Volume 195 - Issue 11
Neonatal vitamin D supplementation: are the protocols getting ahead of the evidence?
Authors: Kate M McCloskey, Natalie Wright, Anne-Louise Ponsonby and Peter J Vuillermin
Med J Aust 2011; 195 (11): 661. || doi: 10.5694/mja11.10493
Published online: 12 December 2011
Published online: 12 December 2011
To the Editor: We recently reviewed the individual policies of seven Australian tertiary maternity hospitals, from across all states, regarding neonatal vitamin D supplementation. An Australian 2006 consensus statement concerning the treatment and prevention of vitamin D deficiency in children and neonates identified the need to implement vitamin D supplementation in neonates born to mothers with serum 25-hydroxyvitamin D (25-OHD) levels of ≤ 50 nmol/L.1 Despite this, we found that a number of institutions have recently adopted a policy of treating infants of mothers with an antenatal serum 25-OHD level of < 75 nmol/L. Treatment of the neonate is with oral stoss therapy (50 000 IU vitamin D as a single dose) and/or daily oral vitamin D therapy (1000 IU) until cessation of breastfeeding. It should be noted that previous research has suggested that a substantial proportion of Australian women of childbearing age have a serum 25-OHD level < 75 nmol/L.2
Vitamin D is a pleiotropic hormone that influences the expression of more than 200 human genes.3 It has a wide range of biological actions, and the full implications of vitamin D supplementation during early life are unknown. While it is clear that very low levels of vitamin D are associated with abnormal bone development and the risk of hypocalcaemic seizures, it is also possible that vitamin D supplementation may have adverse effects. For example, we and others have found that a history of vitamin D supplementation during early life may be associated with an increase in allergic outcomes such as asthma and hayfever in later life.4,5 These are observational findings, limited by potential confounding and reverse causation, but they highlight the potential concern of changes in medical practice without an accompanying updated evidence base. There is an urgent need for improved data and further debate before implementing a public health policy affecting as many as half of all Australian infants. In the interim, we would advocate treatment of neonates only if they fall within the 2006 guidelines (mother’s serum 25-OHD ≤ 50 nmol/L).
Competing interests
No relevant disclosures.
References
- Munns C, Zacharin MR, Rodda CP, et al. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust 2006; 185: 268-272.
- Bowyer L, Catling-Paull C, Diamond T, et al. Vitamin D, PTH and calcium levels in pregnant women and their neonates. Clin Endocrinol (Oxf) 2009; 70: 372-377. 0_i1142868
- Ramagopalan SV, Heger A, Berlanga AJ, et al. A ChIP-seq defined genome-wide map of vitamin D receptor binding: associations with disease and evolution. Genome Res 2010; 20: 1352-1360. 0_i1142870
- Hyppönen E, Sovio U, Wjst M, et al. Infant vitamin d supplementation and allergic conditions in adulthood: northern Finland birth cohort 1966. Ann N Y Acad Sci 2004; 1037: 84-95. 0_i1142872
- Hughes AM, Lucas RM, Ponsonby AL, et al. The role of latitude, ultraviolet radiation exposure and vitamin D in childhood asthma and hayfever: an Australian multicenter study. Pediatr Allergy Immunol 2011; 22: 327-333. Epub 2010; 30 Sep. doi: 10.1111/j.1399-3038.2010.01099.x 0_i1142876