Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n = 55; approximately 800–1000 IU from combined sources) or monitored therapy (n = 54; with an option of dose modification). 25-hydroxyvitamin D [25(OH)D] concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52 ± 2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20–80 ng/mL) at 52 weeks of PCA (p = 0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.

The pivotal role of vitamin D (vit D) in skeletal health is well known. Neonatal vit D storage at birth is dependent on maternal levels, and newborns receive 50–70% of their mother’s 25-hydroxyvitamin D [25(OH)D]. Deficiency of vit D can lead to prematurity bone disease, with an incidence of up to 55% in infants weighing < 1000 g. The aim of this study is to assess the effectiveness of monitored supplementation of vit D in a population of preterm infants. Preterm infants born at 24–32 weeks of gestation will be recruited within the first 7 days of life. Depending on the type of feeding, and after reaching partial enteral feeding or at 7 days of life, vit D supplementation will consist of 500 IU and an additional 150–300 IU/kg included in human milk fortifiers (if fed exclusively with breast milk) or 190 IU/kg in milk formulas. Subjects will be randomised to either monitored (with an option of dose modification based on 25(OH)D levels as per protocol) or standard therapy up to 52 weeks of post-conceptional age (PCA). The primary outcome measure will be the number of neonates with deficiency or excess levels of 25(OH)D at 40 ±2 weeks of PCA. Additional 25(OH)D levels will be measured at birth, at 4 and 8 weeks of age, and/or at 35 and 52 ±2 weeks of PCA. Secondary objectives will include the incidence of osteopenia, nephrocalcinosis and nephrolithiasis. Serum parameters of calcium phosphorus metabolism will also be measured. Despite multiple years of research and numerous publications, there is still a lack of consensus in regard to how much vit D infants should receive and how long they should receive it. Because 80% of calcium and phosphorus placental transfer occurs between 24 and 40 weeks of gestation, preterm infants are especially prone to adverse effects of vit D insufficiency. However, both inadequate and excessive amounts of vit D may be unsafe and lead to serious health issues. The results of our study may shed new light on these concerns and contribute to optimising vit D supplementation. ClinicalTrials.gov, NCT03087149 . Registered on 15 March 2017.

Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n=55; approximately 800-1000 IU from combined sources) or monitored therapy (n=54; with an option of dose modification). 25(OH)D concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52±2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20–80 ng/mL) at 52 weeks of PCA (p=0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.

Vitamin D deficiency can escalate prematurity bone disease in preterm infants and negatively influence their immature immunology system. Infants born at 24 + 0/7 weeks to 32 + 6/7 weeks of gestation will be considered for inclusion. Cord or vein blood samples will be obtained within 48 h after birth for 25-hydroxyvitamin D level measurements. Parathyroid hormone and interleukin-6 levels will be measured. Infants will be randomized to the monitored group (i.e., an initial dose of 1000 IU/day and possible modification) or the controlled group (i.e., 250 IU/day or 500 IU/day dose, depending on weight). Supplementation will be monitored up to a postconceptional age of 35 weeks. The primary endpoint is the percentage of infants with deficient or suboptimal 25-hydroxyvitamin D levels at 28 ± 2 days of age. 25-Hydroxyvitamin D levels will be measured at postconceptional age 35 ± 2 weeks. Secondary goals encompass assessing the occurrence of sepsis, osteopenia, hyperparathyroidism, and interleukin-6 concentration. The aim of this study is to evaluate the efficacy of monitored vitamin D supplementation in a group of preterm infants and ascertain if a high initial dosage of monitored vitamin D supplementation can decrease the occurrence of neonatal sepsis and metabolic bone disease.

Objective: Neonatal sepsis is a major cause of morbidity and mortality. Vitamin D modulates immune responses and influences the risk and outcomes of neonatal sepsis. Therefore, we aimed to systematically outline the role of vitamin D in neonatal sepsis, including its effects on incidence, severity, treatment outcomes, and underlying mechanisms. Methods: A literature search was conducted in the MEDLINE and EMBASE databases with English language restrictions and no date limit. Eligible sources included experimental, observational, and descriptive studies as well as reviews addressing vitamin D status, supplementation, and mechanisms in neonatal sepsis. This review followed the PRISMA Extension for Scoping Reviews guidelines. Results: Forty-five studies were selected and analyzed. Vitamin D deficiency was globally prominent among neonates and may be correlated with an increased risk or severity of sepsis. Most studies were observational, primarily case-control or cross-sectional, and conducted in South Asia and the Middle East, with increasing research activity after 2018. The number of term infants was higher than that of preterm infants. Recently, innate immune mechanisms, including antimicrobial peptides and toll-like receptor signaling, were highlighted. However, comparisons across studies were limited by inconsistencies in design, vitamin D cut-offs, timing of blood sampling, and sepsis definitions. Only six studies included patients with culture-proven sepsis, whereas others included clinically suspected cases. Few studies assessed the long-term outcomes, immune maturation, or neurodevelopmental consequences. Conclusions: Vitamin D deficiency may be associated with neonatal sepsis; however, the findings remain inconsistent because of methodological variability. Therefore, high-quality, standardized, multicenter studies are needed. The review also identified substantial methodological heterogeneity regarding vitamin D assessment, sepsis definitions, and neonatal populations, which currently limits evidence-based clinical recommendations.

The best evidence for the role of vitamin D in infants is its influence on skeletal growth, however, the pleiotropic actions of vitamin D in the foetus and neonates are under-researched. The systematic reviews, based mostly on observational studies, suggest correlations between prenatal and postnatal supplementation and the occurrence of allergy, respiratory infections, sepsis or mental and behavioural development. Some of these studies focused on subgroups of neonates, such as preterm infants, investigating the influence inter alia on sepsis, bronchopulmonary dysplasia, and necrotising enterocolitis. Currently, there is a need for randomised trials for proof of the skeletal and pleiotropic effects of vitamin D in infants.