Differential low uptake of free vitamin D supplements in preterm infants: the Quebec experience

BMC Pediatrics

Celia Rodd¹  Anick Bérard²  Odile Sheehy⁴  Hope A Weiler⁵  Atul K Sharma¹  Tarah Fatani³ 

[1]Department of Pediatrics, Winnipeg Children’s Hospital, 685 William Avenue, FW302, Winnipeg R3E 0Z2, Manitoba, Canada

[2]Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada

[3]Department of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada

[4]Research Center, Centre hospitalier universitaire Ste-Justine, Montreal, Quebec, Canada

[5]School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada

关键词: Education;    Socioeconomic status;    Early preterm;    Fractures;    Mineralization;    Supplementation;    Vitamin D;    Premature infants;   

Others  :  1113323
DOI  :  10.1186/s12887-014-0291-6

 received in 2014-08-11, accepted in 2014-11-10,  发布年份 2014

【 摘 要 】

Background

Vitamin D is essential for bone mineralization, particularly in premature infants. For nearly 20 years, Quebec has offered a program of free vitamin D supplements via its public medication insurance plan Régie de l’Assurance Maladie du Québec (RAMQ). The objective of this study is to evaluate the number of preterm infants that obtained at least one bottle (50 doses) of vitamin D supplement through this program and to determine if uptake varied by gestational age.

Methods

This was a retrospective cohort study of preterm infants covered by RAMQ and born from 1998 to 2008; all infants had 1 year of follow-up data regarding supplement use. Data were extracted from the Quebec Pregnancy Cohort, a linked administrative database and were stratified by early (<34 weeks) or late gestational age premature infants. The number of infants obtaining supplements was the primary outcome and their characteristics were compared across gestational age groups. Predictors for participation (obtaining at least 1 bottle) or adherence (2 or more bottles) were identified via logistic regression (GEE).

Results

10288 infants were eligible; the percentage exposed to vitamin D was 24.5% (37.4%- early; 20.7%-late preterm infants, p < 0.001). The median number of bottles obtained was 2 for early and 1 for late preterms. For all premature infants, there was an apparent geometric decline in the infants obtaining subsequent bottles of supplements over the 12 month period. Additionally, there was a significant decline in program participation over time (OR = 0.90/year, 95% CI: 0.89-0.90) regardless of gestational age. Older or more educated mothers were positive predictors for participation. A prescription from a pediatrician significantly increased the odds of obtaining the supplement.

Conclusion

Early preterm infants were more likely to obtain the supplement post-discharge; uptake was low and decreased with time for both age categories. Specifically, targeting late preterm infants and young mothers with less education could improve vitamin D uptake.

【 授权许可】

   
2014 Fatani et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bishop N, Sprigg A, Dalton A: Unexplained fractures in infancy: looking for fragile bones. Arch Dis Child 2007, 92(3):251-256.
• [2]Bozzetti V, Tagliabue P: Metabolic bone disease in preterm newborn: an update on nutritional issues.Ital J Pediatr 2009, 35(1):20.
• [3]Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, van Goudoever J: Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013, 56(6):692-701.
• [4]Wagner CL, Greer FR: Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008, 122(5):1142-1152.
• [5]Reeve LE, Chesney RW, DeLuca HF: Vitamin D of human milk: identification of biologically active forms. Am J Clin Nutr 1982, 36(1):122-126.
• [6]Jessiman T, Cameron A, Wiggins M, Lucas PJ: A qualitative study of uptake of free vitamins in England. Arch Dis Child 2013, 98(8):587-591.
• [7]Hatun S, Ozkan B, Bereket A: Vitamin D deficiency and prevention: Turkish experience. Acta paediatrica (Oslo, Norway: 1992) 2011, 100(9):1195-1199.
• [8]Millette M, Sharma A, Weiler H, Sheehy O, Berard A, Rodd C: Failure of free vitamin D supplementation program for Quebec infants. Acta paediatrica (Oslo, Norway: 1992) 2014, 103(10):e444-449.
• [9][http:/ / www.hc-sc.gc.ca/ fn-an/ surveill/ nutrition/ commun/ prenatal/ trends-tendances-eng.php] webcite Trends in breastfeeding practices in Canada (2001 to 2009–2010). []
• [10]Berard A, Lacasse A: Validity of perinatal pharmacoepidemiologic studies using data from the RAMQ administrative database. Can J Clin Pharmacol 2009, 16(2):e360-e369.
• [11]Engle WA, Tomashek KM, Wallman C: “Late-preterm” infants: a population at risk. Pediatrics 2007, 120(6):1390-1401.
• [12]Nakhai-Pour HR, Broy P, Berard A: Use of antidepressants during pregnancy and the risk of spontaneous abortion. CMAJ 2010, 182(10):1031-1037.
• [13]Nakhai-Pour HR, Broy P, Sheehy O, Berard A: Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ 2011, 183(15):1713-1720.
• [14]Webb AR, Kline L, Holick MF: Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988, 67(2):373-378.
• [15]Moy RJ, McGee E, Debelle GD, Mather I, Shaw NJ: Successful public health action to reduce the incidence of symptomatic vitamin D deficiency. Arch Dis Child 2012, 97(11):952-954.
• [16][http:/ / www.hc-sc.gc.ca/ fn-an/ surveill/ nutrition/ commun/ prenatal/ initiation-eng.php] webcite Breastfeeding iniatation in Canada: key statistics and graphics (2009–2010). []
• [17]Crocker B, Green TJ, Barr SI, Beckingham B, Bhagat R, Dabrowska B, Douthwaite R, Evanson C, Friesen R, Hydamaka K, Li W, Simmons K, Tse L: Very high vitamin D supplementation rates among infants aged 2 months in Vancouver and Richmond, British Columbia, Canada.BMC Public Health 2011, 11:905.
• [18]Gallo S, Jean-Philippe S, Rodd C, Weiler HA: Vitamin D supplementation of Canadian infants: practices of Montreal mothers. Appl Physiol Nutr Metab 2010, 35(3):303-309.
• [19]Shaikh U, Alpert PT: Practices of vitamin D recommendation in Las Vegas, Nevada. J Hum Lact 2004, 20(1):56-61.
• [20]Adamkin DH: Feeding problems in the late preterm infant. Clin Perinatol 2006, 33(4):831-837. abstract ix
• [21]Ahmed AH: Role of the pediatric nurse practitioner in promoting breastfeeding for late preterm infants in primary care settings. J Pediatr Health Care 2010, 24(2):116-122.
• [22]Downard CD, Renaud E, St Peter SD, Abdullah F, Islam S, Saito JM, Blakely ML, Huang EY, Arca MJ, Cassidy L, Aspelund G: Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2012, 47(11):2111-2122.
• [23]Wataker H, Meberg A, Nestaas E: Neonatal family care for 24 hours per day: effects on maternal confidence and breast-feeding. J Perinat Neonatal Nurs 2012, 26(4):336-342.
• [24]Bartlett DJ, Nijhuis-van der Sanden MW, Fallang B, Fanning JK, Doralp S: Perceptions of vulnerability and variations in childrearing practices of parents of infants born preterm. Pediatr Phys Ther 2011, 23(3):280-288.
• [25]Backstrom MC, Maki R, Kuusela AL, Sievanen H, Koivisto AM, Ikonen RS, Kouri T, Maki M: Randomised controlled trial of vitamin D supplementation on bone density and biochemical indices in preterm infants. Arch Dis Child Fetal Neonatal Ed 1999, 80(3):F161-F166.
• [26]McCarthy RA, McKenna MJ, Oyefeso O, Uduma O, Murray BF, Brady JJ, Kilbane MT, Murphy JF, Twomey A, O’ Donnell CP, Murphy NP, Molloy EJ: Vitamin D nutritional status in preterm infants and response to supplementation. Br J Nutr 2013, 110(1):156-163.