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Serum vitamin D status following pediatric cardiac surgery and association with clinical outcome

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Abstract

Our aim is to determine the prevalence of vitamin D deficiency in children with congenital heart disease (CHD). In addition, we demonstrated the effect of cardiopulmonary bypass (CPB) on vitamin D, parathyroid hormone (PTH), and calcium levels. The association between perioperative vitamin D levels and postoperative clinical outcomes has been explored. A prospective observational study was conducted from February 2018 to June 2019 on 69 children undergoing elective surgery for CHD under CPB. Blood samples were collected preoperatively, immediate postoperatively, and 24 h postoperatively. Vitamin D deficiency was present in 34 (49.3%) patients preoperatively and 63 (91.3%) patients immediately postoperative. We identified 42.03% decline of 25(OH)D immediately postoperative. Changes in ionized calcium (iCa) concentrations were accompanied by reciprocal alterations in PTH concentrations. Lower postoperative 25(OH)D was associated with higher maximum vasoactive inotropic score (VIS) in the first 24 h postoperative (r = − 0.259, p = 0.03).

Conclusion: Vitamin D deficiency is common in children with CHD and the majority are vitamin D deficient following cardiac surgery with acute decline of serum 25(OH)D after CPB. Lower postoperative vitamin D levels in children undergoing cardiac surgery are associated with the need for increasing the inotropic support.

What is Known:

• Vitamin D is a pleiotropic hormone, important for calcium homeostasis.

• Vitamin D deficiency might affect the outcome in critically ill patients.

What is New:

• Cardiopulmonary bypass causes acute decline of vitamin D in children.

• Lower postoperative vitamin D is associated with higher inotropic support.

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Abbreviations

25(OH)D:

25-Hydroxy vitamin D

CHD:

Congenital heart disease

CPB:

Cardiopulmonary bypass

ECMO:

Extracorporeal membrane oxygenation

iCa:

Ionized calcium

ICU:

Intensive care unit

IQR:

Interquartile range

KAUH:

King Abdulaziz University Hospital

PCICU:

Pediatric cardiac intensive care unit

PTH:

Parathyroid hormone

RACHS:

Risk-adjusted classification for congenital heart surgery

VIS:

Vasoactive inotropic score

References

  1. Amrein K, Venkatesh B (2012) Vitamin D and the critically ill patient. Curr Opin Clin Nutr Metab Care 15:188–193. https://doi.org/10.1097/MCO.0b013e32834f0027

    Article  CAS  PubMed  Google Scholar 

  2. Lee P (2011) Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 25:769–781. https://doi.org/10.1016/j.beem.2011.03.001

    Article  CAS  PubMed  Google Scholar 

  3. McNally JD, Menon K, Chakraborty P, Fisher L, Williams KA, Al-Dirbashi OY, Girolamo T, Maharajh G, Doherty DR (2013) Impact of anesthesia and surgery for congenital heart disease on the vitamin D status of infants and children: a prospective longitudinal study. Anesthesiology 119:71–80. https://doi.org/10.1097/ALN.0b013e31828ce817

    Article  CAS  PubMed  Google Scholar 

  4. Graham EM, Taylor SN, Zyblewski SC, Wolf B, Bradley SM, Hollis BW, Mcgowan FX, Atz AM (2013) Vitamin D status in neonates undergoing cardiac operations: relationship to cardiopulmonary bypass and association with outcomes. J Pediatr 162:823–826. https://doi.org/10.1016/j.jpeds.2012.10.013

    Article  CAS  PubMed  Google Scholar 

  5. Wagner CL, Greer FR (2008) Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 122:1142–1152. https://doi.org/10.1542/peds.2008-1862

    Article  PubMed  Google Scholar 

  6. Mcnally JD, Hearn KO, Lawson ML, Maharajh G, Geier P, Weiler H (2015) Prevention of vitamin D deficiency in children following cardiac surgery: study protocol for a randomized controlled trial. Trials 6:402. 1–14. https://doi.org/10.1186/s13063-015-0922-8

    Article  CAS  Google Scholar 

  7. Krishnan A, Ochola J, Mundy J, Jones M, Kruger P, Duncan E, Venkatesh B (2010) Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. Crit Care 14:R216. https://doi.org/10.1186/cc9341

    Article  PubMed  PubMed Central  Google Scholar 

  8. Speeckaert MM, Wehlou C, De Somer F, Speeckaert R, Van Nooten GJ, Delanghe JR (2010) Evolution of vitamin D binding protein concentration in sera from cardiac surgery patients is determined by triglyceridemia. Clin Chem Lab Med 48:1345–1350. https://doi.org/10.1515/CCLM.2010.250

    Article  CAS  PubMed  Google Scholar 

  9. Di Rosa M, Malaguarnera M, Nicoletti F, Malaguarnera L (2011) Vitamin D3: a helpful immuno-modulator. Immunology 134:123–139. https://doi.org/10.1111/j.1365-2567.2011.03482.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Aranow C (2011) Vitamin D and the immune system. J Investig Med 59:881–886. https://doi.org/10.2310/JIM.0b013e31821b8755

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bivona G, Agnello L, Pivetti A, Milano S, Scazzone C, Lo SB, Ciaccio M (2016) Association between hypovitaminosis D and systemic sclerosis: true or fake? Clin Chim Acta 458:115–119. https://doi.org/10.1016/j.cca.2016.04.026

    Article  CAS  PubMed  Google Scholar 

  12. McNally JD, Menon K (2013) Vitamin D deficiency in surgical congenital heart disease: prevalence and relevance. Transl Pediatr 2:99–111. https://doi.org/10.3978/j.issn.2224-4336.2013.07.03

    Article  PubMed  PubMed Central  Google Scholar 

  13. Venkatram S, Chilimuri S, Adrish M, Salako A, Patel M, Diaz-Fuentes G (2011) Vitamin D deficiency is associated with mortality in the medical intensive care unit. Crit Care 15:R292. https://doi.org/10.1186/cc10585

    Article  PubMed  PubMed Central  Google Scholar 

  14. Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK (2012) Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr 36:713–720. https://doi.org/10.1177/0148607112444449

    Article  CAS  PubMed  Google Scholar 

  15. Abou Zahr R, Faustino EVS, Carpenter T, Kirshbom P, Hall EK, Fahey JT, Kandil SB (2017) Vitamin D status after cardiopulmonary bypass in children with congenital heart disease. J Intensive Care Med 32:508–513. https://doi.org/10.1177/0885066616652077

    Article  PubMed  Google Scholar 

  16. Rippel C, South M, Butt WW, Shekerdemian LS (2012) Vitamin D status in critically ill children. Intensive Care Med 38:2055–2062. https://doi.org/10.1007/s00134-012-2718-6

    Article  CAS  PubMed  Google Scholar 

  17. Kimura S, Iwasaki T (2018) High ionized calcium concentration is associated with prolonged length of stay in the intensive care unit for postoperative pediatric cardiac patients. J Cardiothorac Vasc Anesth 32:1667–1675. https://doi.org/10.1053/j.jvca.2017.11.006

    Article  CAS  PubMed  Google Scholar 

  18. Wernovsky G, Wypij D, Jonas RA, Mayer JEJ, Hanley FL, Hickey PR, Walsh AZ, Chang AC, Castaneda AR, Newburger JW, Wessel DL (1995) Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 92:2226–2235

    Article  CAS  Google Scholar 

  19. McNally JD, Menon K, Chakraborty P, Fisher L, Williams KA, Al-Dirbashi OY, Doherty DR (2012) The association of vitamin D status with pediatric critical illness. Pediatrics 130:429–436. https://doi.org/10.1542/peds.2011-3059

    Article  PubMed  Google Scholar 

  20. Madden K, Feldman HA, Smith EM, Gordon CM, Keisling SM, Sullivan RM, Hollis BW, Agan AA, Randolph AG (2012) Vitamin D deficiency in critically ill children. Pediatrics 130:421–428. https://doi.org/10.1542/peds.2011-3328

    Article  PubMed  PubMed Central  Google Scholar 

  21. Acharya N, Doherty DR, Barrowman N, Maharajh G, Girolamo T, Hearn KO, Mcnally JD (2018) Calcitriol trend following pediatric cardiac surgery and association with clinical outcome. Pediatr Res 84:254–260. https://doi.org/10.1038/s41390-018-0049-1

    Article  CAS  PubMed  Google Scholar 

  22. Dyke PC 2nd, Yates AR, Cua CL, Hoffman TM, Hayes J, Feltes TF, Springer MA, Taeed R (2007) Increased calcium supplementation is associated with morbidity and mortality in the infant postoperative cardiac patient. Pediatr Crit Care Med 8:254–257. https://doi.org/10.1097/01.PCC.0000260784.30919.9E

    Article  PubMed  Google Scholar 

  23. Santillan GE, Vazquez G, Boland RL (1999) Activation of a beta-adrenergic-sensitive signal transduction pathway by the secosteroid hormone 1,25-(OH)2-vitamin D3 in chick heart. J Mol Cell Cardiol 31:1095–1104. https://doi.org/10.1006/jmcc.1999.0942

    Article  CAS  PubMed  Google Scholar 

  24. Green JJ, Robinson DA, Wilson GE, Simpson RU, Westfall MV (2006) Calcitriol modulation of cardiac contractile performance via protein kinase C. J Mol Cell Cardiol 41:350–359. https://doi.org/10.1016/j.yjmcc.2006.05.019

    Article  CAS  PubMed  Google Scholar 

  25. Shedeed SA (2012) Vitamin D supplementation in infants with chronic congestive heart failure. Pediatr Cardiol 33:713–719. https://doi.org/10.1007/s00246-012-0199-6

    Article  PubMed  Google Scholar 

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Funding

This project was funded by the Deanship of Scientific Research (DSR), King Abdulaziz University, Jeddah, under grant no. (DF-815-140-1441). The authors, therefore, gratefully acknowledge DSR for the technical and financial support.

Author information

Authors and Affiliations

  1. Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia

    Ahmed M. Dohain, Zaher F. Zaher, Ahmed Abdulgawad & Gaser Abdelmohsen

  2. Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt

    Ahmed M. Dohain & Gaser Abdelmohsen

  3. Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia

    Joud Almogati, Osman O. Al-Radi & Ahmed A. Elassal

  4. Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt

    Ahmed A. Elassal

  5. Pediatric Endocrinology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia

    Tarah H. Fatani

Authors
  1. Ahmed M. Dohain
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  2. Joud Almogati
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  3. Osman O. Al-Radi
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  4. Ahmed A. Elassal
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  5. Zaher F. Zaher
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  6. Tarah H. Fatani
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  7. Ahmed Abdulgawad
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  8. Gaser Abdelmohsen
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Contributions

AMD: study concept/design, data collection, data analysis/interpretation, writing the article and reviewing the manuscript. JA: data collection and drafting the initial manuscript. OOA: study concept/design and critical revision of article. AAE: data interpretation and critical revision of article. ZFZ: data collection and critical revision of article. THF: study design and reviewing the manuscript. AA: data collection and interpretation. GA: study design, statistical analysis and data interpretation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ahmed M. Dohain.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the King Abdulaziz University Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Peter de Winter

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Dohain, A.M., Almogati, J., Al-Radi, O.O. et al. Serum vitamin D status following pediatric cardiac surgery and association with clinical outcome. Eur J Pediatr 179, 635–643 (2020). https://doi.org/10.1007/s00431-019-03538-x

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  • DOI: https://doi.org/10.1007/s00431-019-03538-x

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