Efficacy and safety of parenteral vitamin D therapy in infants and children with vitamin D deficiency caused by intestinal malabsorption
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Purpose: Oral supplementation of vitamin D can be inefficient in patients with vitamin D deficiency caused by intestinal malabsorption. This study investigated the efficacy and safety of parenteral vitamin D supplementation in infants and children with vitamin D deficiency caused by intestinal malabsorption. Methods: This study included 11 patients with vitamin D deficiency who were unresponsive to oral vitamin D or were unable to try oral vitamin D therapy due to underlying conditions. All patients were treated with weekly intramuscular injection of cholecalciferol 50,000 IU. Radiological findings and biochemical parameters including serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D3 (25(OH)D3), and parathyroid hormone levels were reviewed retrospectively. Results: Underlying diseases included small bowel atresia (n=3), necrotizing enterocolitis (n=3), congenital megacolon (n=2), chronic intestinal pseudo-obstruction (n=1), congenital mesenteric band (n=1), and Crohn disease (n=1). Three patients exhibited rickets on X-ray findings. The mean duration of treatment was 4.8±2.9 weeks. The alkaline phosphatase levels were decreased from 710±650 IU/L to 442±284 IU/L (P=0.143). The 25(OH)D3 level was increased from 6.0±3.4 ng/mL to 50.4±28.8 ng/mL (P=0.008) after 3 months. Two patients with rickets showed improved radiologic findings after parenteral treatment. Conclusion: Parenteral vitamin D therapy was effective and safe in patients with vitamin D deficiency caused by intestinal malabsorption. Long-term follow-up is needed to establish the efficacy of parenteral vitamin D therapy in a large number of patients.
Abstract
Purpose: Oral supplementation of vitamin D can be inefficient in patients with vitamin D deficiency caused by intestinal malabsorption. This study investigated the efficacy and safety of parenteral vitamin D supplementation in infants and children with vitamin D deficiency caused by intestinal malabsorption. Methods: This study included 11 patients with vitamin D deficiency who were unresponsive to oral vitamin D or were unable to try oral vitamin D therapy due to underlying conditions. All patients were treated with weekly intramuscular injection of cholecalciferol 50,000 IU. Radiological findings and biochemical parameters including serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D3 (25(OH)D3), and parathyroid hormone levels were reviewed retrospectively. Results: Underlying diseases included small bowel atresia (n=3), necrotizing enterocolitis (n=3), congenital megacolon (n=2), chronic intestinal pseudo-obstruction (n=1), congenital mesenteric band (n=1), and Crohn disease (n=1). Three patients exhibited rickets on X-ray findings. The mean duration of treatment was 4.8±2.9 weeks. The alkaline phosphatase levels were decreased from 710±650 IU/L to 442±284 IU/L (P=0.143). The 25(OH)D3 level was increased from 6.0±3.4 ng/mL to 50.4±28.8 ng/mL (P=0.008) after 3 months. Two patients with rickets showed improved radiologic findings after parenteral treatment. Conclusion: Parenteral vitamin D therapy was effective and safe in patients with vitamin D deficiency caused by intestinal malabsorption. Long-term follow-up is needed to establish the efficacy of parenteral vitamin D therapy in a large number of patients.
참고문헌 (23)
- Bouillon R, "Vitamin D insufficiency : definition, diagnosis and management", Best Pract Res Clin Endocrinol Metab, 32, pp.669~684 (2018)
- Choi HS, "Vitamin D insufficiency in Korea--a greater threat to younger generation : the Korea National Health and Nutrition Examination Survey(KNHANES)2008", J Clin Endocrinol Metab, 96, pp.643~651 (2011)
- Maiya S, "Hypocalcaemia and vitamin D deficiency : an important, but preventable, cause of life-threatening infant heart failure", Heart, 94, pp.581~584 (2008)
- Allgrove J, "A Practical approach to Vitamin D deficiency and rickets", Endocr Dev, 28, pp.119~133 (2015)
- Munns CF, "Global consensus recommendations on prevention and management of nutritional rickets", J Clin Endocrinol Metab, 101, pp.394~415 (2016)
- Holick MF, "Evaluation, treatment, and prevention of vitamin D deficiency : an Endocrine Society clinical practice guideline", J Clin Endocrinol Metab, 96, pp.1911~1930 (2011)
- Gordon CM, "Treatment of hypovitaminosis D in infants and toddlers", J Clin Endocrinol Metab, 93, pp.2716~2721 (2008)
- Wagner CL, "Prevention of rickets and vitamin D deficiency in infants, children, and adolescents", Pediatrics, 122, pp.1142~1152 (2008)
- Soliman AT, "Clinical responses to a mega-dose of vitamin D3 in infants and toddlers with vitamin D deficiency rickets", J Trop Pediatr, 56, pp.19~26 (2010)
- Misra M, "Vitamin D deficiency in children and its management: review of current knowledge and recommendations", Pediatrics, 122, pp.398~417 (2008)
- Grenade N, "Use of a loading dose of vitamin d for treatment of vitamin d deficiency in patients with intestinal failure", JPEN J Parenter Enteral Nutr, 41, pp.512~516 (2017)
- Yang CF, "High prevalence of multiple micronutrient deficiencies in children with intestinal failure : a longitudinal study", J Pediatr, 159, pp.39~44 (2011)
- 김재현, "The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects", Clinical and Experimental Pediatrics, 61(5), pp.135~149 (2018), 대한소아청소년과학회
- Mittal H, "300, 000 IU or 600, 000 IU of oral vitamin D3 for treatment of nutritional rickets : a randomized controlled trial", Indian Pediatr, 51, pp.265~272 (2014)
- Tannous P, "Safety and effectiveness of stoss therapy in children with vitamin D deficiency", J Paediatr Child Health, 56, pp.81~89 (2020)
- Mondal K, "A Randomized controlled trial on safety and efficacy of single intramuscular versus staggered oral dose of 600 000IU Vitamin D in treatment of nutritional rickets", J Trop Pediatr, 60, pp.203~210 (2014)
- Burris HH, "Vitamin D status among preterm and full-term infants at birth", Pediatr Res, 75, pp.75~80 (2014)
- Natarajan CK, "Trial of daily vitamin D supplementation in preterm infants", Pediatrics, 133, pp.e628~e634 (2014)
- Abrams SA, "Calcium and vitamin d requirements of enterally fed preterm infants", Pediatrics, 131, pp.e1676~e1683 (2013)
- Monangi N, "Vitamin D status of early preterm infants and the effects of vitamin D intake during hospital stay", Arch Dis Child Fetal Neonatal Ed, 99, pp.F166~F168 (2014)
- Cole CR, "Very low birth weight preterm infants with surgical short bowel syndrome: incidence, morbidity and mortality, and growth outcomes at 18 to 22 months", Pediatrics, 122, pp.e573~e582 (2008)
- de Boer IH, "Chronic kidney disease, dialysis, and transplantation", pp.115~127 (2010), Elsevier Saunders
- Bowden SA, "Prevalence of vitamin D deficiency and insufficiency in children with osteopenia or osteoporosis referred to a pediatric metabolic bone clinic", Pediatrics, 121, pp.e1585~e1590 (2008)