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A 5-year-old boy presents with a 4-day history of cough, fever and increased work of breathing. On auscultation, he has right-sided basal crepitations. A chest X-ray shows a right lower lobe pneumonia. He has a medical history of vitamin D deficiency; however, his mother informs you that his vitamin D levels are now normal. This is his second episode of pneumonia since birth. You wonder if there is any evidence to suggest that vitamin D supplementation will reduce his risk of further episodes of lower respiratory tract infection (LRTI).
Structured clinical question
In a child with pneumonia (patient), does vitamin D supplementation (intervention) lead to a reduced risk of LRTIs (outcome)?
EMBASE and Medline were searched using the Ovid Medline(R) database (1946 to present) in May 2014 with Daily Update Search strategy. The following key words were used: (Vitamin D OR Ergocalciferol OR Cholecalciferol OR alfacalcidol) AND (Respiratory tract infections OR lower respiratory tract OR Pneumonia). The search language was limited to English and ‘all child’ (0–18 years). This identified 35 articles. Only trials investigating the effects of vitamin D supplementation on the incidence of acute LRTI were included, leaving three relevant articles. The references of all relevant publications were reviewed and two further articles were identified. A total of five articles were available for review1–5 (table 1).
A Cochrane library search revealed a protocol for vitamin D supplementation for preventing infections in children aged <5 years; however, the results are pending and there are currently no articles for review.
Acute LRTIs, predominantly pneumonia, are the most common cause of childhood mortality worldwide.8 Poor nutritional status is a well-recognised cause of susceptibility to acute LRTIs in children.9 ,10 Vitamin D deficiency …
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