Audit of detection and management of vitamin d deficiency in childhood in the United Kingdom

Arch Dis Child 2012;97:A119-A120 doi:10.1136/archdischild-2012-301885.285
British Association of General Paediatrics/British Society for Paediatric Endocrinology & Diabetes
PV Dissanayake, R Jayatunge
Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, Birmingham, UK
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Summary by VitaminDWiki

• 34% > 20 nanograms
• 27% 10-20 nanograms: 78% did not receive recommended treatment
• 27% < 10 nanograms: 84% had no symptoms, 13% undertreated, 20% not treated

Additional kids which the UK should consider to be at high risk include:

obese, wear excessive clothes, had recent trauma/surgery, . . . .

Most countries consider deficiency as < 30 nanograms

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Aims Vitamin D deficiency related to inadequate exposure to sunlight and poor nutritional intake is a growing problem in the United Kingdom.
Despite a treatable condition, there are no National guidelines within the NHS providing investigation and treatment protocols for children.

We proactively investigate “at risk” (dark pigmented) children for vitamin D deficiency opportunistically and treat according to the Paediatric BNF.
Our aim was to ascertain the effectiveness of this strategy.

Method Data was collected retrospectively over 12 months on children 0-16 years attending an acute NHS trust that had vitamin D levels tested.
Vitamin D deficiency due to other medical problems was excluded.
Pre-treatment and follow-up investigations (bone profile, vitamin D and parathormone levels) and treatment given were analysed including the cost implications of both.

Results 116 patients were investigated for vitamin D status and 31 (26.7%) had deficiency (<25 nmol/L) while 32 (27.5%) had insufficiency (25–50 nmol/L) and 37 (34%) were normal.
A further 12% had insufficient samples for analysis but investigations were not repeated.

Of the deficient group only 5 (16%) were symptomatic. 61% of the deficient group and only 22% of the insufficient group received recommended treatment.

Unfortunately 20% of the deficient and 53% of the insufficient groups were not treated probably due to lack of appreciation of a low result in an asymptomatic child.
25% of the insufficient group was over-treated while 13.3% of the deficient group was under-treated.

Recommended follow-up investigations to detect compliance and complications were carried out only in 22% of deficient patients.

Conclusion As 84% of vitamin D deficient children were asymptomatic, we conclude that “at risk” children should be proactively investigated.
Early treatment of vitamin D insufficiency would prevent the subsequent necessity for more expensive treatment of deficiency.
As a significant proportion received inadequate management we highlight the lack of a uniform approach to the management of vitamin D deficiency.
A larger multi-centre study is recommended to develop National guidelines defining appropriate investigations and treatment thresholds for vitamin D deficiency and insufficiency in high risk children.
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BNF = British National Formulary
wonder how much BNF recommends? - cannot find out, as those outside of the UK do not have access

See also VitaminDWiki

• Overview Dark Skin and Vitamin D
• 82 % of black US adults < 20 ng of vitamin D – Jan 2011
• 88 % of African immigrants to Melborne had < 20 ng of vitamin D
• All items in Skin Color and vitamin D 467 items
• Vitamin D insufficiency in UK youths – 37X more likely if dark skin – July 2011
• All items in category Youths and vitamin D 174 items
• UK pediatrics has a lot to learn about vitamin D – May 2012
• Immigrant vitamin D deficiency in Europe – May 2011