When to start Vitamin D after European births - UK 180 days, many 6-31 days, the rest 1-5 days

Created September 2017

Variations in infant and childhood vitamin D supplementation programs across Europe and factors influencing adherence.

Endocr Connect. 2017 Sep 18. pii: EC-17-0193. doi: 10.1530/EC-17-0193. [Epub ahead of print]

Uday S1, Kongjonaj A2, Aguiar M3, Tulchinsky T4, Hoegler W5.

  • 1 S Uday, Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TG, United Kingdom of Great Britain and Northern Ireland.

  • 2 A Kongjonaj, MEAL specialist, Save the children international , Albania, United Kingdom of Great Britain and Northern Ireland.

  • 3 M Aguiar, Health Economics, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland.

  • 4 T Tulchinsky, Hebrew University of Jerusalem Braun School of Public Health and Community Medicine, Jerusalem, Israel.

  • 5 W Hoegler, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland Wolfgang.Hogler@bch.nhs.uk.

1. No indication in this 2014 survey of 1. Vitamin D levels to be achieved (10-30 ng) 1. Vitamin D levels actually achieved 1. Dose size recommended (200 IU - 2000 IU) 1. Increased dose if breastfeeding * only tiny % have enough Vitamin D in their breast milk 1. Vitamin D recommendation during pregnancy (200 IU - 6,000 IU) 1. Vitamin D supplementation to be continued after weaning 1. No increased recommendation for infants at high risk of vitamin D deficiency * Dark Skin, premature, mother wearing excessive clothes, excessive infant illnesses, etc. --- * * Infant-Child category listing has items along with related searches** * All pregnant women in Scotland to get free vitamin D - April 2017 * Maternal vitamin D supplementation – only 1 in 300 in Spain– April 2014 * Nordic mothers vitamin D deficient even though meet recommendations – April 2010 * Vitamin D once during pregnancy reduced infant health care costs (300 times ROI) – RCT Dec 2015 * Leading cause of death age 0-5 – vitamin D deficiency US * Most European infants get vitamin D supplements, vs only 1 in 50 in US – June 2013 * Many US kids have less than 40 ng of Vitamin D – 99 out of 100 blacks, 91 out of 100 whites – Jan 2017 * Vitamin D in US children: those having more than 40 ng increased 60 percent (2001-2010) - Dec 2016 * Infants in France and Finland need 1000 IU of vitamin D, but apparently infants in US need only 400 - 2013 * Vitamin D guidelines of American Academy of Pediatrics said none should be even tested, yet 91 percent had less than 30 ng – June 2017 Items in both categories Infant/Child and Europe are listed here: {category}

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BACKGROUND:

Nutritional rickets is a growing global public health concern despite existing prevention programs and health policies. We aimed to compare infant and childhood vitamin D supplementation policies, implementation strategies and practices across Europe and explore factors influencing adherence.

METHODS:

European Society for Paediatric Endocrinology Bone and Growth Plate Working Group members and other specialists completed a questionnaire on country-specific vitamin D supplementation policy and child healthcare programs, socioeconomic factors, policy implementation strategies, and adherence. Factors influencing adherence were assessed using Kendall's tau-b correlation coefficient.

RESULTS:

Responses were received from 29 of 30 European countries (97%). Ninety-six per cent had national policies for infant vitamin D supplementation. Supplements are commenced on day 1-5 in 48% (14/29) of countries, day 6-21 in 48% (14/29); only the UK (1/29) starts supplements at 6 months. Duration of supplementation varied widely (6 months to lifelong in at-risk populations). Good (≥80% of infants), moderate (50-79%) and low adherence (<50%) to supplements was reported by 59% (17/29), 31% (9/29) and 10% (3/29) of countries, respectively. UK reported lowest adherence (5-20%). Factors significantly associated with good adherence were universal supplementation independent of feeding mode (p=0.007), providing information at neonatal unit (NNU) discharge (p=0.02), financial family support (p=0.005); monitoring adherence at surveillance visits (p=0.001) and the total number of factors adopted (p<0.001).

CONCLUSIONS:

Good adherence to supplementation is a multi-task operation that works best when parents are informed at birth, all babies are supplemented and adherence monitoring is incorporated into child health surveillance visits. Implementation strategies matter for delivering efficient prevention policies.

PMID: 28924002 DOI: 10.1530/EC-17-0193

Tags: Europe Infant-Child