This article discusses negative effects of vitamin D deficiency on low birthweight preterm and full-term newborns. Results of the studies on vitamin D provision to pregnant women and their newborn children are addressed. Vitamin D deficiency is highly prevalent in pregnant women and newborns. It was demonstrated that inadequate antenatal provision of a fetus with vitamin D may result in congenital rickets and neonatal seizures due to hypocalcemia in newborns and also accounts for increased rates of necrotic enterocolitis, bronchopulmonary dys-plasia, and impaired growth and development as well as higher risk of lower respiratory tract infections (i.e., bronchiolitis, pneumonia) during the first year of a child’s life. In addition, it was shown that persistent vitamin D deficiency in future years may be associated with recurrent respiratory infections, allergic (e.g., atopic dermatitis, asthma, etc.), autoimmune, endocrine, and psycho-neurological disorders. Preventive and therapeutic strategies for vitamin D deficiency in low birthweight preterm and full-term newborns since neonatal period are discussed.Keywords: vitamin D, vitamin D deficiency, calcidiol, low birthweight newborn, preterm newborn, full-term newborn.For citation: Zakharova I.N., Mal’tsev S.V., Zubkov V.V. et al. Vitamin D, low birthweight preterm and full-term newborns: time for a paradigm shift. Russian Journal of Woman and Child Health. 2020;3(2):142–148. DOI: 10.32364/2618-8430-2020-3-2-142-148.
This paper reviews the effects of vitamin D deficiency on pregnant women and newborns. It was demonstrated that vitamin D deficiency in pregnant women is associated with higher risks of threatened preterm labor, placental insufficiency, preeclampsia, gestational diabetes, bacterial vaginosis, and impaired uterine contractility as well as higher rate of C-sections. Vitamin D insufficiency in newborns is associated with inadequate bone mineralization and also results in metabolic disorders, hypocalcemic seizures, bronchopulmonary dysplasia, necrotic enterocolitis, sepsis, mental and developmental disorders, and higher risks of various (infectious, allergic etc.) disorders. Optimal vitamin D dosing regimen in pregnant women and newborns is discussed.KEYWORDS: pregnancy, vitamin D, vitamin D insufficiency, newborn, complications of pregnancy, preeclampsia, gestational diabetes.FOR CITATION: Zakharova I.N., Mal’tsev S.V., Zubkov V.V. et al. Effect of vitamin D on the pregnancy and the health of newborns and infants: state-of-the-art. Russian Journal of Woman and Child Health. 2020;3(3):174–181. DOI: 10.32364/2618-8430-2020-3-3-174-181.
children with sickle cell disease. The secondary aim is to analyse whether there is an association in children with sickle cell disease between health-related quality of life and 1) patient's age, 2) disease severity, and 3) caregiver's sociodemographic characteristics.A retrospective cross-sectional evaluation of TNO-AZL Preschool Children Quality of Life questionnaire (TAPQOL, 0-1 year) and Pediatric Quality of Life Inventory™ (PedsQL™, 2-7 years) data was conducted in children aged 0-7 years, living in the Netherlands. Study participants included caregivers of children with sickle cell disease referred for clinical follow-up at the sickle cell comprehensive care centres at Amsterdam UMC and Erasmus MC Rotterdam between April 2012 and October 2020. Clinical data were obtained from medical records record abstraction. Comparisons were made with previously published normative data on health-related quality of life in the general paediatric population, living in the Netherlands.The study enrolled 136 caregivers of 136 children. On domains where significant differences existed between children with sickle cell disease and the general paediatric population, children with sickle cell disease scored lower with the most extensive impairment in children aged 5-7 years.Multiple regression models showed a significant negative association between age and health-related quality of life. No association was found between health-related quality of life and disease severity or health-related quality of life and sociodemographic characteristics.This study has demonstrated that health-related quality of life declines with age in very young children with sickle cell disease, with an extensive impaired health-related quality of life from 5 years of age when compared to the general paediatric population. This underlines the importance of the identification of high-risk patients with significantly impaired healthrelated quality of life as early in life as possible, to apply appropriate interventions for quality of life improvement. Future research should focus on factors influencing healthrelated quality of life in children with sickle cell disease.
To date, the most discussed issue is the rational dosage and duration of cholecalciferol preparations course for the correction and prevention of hypovitaminosis D. Objective of the research: to compare the structure of provision and the median 25 (OH) D before (2013–2016) and during the introduction into clinical practice (2018–2019) of the National Program Vitamin D Deficiency in Children and Adolescents in the Russian Federation: Modern approaches to correction» in young children. Materials and methods: the study had two stages. The first stage took place as a part of the RODNICHOK2 study from 2013 to 2016 before the implementation of the National Program «Vitamin D Deficiency in Children and Adolescents in the Russian Federation: Modern Approaches to Correction». The second stage of the study took place in 2018–2019 during the implementation of the National Program in clinical practice. The study participants were 246 children aged from 1 month to 3 years who took cholecalciferol preparations. The assessment of calcidiol concentration in the blood serum was assessed by the method of chemiluminescence immunoassay (CLIA) using reagents Liaison® 25OH Vitamin D Total Assay on the Liaison Dia Sorin Pleutschland GmbH device in the centralized laboratory of Scientific Center EFIS Ltd, Moscow. Results: during the introduction into clinical practice of the National Program, the frequency of prescribing a dosage of 500 IU/day significantly decreased to 4,9% (χ2=80,4, p<0,001), 1000 IU/day – statistically significantly increased to 71% (χ2=53,5; p<0,001), and a dose of 1500 IU/day was taken by 24% of children, mainly in the second and third years of life. In children examined in 2013–2016, the median serum calcidiol was 29,1 [22,8; 39,5] ng/ml, statistically significantly lower than in 2018– 2019, – 51,3 [38,1; 61,5] ng/ml (p<0,001). Hypovitaminosis D in young children in southern Russia until 2018 was diagnosed in 54,9%, statistically significantly more often than during the implementation of the National Program – in 12.2% of children (χ2=24,3, p<0,001). The number of children with a calcidiol level of more than 30 ng/ml, on the contrary, statistically significantly increased from 45,1 to 87,8% (χ2=39,9, p<0,001). There was a statistically significant decrease in the number of children with vitamin D deficiency – only 10 (12,2%) cases, while earlier their number was 62 (37,8%) (χ2=17,3, p<0,001). Among children examined in 2018–2019, it was possible to completely eliminate severe deficiency (calcidiol level less than 10 ng/ml) and vitamin D deficiency (10–20 ng/ml), while previously it was revealed in 6 (3,7%) (χ2=220,8, p<0,001) and 22 (13,4%) children (χ2=167,9, p<0,001). In 2013–2016 the indicator of the recommended average daily dosage of vitamin D was 73,3 [51,6; 103,1] IU/kg per day, while in 2018–2019. During the implementation of the recommendations set out in the National Program – 125,0 [102,0; 148,7] IU/kg per day (p<0,0001). Conclusion: the study confirmed daily doses per kilogram of body weight in the range from 100 to 150 IU/kg, included in the main provisions of the recommendations for prophylactic intake of vitamin D preparations at an early age. The introduction of the recommendations on the prophylactic course of vitamin D supplementation described in the National Program «Vitamin D Deficiency in Children and Adolescents in the Russian Federation: Modern Approaches to Correction» into wide clinical practice allowed to achieve a significant increase in the number of children receiving additional vitamin D supplements. The recommended average daily dose in comparison with the period before the implementation of the National Program has increased statistically significantly.
Case Discussion Though MIS-C is rare, with an incidence of 0.14% among children with SARS CoV-2 infection according to one Systematic Review (Hoang Et al. 2020), it is an important new differential which must be borne in mind in cases of fever with no clear source. Both of these cases had a negative PCR test for SARS CoV-2 and no history of Covid 19 disease. No serological testing for SARS CoV-2 was available in our hospital setting. But in accordance with RCPCH guidelines this does not exclude the diagnosis of MIS-CIn previous studies as many as 71% of cases of MIS-C required PICU admission (Ahmed Et al., 2020), however not all are severely unwell and may be stable enough to be managed on a ward setting as described above.
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