儿童和青少年维生素D与钙缺乏的预防和治疗：印度儿科学会（IAP）指南
Prevention and Treatment of Vitamin D and Calcium Deficiency in Children and Adolescents: Indian Academy of Pediatrics (IAP) Guidelines.
作者信息
Khadilkar Anuradha, Khadilkar Vaman, Chinnappa Jagdish, Rathi Narendra, Khadgawat Rajesh, Balasubramanian S, Parekh Bakul, Jog Pramod
机构信息
Correspondence to: Dr. Anuradha Khadilkar, Deputy Director and Consultant Pediatrician, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
出版信息
Indian Pediatr. 2017 Jul 15;54(7):567-573. doi: 10.1007/s13312-017-1070-x.
JUSTIFICATION
Vitamin D deficiency (VDD) is being increasingly reported from India from all age-groups. Reports suggest that VDD affects all age groups, from neonates to adolescents. Further, habitually low calcium intakes are also reported in Indian children. Given the multiple guidelines, peculiarities of Indian circumstances, changing lifestyles, and lack of fortification, the Indian Academy of Pediatrics (IAP) felt the need for a Practice Guideline for Pediatricians for the prevention and treatment of vitamin D and calcium deficiency in children and adolescents.
PROCESS
The 'Guideline for Vitamin D and Calcium in Children' committee was formed by the IAP in September 2016. A consultative committee meeting was held in November 2016 in Mumbai. Evidence from Indian and international studies and other previous published recommendations, which were pertinent to the Indian circumstances, were collated for the preparation of these guidelines.
RESULTS
To present a practice guideline for pediatricians for the prevention and treatment of deficiency of vitamin D and calcium in the Indian context.
RECOMMENDATIONS
For the prevention of rickets in premature infants, 400 IU of vitamin D and 150-220 mg/kg of calcium, and in neonates, 400 IU of vitamin D and 200 mg of calcium are recommended daily. For prevention of rickets and hypocalcemia in infants (after neonatal period) upto 1 year of age, and from 1-18 years, 400 IU and 600 IU vitamin D/day and 250-500 mg/day and 600-800 mg/day of calcium, respectively, are recommended. For treatment of rickets in premature neonates, infants upto 1 year and from 1-18 years, 1000 IU, 2000 IU and 3000-6000 IU of vitamin D daily, respectively, and elemental calcium of 70-80 mg/kg/day in premature neonates and 500-800 mg daily for all children over that age are recommended. Larger doses of vitamin D may be given from 3 months to 18 years of age as 60,000 IU/week for 6 weeks.
理由
印度各年龄段维生素D缺乏（VDD）的报告日益增多。报告显示，VDD影响从新生儿到青少年的所有年龄组。此外，据报道印度儿童习惯性钙摄入量较低。鉴于多项指南、印度情况的特殊性、生活方式的改变以及缺乏强化措施，印度儿科学会（IAP）认为有必要为儿科医生制定一份关于预防和治疗儿童及青少年维生素D和钙缺乏的实践指南。
过程
IAP于2016年9月成立了“儿童维生素D和钙指南”委员会。2016年11月在孟买举行了一次咨询委员会会议。整理了来自印度和国际研究以及其他先前发表的与印度情况相关的建议，以编写这些指南。
结果
提出一份针对印度背景下儿科医生预防和治疗维生素D和钙缺乏的实践指南。
建议
对于预防早产儿佝偻病，建议每日补充400国际单位维生素D和150 - 220毫克/千克钙；对于新生儿，建议每日补充400国际单位维生素D和200毫克钙。对于预防1岁以内（新生儿期后）婴儿以及1 - 18岁儿童的佝偻病和低钙血症，建议分别每日补充400国际单位和600国际单位维生素D，以及250 - 500毫克/天和600 - 800毫克/天钙。对于治疗早产儿、1岁以内婴儿以及1 - 18岁儿童的佝偻病，建议分别每日补充1000国际单位、2000国际单位和3000 - 6000国际单位维生素D，早产儿每日补充元素钙70 - 80毫克/千克，该年龄以上所有儿童每日补充500 - 800毫克。3个月至18岁儿童可给予更大剂量维生素D，即每周60,000国际单位，共6周。
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