Abstract
Objective
To determine the prevalence of vitamin D deficiency in critically ill children, and to study its association with parathyroid response, severity of illness and clinical outcomes.
Design
Prospective observational study.
Setting
Medical Pediatric Intensive Care Unit of a tertiary care centre of Northern India.
Participants
154 children in-patients: August 2011-January 2013.
Main outcome measures
Vitamin D deficient children were (serum 25-hydroxy vitamin D <20 µg/mL) divided into “parathyroid-responder” [serum parathyroid hormone >65 pg/mL with 25(OH)D<20 µg/mL and/or calcium corrected for albumin <8.5 mg/dL] and “non parathyroid-responder.” Illness severity was assessed by Pediatric Index of Mortality-2 (PIM-2) score at admission. Biochemical parameters, illness severity scores and clinical outcomes were compared between parathyroidresponders and non-parathyroid-responders.
Results
Vitamin D deficiency and hypocalcemia were observed in 125 (83.1%) and 91 (59%) children, respectively at admission. There were no differences in illness severity score at admission, mortality rate and length of stay between vitamin Ddeficient children and 19.8% of non-vitamin D-deficient children. Among Vitamin D-deficient children, parathyroid-responders had higher PIM-2 score at admission compared to non-parathyroidresponder [12.8 (7.4,20.6) vs. 6.5 (2.5,12.2), P=0.01]. However, there were no differences in other clinical outcomes between two groups.
Conclusion
Critically ill children have high prevalence of vitamin D deficiency. Parathyroid gland response secondary to hypocalcemia or vitamin D defiency is impaired in critical illness.
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Shah, S.K., Kabra, S.K., Gupta, N. et al. Vitamin D deficiency and parathyroid response in critically-ill children: Association with illness severity and clinical outcomes. Indian Pediatr 53, 479–484 (2016). https://doi.org/10.1007/s13312-016-0876-2
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DOI: https://doi.org/10.1007/s13312-016-0876-2