Abstract: SUN 002

Vitamin D Status Among Preterm Infants with Metabolic Bone Disease and Cholestasis

Presenter: Supamit Ukarapong


Abstract


Background: Metabolic bone disease of prematurity (MBD) is a common problem among preterm infants. Preterm infants often require prolonged parenteral nutrition, which can lead to cholestasis. Our previous study identified cholestasis as an important risk factor in the development of MBD (1). As absorption of vitamin D is affected by cholestasis, we investigated the vitamin D level in preterm infants with MBD and cholestasis.
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Background: Metabolic bone disease of prematurity (MBD) is a common problem among preterm infants. Preterm infants often require prolonged parenteral nutrition, which can lead to cholestasis. Our previous study identified cholestasis as an important risk factor in the development of MBD (1). As absorption of vitamin D is affected by cholestasis, we investigated the vitamin D level in preterm infants with MBD and cholestasis.
 
Method: We retrospectively reviewed medical record of preterm infants admitted to NICU at Holtz’s Children’s Hospital who developed MBD between June 2014 and May 2016. The study was approved by the University of Miami IRB. MBD was defined as peak serum alkaline phosphates above 500 U/L with characteristic findings on radiogram of long bones. Patients were then divided into those with cholestasis (C) and no-cholestasis (NC) group. Cholestasis was defined as persistent elevation of direct bilirubin (>2 mg/dl) for more than 2 weeks. Demographic and biochemical data including birth weight, gestational age, serum 25-hydroxyvitamin D, PTH, calcium and phosphorus levels were collected and analyzed.

Results: We identified 53 preterm infants with MBD among whom, 24 infants also had cholestasis. Median gestational age and birth weight were similar in C (25 weeks, IQR 24-26; 582 g, IQR 411-753) to that in NC group (26 weeks, IQR 25-27; 675 g, IQR 494-856), (p = 0.63 and 0.06). Median serum 25-hydroxyvitamin D level at the time MBD was diagnosed, average postnatal age 6 weeks, was similar (p= 0.41) in C (29.1 ng/ml, IQR 24.4–33.5) and NC (28.7 ng/ml, IQR 22.7-34.6) group. The proportion of infants with vitamin D deficiency (serum level less than 20 ng/ml) was also similar in both groups (C vs. NC; 12.5% vs. 13.7%, p-value= 0.89). Median serum PTH was slightly lower in C (60.1pg/ml, IQR 25.1- 95.1) than in NC (84.8pg/ml, IQR 49.2-119.6) group but the difference was not significant (p=0.05). Repeat determination about 6 weeks after the first measurement indicated that serum 25-hydroxyvitamin D level was lower (p=0.02) in C (31.2 ng/ml, IQR 23.5-38.8) than in NC (36.5 ng/ml, IQR 28-45) group. However, the proportion of infants with vitamin D deficiency remained similar in both group (C vs. NC; 15% vs.9%, p=0.55). Serum calcium and phosphorus level determined between first and second vitamin D measurement were also similar in both group (time x group effect p-value = 0.23 and 0.81 respectively).

Conclusion: Preterm infants with MBD and cholestasis had serum 25-hydroxyvitmain D levels that were satisfactory and similar to those without cholestasis. Our study suggests that vitamin D does not play an important role in the etiology of MBD.

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