极早早产儿维生素D补充实践调查
Survey of vitamin D supplementation practices in extremely preterm infants.
作者信息
Romero-Lopez Mar, Naik Mamta, Holzapfel Lindsay F, Salas Ariel A, Ahmad Kaashif A, Rysavy Matthew A, Carlo Waldemar A, Zhang Yuxin, Tibe Covi, Tyson Jon E
机构信息
Department of Pediatrics, Division of Perinatal-Neonatal Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA.
Institute for Clinical Research and Learning Health Care, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA.
出版信息
Pediatr Res. 2025 Feb;97(3):1009-1015. doi: 10.1038/s41390-024-03514-8. Epub 2024 Aug 27.
BACKGROUND
Most extremely preterm (EP) infants are vitamin D deficient (serum 25-hydroxyvitamin D levels below 20 ng/mL), and optimal supplementation practices for EP infants remain unknown. Our objective is to assess current vitamin D supplementation practices in U.S. neonatal intensive care units (NICU) for EP infants to provide baseline information for the design of future clinical trials.
METHODS
We conducted an online survey to study vitamin D intake and supplementation practices in U.S. NICUs caring for EP infants. Descriptive statistics compared responses by affiliation and level of care.
RESULTS
We analyzed responses from 253 NICUs, representing the majority of academic and level IV centers. Nearly all centers (97%) provided enteral vitamin D supplementation during the NICU stay, with 400 IU/day as the most common dosage (77%). Over half (56%) used feeding volume to initiate supplementation, with 71% of centers starting after achieving at least 120 ml/kg/day. Additionally, 94% of NICUs reported prescribing a vitamin D supplementation at discharge.
CONCLUSIONS
Most NICUs in the U.S. supplement EP infants with 400 IU/day of enteral vitamin D. Clinical trials of vitamin D supplementation comparing the most common regimen to earlier and higher doses are needed to identify adequate regimens for EP infants.
IMPACT
Despite the prevalence of vitamin D deficiency in extremely preterm (EP) infants at birth, optimal levels and supplementation strategies remain debated. Recent studies have suggested benefits of early high-dose vitamin D supplementation (800 IU/day) for reducing complications like bronchopulmonary dysplasia, infections, and disability. There is US center variation in timing and dose of vitamin D supplementation, being the most common regimen 400 IU/d started after established feedings (≥120 ml/kg/day). These findings inform and highlight the need for clinical trials of usual vs. early, higher-dose vitamin D supplementation to advance clinical outcomes and define desirable blood levels of EP infants.
背景
大多数极早产儿（EP）维生素D缺乏（血清25-羟维生素D水平低于20 ng/mL），而EP婴儿的最佳补充方案仍不明确。我们的目的是评估美国新生儿重症监护病房（NICU）对EP婴儿的当前维生素D补充方案，为未来临床试验的设计提供基线信息。
方法
我们进行了一项在线调查，以研究美国照顾EP婴儿的NICU中维生素D的摄入和补充方案。描述性统计比较了不同机构和护理水平的回复。
结果
我们分析了来自253个NICU的回复，这些NICU代表了大多数学术中心和四级中心。几乎所有中心（97%）在NICU住院期间提供肠内维生素D补充，最常见的剂量为400 IU/天（77%）。超过一半（56%）的中心根据喂养量开始补充，71%的中心在达到至少120 ml/kg/天后开始。此外，94%的NICU报告在出院时开具维生素D补充剂。
结论
美国大多数NICU给EP婴儿补充400 IU/天的肠内维生素D。需要进行维生素D补充的临床试验，将最常见的方案与更早和更高剂量的方案进行比较，以确定适合EP婴儿的方案。
影响
尽管极早产儿（EP）出生时维生素D缺乏普遍存在，但最佳水平和补充策略仍存在争议。最近的研究表明，早期高剂量维生素D补充（800 IU/天）有助于减少支气管肺发育不良、感染和残疾等并发症。美国各中心在维生素D补充的时间和剂量上存在差异，最常见的方案是在建立喂养（≥120 ml/kg/天）后开始补充400 IU/天。这些发现为开展常规与早期、高剂量维生素D补充的临床试验提供了依据，并突出了开展此类试验以改善临床结局和确定EP婴儿理想血药浓度的必要性。
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