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Audit of detection and management of vitamin d deficiency in childhood in the United Kingdom
  1. PV Dissanayake,
  2. R Jayatunge
  1. Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, Birmingham, UK

Abstract

Aims Vitamin D deficiency related to inadequate exposure to sunlight and poor nutritional intake is a growing problem in the United Kingdom. Despite a treatable condition, there are no National guidelines within the NHS providing investigation and treatment protocols for children. We proactively investigate “at risk” (dark pigmented) children for vitamin D deficiency opportunistically and treat according to the Paediatric BNF. Our aim was to ascertain the effectiveness of this strategy.

Method Data was collected retrospectively over 12 months on children 0-16 years attending an acute NHS trust that had vitamin D levels tested. Vitamin D deficiency due to other medical problems was excluded. Pre-treatment and follow-up investigations (bone profile, vitamin D and parathormone levels) and treatment given were analysed including the cost implications of both.

Results 116 patients were investigated for vitamin D status and 31 (26.7%) had deficiency (<25 nmol/L) while 32 (27.5%) had insufficiency (25–50 nmol/L) and 37 (34%) were normal. A further 12% had insufficient samples for analysis but investigations were not repeated.

Of the deficient group only 5 (16%) were symptomatic. 61% of the deficient group and only 22% of the insufficient group received recommended treatment.

Unfortunately 20% of the deficient and 53% of the insufficient groups were not treated probably due to lack of appreciation of a low result in an asymptomatic child. 25% of the insufficient group was over-treated while 13.3% of the deficient group was under-treated.

Recommended follow-up investigations to detect compliance and complications were carried out only in 22% of deficient patients.

Conclusion As 84% of vitamin D deficient children were asymptomatic, we conclude that “at risk” children should be proactively investigated. Early treatment of vitamin D insufficiency would prevent the subsequent necessity for more expensive treatment of deficiency. As a significant proportion received inadequate management we highlight the lack of a uniform approach to the management of vitamin D deficiency. A larger multi-centre study is recommended to develop National guidelines defining appropriate investigations and treatment thresholds for vitamin D deficiency and insufficiency in high risk children.

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