6 studies, 409 infants).

Conclusion(s): Vitamin D supplementation in preterm and term LBW infants reduces the risk of vitamin D deficiency and insufficiency. Higher doses may increase bone mineral content and probably reduce secondary hyperparathyroidism.

Vitamin D supplementation versus no supplementation in preterm infants for prevention of vitamin D deficiency
Table1.pdf

Vitamin D supplementation versus no supplementation in low birth weight term and near term infants for prevention of vitamin D deficiency
Table2.pdf

Higher dose vitamin D supplementation compared to lower dose vitamin D supplementation in preterm infants for prevention of vitamin D deficiency
Table3.pdf