Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n=55; approximately 800-1000 IU from combined sources) or monitored therapy (n=54; with an option of dose modification). 25(OH)D concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52±2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20–80 ng/mL) at 52 weeks of PCA (p=0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.
The best evidence for the role of vitamin D in infants is its influence on skeletal growth, however, the pleiotropic actions of vitamin D in the foetus and neonates are under-researched. The systematic reviews, based mostly on observational studies, suggest correlations between prenatal and postnatal supplementation and the occurrence of allergy, respiratory infections, sepsis or mental and behavioural development. Some of these studies focused on subgroups of neonates, such as preterm infants, investigating the influence inter alia on sepsis, bronchopulmonary dysplasia, and necrotising enterocolitis. Currently, there is a need for randomised trials for proof of the skeletal and pleiotropic effects of vitamin D in infants.
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