Role of Vitamin D in neonatal health
Did you know? Babies who do not get enough amount of vitamin D tend to have its deficiency. Here, we help you understand what the role of vitamin-D is in neonatal health, the symptoms to watch out for in babies, and how to overcome the deficiency.
Babies require vitamin D for healthy growth and development and it also helps them build strong, healthy bones and teeth. Babies who do not get enough amount of it are said to be deficient in vitamin D. It is common in our population and therefore in pregnant women. To prevent vitamin D deficiency in infants, pregnant women who are at risk should be screened and treated for it in the first trimester. Screening of the newborn's vitamin D status is not essential as it is the mother's status which should be evaluated.
What is Vitamin-D deficiency in newborns?
According to the World Health Organization (WHO), Vitamin D plays a pivotal role in bone metabolism through the regulation of calcium and phosphate homeostasis and in regulating the immune system. Vitamin D is produced by the body during exposure to sunlight but is also found in oily fish, eggs and fortified food products. Infants are born with low vitamin D stores and are dependent on breast milk, sunlight or supplements as sources of vitamin D in the first few months of life. As the vitamin D content of breast milk is dependent on maternal vitamin D status and is often low, and sun exposure may be restricted for infants living at higher latitudes for various reasons. Vitamin D deficiency in infants can lead to bone malformation (rickets), seizures and difficulty breathing. Since, vitamin D is required for building strong, healthy bones and teeth. Parents can make sure your baby has enough vitamin D by giving a daily supplement (a dose of drops every day) after consulting the expert. This should be done as soon as the baby is born. Tons of research suggests that, a routine vitamin D supplementation programme should be seriously considered starting from the neonatal period extending right through the childhood into adolescence. Oral vitamin D3supplementation as an oil emulsion has been shown to be associated with significant and sustained increases in 25(OH) D from baseline in fully breastfeeding infants through 7 months. Whereas, few studies also revealed that newborns with vitamin D deficiency had a 44% increased risk of being diagnosed with schizophrenia as young adults, compared with newborns with normal levels of vitamin D.
Incidences of Vitamin-D deficiency in newborns in India
Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context, it has been reported to be present in many children in spite of the wide availability of sunlight. The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Also, various studies suggest that women who lack vitamin D will give birth to such children. Ideally, both the mother and children should go out in the sun by wearing half-sleeve cotton clothes, which tend to allow absorption of the required vitamin. In the case of neonatal, babies are also hardly out in the sun. Hence, it is essential to address it at the right time.
Symptoms of vitamin D deficiency in infants
- Craniotabes (softening of skull bones)
- Other osseous signs (such as rickets) are not seen in the newborn but classical signs in the older infant include a broadening of the metaphyses, bowing of the long bones once weight bearing
- hypocalcaemic seizures
How to know if your baby is at risk of vitamin D deficiency?
- If they are breastfed
- If mothers don’t have enough vitamin D
- Babies born prematurely
Know how low vitamin D can be harmful to babies
Some children with low vitamin D get bone and muscle pain. As mentioned earlier, very low vitamin D can soft bones, and raise the risk of rickets in children. Rickets only occurs when children are growing – if a child has softer bones from low vitamin D, the bones can bend and cause 'bow legs' or 'knock knees', and other changes too. Low vitamin D can cause low calcium, which can invite muscle cramps in children. Not only this, but low calcium levels may also cause seizures (convulsions or fits), mainly in young babies.
Diagnosis of vitamin-D deficiency
- Serum 25-OHD concentration is the most excellent indicator of vitamin D status.
- The normal adult concentration is > 50 nmol/L, although several sources use > 75 nmol/L for pregnant women.
How should the vitamin D deficiency tackled in newborns
- According to the WHO, vitamin D supplements may be effective in preventing rickets, particularly for infants and children who may be at higher risk due to limited sun exposure or those with darker skin pigmentation. Also, it recommends that newborn babies must be supplied with Vitamin D through sunlight or supplements in the first few months of life. An infant between the ages of 1-2 years requires 400 IU per day, while older children need 600 IU. Regular sunlight exposure can help keep vitamin D deficiency at bay. But, you should speak to your expert before exposing children to the sun.
- Breast milk is the best food that can offer your growing baby. Even if you make your baby eat other foods, you can continue to breastfeed until 2 years. As discussed earlier, breast milk has only small amounts of vitamin D (4 to 40 IU per litre, which may not be sufficient for your newborn. That’s why babies who are breastfed should receive a daily supplement of vitamin D from birth until they get enough from their diet. This should also be strictly done under the guidance of the expert.
- Treatment of vitamin D deficiency involves giving ergocalciferol or cholecalciferol for 3 months.
- High-dose bolus therapy (300 000–500 000 IU) should be given to children over 12 months of age if compliance or absorption issues are suspected.
Dr Peeyoosh Rankhamb is Consultant, Pediatrician & Neonatologist at Motherhood Hospital, Kharghar.