In the Journals

Vitamin D supplements decrease recurrent wheeze in black preterm infants

Black preterm infants who received vitamin D supplementation until 12 months’ adjusted gestational age were nearly 11% less likely to experience recurrent wheezing when compared with neonates who did not receive the supplementation, according to research published in JAMA.

“Parents need to know that African American preterm infants are at high risk of wheezing in infancy,” Anna Maria Hibbs, MD, MSCE, FAAP, from Case Western Reserve University and the University Hospitals Cleveland Medical Center, said in a press release. “I hope this study can highlight the burden of wheezing illness experienced by premature babies and the importance of targeting interventions that can lessen this burden.”

To observe whether two vitamin D dosing strategies could prevent recurrent wheezing in black preterm infants, Hibbs and colleagues conducted a randomized clinical trial that included black infants born 28 to 36 weeks’ gestation. All infants were born between January 2013 and January 2016 in the United States, were enrolled before discharge and were randomly assigned based on four birth sites and exposure to maternal milk.

Once discharged from the NICU or newborn nursery, neonates were administered an open-label multivitamin. This administration continued until the infant was able to consume 200 IU per day of cholecalciferol, which could be supplied from formula or an additional fortifier for human milk. When infants were able to consume this amount, they were administered 400 IU per day of cholecalciferol until they reached 6 months’ adjusted age.

Of the infants who were included in the study, 153 received the intervention (sustained supplementation) and 147 received a placebo (diet limited). After data were collected, Hibbs and colleagues assessed whether recurrent wheezing was affected by 12 months’ adjusted age. Compliance was high, with 92.3% of patients completing the trial (mean gestational age, 33 weeks; median birth weight, 1.9 kg).

Infants who were administered sustained supplementation were less likely to experience recurrent wheezing at 12 months’ adjusted age (31.1%) when compared with infants who were in the diet-limited group (41.8%; difference, 10.7 [95% CI, 27.4% to 2.9%]; RR = 0.66 [95% CI, 0.47-0.94]).

Adverse events were reported, and the most common ones included upper and lower respiratory infections. Neonates who were in the sustained supplementation group experienced fewer adverse events when compared with the diet-limited group for both upper respiratory infections (54.9% vs. 56.5%; difference, 1.6% [95% CI, 17.1% to 7.0%]) and lower respiratory infections (21.6% vs. 25.2%; difference, 3.6% [95% CI, 16.4% to 4.4%]).

Vitamin D is an attractive treatment option because it is easy to administer and is relatively inexpensive,” Hibbs said in the release. “Further research is needed to identify and optimize interventions that can reduce the wheezing burden and help us understand any health benefits that may continue as these infants grow up.” – by Katherine Bortz

Disclosures: Hibbs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Black preterm infants who received vitamin D supplementation until 12 months’ adjusted gestational age were nearly 11% less likely to experience recurrent wheezing when compared with neonates who did not receive the supplementation, according to research published in JAMA.

“Parents need to know that African American preterm infants are at high risk of wheezing in infancy,” Anna Maria Hibbs, MD, MSCE, FAAP, from Case Western Reserve University and the University Hospitals Cleveland Medical Center, said in a press release. “I hope this study can highlight the burden of wheezing illness experienced by premature babies and the importance of targeting interventions that can lessen this burden.”

To observe whether two vitamin D dosing strategies could prevent recurrent wheezing in black preterm infants, Hibbs and colleagues conducted a randomized clinical trial that included black infants born 28 to 36 weeks’ gestation. All infants were born between January 2013 and January 2016 in the United States, were enrolled before discharge and were randomly assigned based on four birth sites and exposure to maternal milk.

Once discharged from the NICU or newborn nursery, neonates were administered an open-label multivitamin. This administration continued until the infant was able to consume 200 IU per day of cholecalciferol, which could be supplied from formula or an additional fortifier for human milk. When infants were able to consume this amount, they were administered 400 IU per day of cholecalciferol until they reached 6 months’ adjusted age.

Of the infants who were included in the study, 153 received the intervention (sustained supplementation) and 147 received a placebo (diet limited). After data were collected, Hibbs and colleagues assessed whether recurrent wheezing was affected by 12 months’ adjusted age. Compliance was high, with 92.3% of patients completing the trial (mean gestational age, 33 weeks; median birth weight, 1.9 kg).

Infants who were administered sustained supplementation were less likely to experience recurrent wheezing at 12 months’ adjusted age (31.1%) when compared with infants who were in the diet-limited group (41.8%; difference, 10.7 [95% CI, 27.4% to 2.9%]; RR = 0.66 [95% CI, 0.47-0.94]).

Adverse events were reported, and the most common ones included upper and lower respiratory infections. Neonates who were in the sustained supplementation group experienced fewer adverse events when compared with the diet-limited group for both upper respiratory infections (54.9% vs. 56.5%; difference, 1.6% [95% CI, 17.1% to 7.0%]) and lower respiratory infections (21.6% vs. 25.2%; difference, 3.6% [95% CI, 16.4% to 4.4%]).

Vitamin D is an attractive treatment option because it is easy to administer and is relatively inexpensive,” Hibbs said in the release. “Further research is needed to identify and optimize interventions that can reduce the wheezing burden and help us understand any health benefits that may continue as these infants grow up.” – by Katherine Bortz

Disclosures: Hibbs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.