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Vitamin D Status and Associations in Newborn Formula-Fed Infants during Initial Hospitalization



      Evidence suggests that adequate vitamin D status in infancy plays a role in improving bone health and preventing disease, including type 1 diabetes, infections, and asthma. The objective of this study was to provide newborn hospitalized infants with American Academy of Pediatrics recommendations of 400 IU/day vitamin D-3 and measure the effect on serum 25(OH)D levels.


      This trial was conducted August 2009 to June 2010. Infants were randomized to a control were measured from cord blood, every 7 days, and at discharge. Intact parathyroid hormone was measured at discharge.


      Fifty-two infants <32 weeks gestational age who received formula feedings during their neonatal intensive care unit hospitalization.

      Statistical analysis

      Patient characteristics for each treatment group were summarized using descriptive statistics. The Mann-Whitney test was used to compare continuous variables, and categorical variables were compared using the χ2 test or Fisher's exact test. The Pearson correlation coefficient was used to look at associations between continuous variables.


      The mean cord blood level for all participants was 17.6±7.0 ng/mL. White infants had significantly higher 25(OH)D levels than non-white infants (P=0.0003). The mean 25(OH)D level at discharge of the supplemented group was 23.1±7.0 ng/mL (57.66±17.47 nmol/L), the mean 25(OH)D level of the unsupplemented group was 17.8±4.7 ng/mL (44.43±11.3 nmol/L), (P=0.007). Serum 25(OH)D showed a positive correlation with serum calcium in the first week of life (r=0.44, P=0.003) and negative correlation with parathyroid hormone levels at discharge (r=−0.35, P=0.02).


      In newborn hospitalized infants, vitamin D-3 supplementation of 400 IU/day increased mean 25(OH)D levels from 17 ng/mL at birth to 23.1 ng/mL at discharge. Lower 25(OH)D levels were correlated with hypocalcemia during the first week of life, and elevated parathyroid hormone levels at discharge.
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        • Morley R.
        • Carlin J.B.
        • Pasco J.A.
        • Wark J.D.
        Maternal 25-hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size.
        J Clin Endocrinol Metab. 2006; 91: 906-912
        • Haugen M.
        • Brantsaeter A.L.
        • Trogstad L.
        Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women.
        Epidemiology. 2009; 20: 720-726
        • Bodnar L.M.
        • Catov J.M.
        • Simhan H.N.
        • Holick M.F.
        • Powers R.W.
        • Roberts J.M.
        Maternal vitamin D deficiency increases the risk of preeclampsia.
        J Clin Endocrinol Metab. 2007; 92: 3517-3522
        • Merewood A.
        • Mehta S.D.
        • Chen T.C.
        • Bauchner H.
        • Holick M.F.
        Association between vitamin D deficiency and primary cesarean section.
        J Clin Endocrinol Metab. 2009; 94: 940-945
        • Bowyer L.
        • Catling-Paull C.
        • Diamond T.
        • Homer C.
        • Davis G.
        • Craig M.E.
        Vitamin D, parathyroid hormone and calcium levels in pregnant women and their neonates.
        Clin Endocrinol (Oxf). 2009; 70: 372-377
        • Morley R.
        • Carlin J.B.
        • Pasco J.A.
        • Wark J.D.
        • Ponsonby A.L.
        Maternal 25-hydroxyvitamin D concentration and offspring birth size: effect modification by infant VDR genotype.
        Eur J Clin Nutr. 2009; 63: 802-804
        • Sabour H.
        • Hossein-Nezhad A.
        • Maghbooli Z.
        • Madani F.
        • Mir E.
        • Larijani B.
        Relationship between pregnancy outcomes and maternal vitamin D and calcium intake: A cross-sectional study.
        Gynecol Endocrinol. 2006; 22: 585-589
        • Mannion C.A.
        • Gray-Donald K.
        • Koski K.G.
        Association of low intake of milk and vitamin D during pregnancy with decreased birth weight.
        CMAJ. 2006; 174: 1273-1277
        • Bodnar L.M.
        • Catov J.M.
        • Zmuda J.M.
        • et al.
        Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women.
        J Nutr. 2010; 140: 999-1006
      1. Vitamin D supplement in early childhood and risk for Type I (insulin-dependent) diabetes mellitus.
        Diabetologia. 1999; 42: 51-54
        • Hypponen E.
        • Laara E.
        • Reunanen A.
        • Jarvelin M.R.
        • Virtanen S.M.
        Intake of vitamin D and risk of type 1 diabetes: A birth-cohort study.
        Lancet. 2001; 358: 1500-1503
        • Stene L.C.
        • Ulriksen J.
        • Magnus P.
        • Joner G.
        Use of cod liver oil during pregnancy associated with lower risk of type I diabetes in the offspring.
        Diabetologia. 2000; 43: 1093-1098
        • Staples J.A.
        • Ponsonby A.L.
        • Lim L.L.
        • McMichael A.J.
        Ecologic analysis of some immune-related disorders, including type 1 diabetes, in Australia: Latitude, regional ultraviolet radiation, and disease prevalence.
        Environ Health Perspect. 2003; 111: 518-523
        • van der Mei I.A.
        • Ponsonby A.L.
        • Dwyer T.
        Past exposure to sun, skin phenotype, and risk of multiple sclerosis: Case-control study.
        BMJ. 2003; 327: 316
        • Hernan M.A.
        • Olek M.J.
        • Ascherio A.
        Geographic variation of MS incidence in two prospective studies of US women.
        Neurology. 1999; 53: 1711-1718
        • Chang E.T.
        • Smedby K.E.
        • Hjalgrim H.
        • Porwit-MacDonald A.
        • Roos G.
        • Gimelius B.
        • Adami H.O.
        Family history of hematopoietic malignancy and risk of lymphoma.
        J Natl Cancer Inst. 2005; 97: 1466-1474
        • Berwick M.
        • Armstrong B.K.
        • Ben-Porat L.
        • Fine J.
        • Kricker A.
        • Eberle C.
        • Barnhill R.
        Sun exposure and mortality from melanoma.
        J Natl Cancer Inst. 2005; 97: 195-199
        • Davies G.
        • Welham J.
        • Chant D.
        • Torrey E.F.
        • McGrath J.
        A systematic review and meta-analysis of Northern Hemisphere season of birth studies in schizophrenia.
        Schizophr Bull. 2003; 29: 587-593
        • Ginde A.A.
        • Mansbach J.M.
        • Camargo Jr, C.A.
        Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey.
        Arch Intern Med. 2009; 169: 384-390
        • Najada A.S.
        • Habashneh M.S.
        • Khader M.
        The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases.
        J Trop Pediatr. 2004; 50: 364-368
        • Karatekin G.
        • Kaya A.
        • Salihoglu O.
        • Balci H.
        • Nuhoglu A.
        Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers.
        Eur J Clin Nutr. 2009; 63: 473-477
        • Erkkola M.
        • Kaila M.
        • Nwaru B.I.
        • et al.
        Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children.
        Clin Exp Allergy. 2009; 39: 875-882
        • Camargo Jr, C.A.
        • Rifas-Shiman S.L.
        • Litonjua A.A.
        • Rich-Edwards J.W.
        • Weiss S.T.
        • Gold D.R.
        • Kleinman K.
        • Gillman M.W.
        Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age.
        Am J Clin Nutr. 2007; 85: 788-795
        • Kovacs C.
        Vitamin D in pregnancy and lactation: Maternal, fetal, and neonatal outcomes from human and animal studies.
        Am J Clin Nutr. 2008; 88: 520S-528S
        • Bodnar L.M.
        • Simhan H.N.
        • Powers R.W.
        • Frank M.P.
        • Cooperstein E.
        • Roberts J.M.
        High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates.
        J Nutr. 2007; 137: 447-452
        • Saintonge S.
        • Bang H.
        • Gerber L.M.
        Implications of a new definition of vitamin D deficiency in a multiracial us adolescent population: The National Health and Nutrition Examination Survey III.
        Pediatrics. 2009; 123: 797-803
        • Ginde A.A.
        • Liu M.C.
        • Camargo Jr, C.A.
        Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004.
        Arch Intern Med. 2009; 169: 626-632
        • Nesby-O'Dell S.
        • Scanlon K.S.
        • Cogswell M.E.
        • et al.
        Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: Third National Health and Nutrition Examination Survey, 1988-1994.
        Am J Clin Nutr. 2002; 76: 187-192
        • Singh R.J.
        • Taylor R.L.
        • Reddy G.S.
        • Grebe S.K.
        C-3 epimers can account for a significant proportion of total circulating 25-hydroxyvitamin D in infants, complicating accurate measurement and interpretation of vitamin D status.
        J Clin Endocrinol Metab. 2006; 91: 3055-3061
        • Basile L.A.
        • Taylor S.N.
        • Wagner C.L.
        • Quinones L.
        • Hollis B.W.
        Neonatal vitamin D status at birth at latitude 32 degrees 72': evidence of deficiency.
        J Perinatol. 2007; 27: 568-571
        • Taylor S.N.
        • Wagner C.L.
        • Fanning D.
        • Quinones L.
        • Hollis B.W.
        Vitamin D status as related to race and feeding type in preterm infants.
        Breastfeed Med. 2006; 1: 156-163
        • Wagner C.L.
        • Greer F.R.
        • American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition
        Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.
        Pediatrics. 2008; 122: 1142-1152
        • Lee J.M.
        • Smith J.R.
        • Philipp B.L.
        • Chen T.C.
        • Mathieu J.
        • Holick M.F.
        Vitamin D deficiency in a healthy group of mothers and newborn infants.
        Clin Pediatr (Phila). 2007; 46: 42-44
        • Hollis B.W.
        • Wagner C.L.
        Vitamin D requirements during lactation: High-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant.
        Am J Clin Nutr. 2004; 80: 1752S-1758S
        • Hollis B.W.
        Vitamin D requirement during pregnancy and lactation.
        J Bone Miner Res. 2007; 22: V39-V44
        • Wagner C.M.
        • Hulsey T.C.
        • Fanning D.
        • Ebeling M.
        • Hollis B.
        High dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: A 6-month follow-up pilot study.
        Breastfeeding Med. 2006; 2: 59-70
        • Merewood A.
        • Mehta S.D.
        • Grossman X.
        • Chen T.C.
        • Mathieu J.S.
        • Holick M.F.
        • Bauchner H.
        Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers.
        Pediatrics. 2010; 125: 640-647
        • Wagner C.L.
        • Howard C.
        • Hulsey T.C.
        • Lawrence R.A.
        • Taylor S.N.
        • Will H.
        • Ebeling M.
        • Hutson J.
        • Hollis B.W.
        Circulating 25-hydroxyvitamin D levels in fully breastfed infants on oral vitamin D supplementation.
        Int J Endocrinol. 2010; 2010: 235035
        • Javaid M.K.
        • Crozier S.R.
        • Harvey N.C.
        • Gale C.R.
        • Dennison E.M.
        • Boucher B.J.
        • Arden N.K.
        • Godfrey K.M.
        • Cooper C.
        • Princess Anne Hospital Study Group
        Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: A longitudinal study.
        Lancet. 2006; 367: 36-43
        • Mahon P.
        • Harvey N.
        • Crozier S.
        • Inskip H.
        • Robinson S.
        • Arden N.
        • Swaminathan R.
        • Cooper C.
        • Godfrey K.
        • SWS study group
        Low maternal vitamin D status and fetal bone development: Cohort study.
        J Bone Miner Res. 2010; 25: 14-19
        • Yorifuji J.
        • Yorifuji T.
        • Tachibana K.
        • Nagai S.
        • Kawai M.
        • Momoi T.
        • Nagasaka H.
        • Hatayama H.
        • Nakahata T.
        Craniotabes in normal newborns: The earliest sign of subclinical vitamin D deficiency.
        J Clin Endocrinol Metab. 2008; 93: 1784-1788
        • Weiler H.
        • Fitzpatrick-Wong S.
        • Veitch R.
        • Kovacs H.
        • Schellenberg J.
        • McColy U.
        • Yuen C.K.
        Vitamin D deficiency and whole-body and femur bone mass relative to weight in healthy newborns.
        CMAJ. 2005; 172: 757-761
        • Alemzadeh R.
        • Kichler J.
        • Babar G.
        • Calhoun M.
        Hypovitaminosis D in obese children and adolescents: Relationship with adiposity, insulin sensitivity, ethnicity, and season.
        Metabolism. 2008; 57: 183-191
        • Weng F.L.
        • Shults J.
        • Leonard M.B.
        • Stallings V.A.
        • Zemel B.S.
        Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents.
        Am J Clin Nutr. 2007; 86: 150-158
        • Gordon C.M.
        • Feldman H.A.
        • Sinclair L.
        • Williams A.L.
        • Kleinman P.K.
        • Perez-Rossello J.
        • Cox J.E.
        Prevalence of vitamin D deficiency among healthy infants and toddlers.
        Arch Pediatr Adolesc Med. 2008; 162: 505-512
        • Gordon C.M.
        • DePeter K.C.
        • Feldman H.A.
        • Grace E.
        • Emans S.J.
        Prevalence of vitamin D deficiency among healthy adolescents.
        Arch Pediatr Adolesc Med. 2004; 158: 531-537
        • Harkness L.
        • Cromer B.
        Low levels of 25-hydroxy vitamin D are associated with elevated parathyroid hormone in healthy adolescent females.
        Osteoporos Int. 2005; 16: 109-113
        • Sullivan S.S.
        • Rosen C.J.
        • Halteman W.A.
        • Chen T.C.
        • Holick M.F.
        Adolescent girls in Maine are at risk for vitamin D insufficiency.
        J Am Diet Assoc. 2005; 105: 971-974
        • Kotowicz M.A.
        • Klee G.G.
        • Kao P.C.
        • O'Fallon W.M.
        • Hodgson S.F.
        • Cedel S.L.
        • Eriksen E.F.
        • Gonchoroff D.G.
        • Judd H.L.
        • Riggs B.L.
        Relationship between serum intact parathyroid hormone concentrations and bone remodeling in type I osteoporosis: Evidence that skeletal sensitivity is increased.
        Osteoporos Int. 1990; 1: 14-22
        • Garnero P.
        • Sornay-Rendu E.
        • Claustrat B.
        • Delmas P.D.
        Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study.
        J Bone Miner Res. 2000; 15: 1526-1536
        • Zeghoud F.
        • Vervel C.
        • Guillozo H.
        • Walrant-Debray O.
        • Boutignon H.
        • Garabedian M.
        Subclinical vitamin D deficiency in neonates: Definition and response to vitamin D supplements.
        Am J Clin Nutr. 1997; 65: 771-778
        • Ashraf A.
        • Mick G.
        • Atchison J.
        • Petrey B.
        • Abdullatif H.
        • McCormick K.
        Prevalence of hypovitaminosis D in early infantile hypocalcemia.
        J Pediatr Endocrinol Metab. 2006; 19: 1025-1031
        • Balasubramanian S.
        • Shivbalan S.
        • Kumar P.S.
        Hypocalcemia due to vitamin D deficiency in exclusively breastfed infants.
        Indian Pediatr. 2006; 43: 247-251
        • Newhook L.A.
        • Sloka S.
        • Grant M.
        • Randell E.
        • Kovacs C.S.
        • Twells L.K.
        Vitamin D insufficiency common in newborns, children and pregnant women living in Newfoundland and Labrador, Canada.
        Matern Child Nutr. 2009; 5: 186-191
        • Pettifor J.M.
        • Moodley G.P.
        • Hough F.S.
        • Koch H.
        • Chen T.
        • Lu Z.
        • Holick M.F.
        The effect of season and latitude on in vitro vitamin D formation by sunlight in South Africa.
        S Afr Med J. 1996; 86: 1270-1272
        • Bodnar L.M.
        • Catov J.M.
        • Wisner K.L.
        • Klebanoff M.A.
        Racial and seasonal differences in 25-hydroxyvitamin D detected in maternal sera frozen for over 40 years.
        Br J Nutr. 2008; : 1-7
        • Maxwell J.D.
        • Ang L.
        • Brooke O.G.
        • Brown I.R.
        Vitamin D supplements enhance weight gain and nutritional status in pregnant Asians.
        Br J Obstet Gynaecol. 1981; 88: 987-991


      C. Hanson is an assistant professor, School of Allied Health, University of Nebraska Medical Center, Omaha, NE.


      E. Lyden is a statistician, College of Public Health, University of Nebraska Medical Center, Omaha, NE.


      A. Anderson-Berry is an associate professor, Division of Pediatrics, University of Nebraska Medical Center, Omaha, NE.


      L. Armas is an assistant professor, Endocrine Division, Creighton University, Omaha, NE.