Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets.

Autor: Gupta P; Department of Pediatrics, University College of Medical Sciences, New Delhi. Correspondence to: Dr Piyush Gupta, Professor and Head, Department of Pediatrics, University College of Medical Sciences, and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi 110095, India. prof.piyush.gupta@gmail.com., Dabas A; Department of Pediatrics, Maulana Azad Medical College, New Delhi., Seth A; Department of Pediatrics, Lady Hardinge Medical College, New Delhi., Bhatia VL; Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh., Khadgawat R; Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi., Kumar P; Department of Pediatrics, Lady Hardinge Medical College, New Delhi., Balasubramanian S; Kanchi Kamakoti CHILDS Trust, Chennai., Khadilkar V; Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra., Mallikarjuna HB; Senior Consultant Pediatrician, Bangluru., Godbole T; Dr Vasantarao Pawar Medical College, Nashik, Mumbai., Krishnamurthy S; JIPMER, Puducherry., Goyal JP; All India Institute of Medical Sciences, Jodhpur, Rajasthan., Bhakhri BK; Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, NOIDA., Ahmad A; Aligarh Muslim University, Aligarh, Uttar Pradesh., Angadi K; MR Medical College, Gulbarga., Basavaraj GV; Indira Gandhi Institute of Child Health, Bengluru, Karnataka., Parekh BJ; Bakul Parekh Children's Hospital, Mumbai., Kurpad A; Indian Council of Medical Research Expert Committee on Nutrient Requirements of Indians and Scientific Committee, Food Safety and Standards Authority of India, New Delhi., Marwaha RK; Society of Endocrine Health Care for Elderly Adolescents and Children (SEHEAC), New Delhi., Shah D; Department of Pediatrics, University College of Medical Sciences, New Delhi., Munns C; Department of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia and Pediatric Bone and Mineral Medicine, Sydney Medical School, University of Sydney, Sydney, Australia., Sachdev HPS; Department of Pediatric and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi.
Jazyk: angličtina
Zdroj: Indian pediatrics [Indian Pediatr] 2022 Feb 15; Vol. 59 (2), pp. 142-158. Date of Electronic Publication: 2021 Dec 29.
Abstrakt: Justification: The emerging literature on prevalence of vitamin D deficiency in India, prevention and treatment strategies of rickets, and extra-skeletal benefits of vitamin D suggest the need for revising the existing guidelines for prevention and treatment of vitamin D deficiency in India.
Objectives: To review the emerging literature on vitamin D prevalence and need for universal vitamin D supplementation. To suggest optimum vitamin D therapy for treatment of asymptomatic and symptomatic vitamin D deficiency, and rickets. To evaluate the extra-skeletal health benefits of vitamin D in children.
Process: A National consultative committee was formed that comprised of clinicians, epidemiologists, endocrinologists, and nutritionists. The Committee conducted deliberations on different aspects of vitamin D deficiency and rickets through ten online meetings between March and September, 2021. A draft guideline was formulated, which was reviewed and approved by all Committee members.
Recommendations: The group reiterates the serum 25-hydroxy vitamin D cutoffs proposed for vitamin D deficiency, insufficiency, and sufficiency as <12 ng/mL, 12-20 ng/mL and >20 ng/mL, respectively. Vitamin D toxicity is defined as serum 25OHD >100 ng/mL with hypercalcemia and/or hypercalciuria. Vitamin D supplementation in doses of 400 IU/day is recommended during infancy; however, the estimated average requirement in older children and adolescents (400-600 IU/day, respectively) should be met from diet and natural sources like sunlight. Rickets and vitamin D deficiency should be treated with oral cholecalciferol, preferably in a daily dosing schedule (2000 IU below 1 year of age and 3000 IU in older children) for 12 weeks. If compliance to daily dosing cannot be ensured, intermittent regimens may be prescribed for children above 6 months of age. Universal vitamin D supplementation is not recommended in childhood pneumonia, diarrhea, tuberculosis, HIV and non-infectious conditions like asthma, atopic dermatitis, and developmental disorders. Serum 25-hydroxy vitamin D level of >20 ng/mL should be maintained in children with conditions at high-risk for vitamin deficiency, like nephrotic syndrome, chronic liver disease, chronic renal failure, and intake of anticonvulsants or glucocorticoids.
Databáze: MEDLINE
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