Article Text
PDF
Abstract
Background Maternal Vitamin D deficiency has implications for neonatal health with increased rates of intrauterine growth restriction and metabolic bone disease.1 Screening for Vitamin D deficiency in pregnancy is not recommended and currently most antenatal units direct testing based on maternal risk factors.1,2 Treating Vitamin D deficiency in neonates is controversial with most guidelines suggesting a Vitamin D dose of 1000–2000IU for a period of 6–12 weeks; although it has been suggested that this may be insufficient2,3,4. As far as we are aware there are no RCTs exploring the appropriate dose and duration of Vitamin D supplementation in Vitamin D deficient term neonates.
We routinely treat Vitamin D deficient neonates with 3000IU of Cholecalciferol for 12 weeks; and as far as we are aware we are the first to present data on the safety and effectiveness of such a regimen.
Aims
Assess our current approach to antenatal Vitamin D testing
Determine the safety and effectiveness of 3000IU of Cholecaliferol over 12 weeks in term neonates.
Methods We conducted a prospective audit over 9 months; Vitamin D deficient mothers were identified by the obstetric team and neonates born to Vitamin D deficient mothers had their Vitamin D (25(OH)D) levels tested at birth using the Abbott Architect assay. Neonates with Vitamin D levels of <30nmol/l were treated for 12 weeks with 3000IU of Cholecalciferol.
Results Based on local demographic data and birth rates we would expect approximately 970 Vitamin D deficient (<25nmol/l)2 mothers to deliver during the study period – Only 17 expectant mothers (1.8%) were diagnosed as Vitamin D deficient.
Of those neonates treated with 3000 IU of Cholecalciferol for 3 months (n = 10), none reached toxic levels (>250nmol/l). Following treatment the Vitamin D level significantly increased (P = 0.002), with a median 25(OH)D level of 94nmol/l (IQR 75–94.5).
Conclusion Maternal Vitamin D deficiency is under recognised and screening of high risk groups should be considered in pregnancy. Our experience suggests 3000IU Cholecalciferol over 12 weeks is a safe and effective treatment for Vitamin D deficiency in neonates.