COMMENTARY

5 Best of 2018: Pediatrics Viewpoints

William T. Basco, Jr, MD, MS

Disclosures

January 11, 2019

In This Article

Most Widely Read Viewpoints of 2018

At the end of each year, I like to revisit some of the most widely read pediatric viewpoints from the previous 12 months. These five topics—as determined by you, our readers—and the comments they generated underscore how important they are in pediatric practice. Read on!

Vitamin D and Wheeze in Infants

A study published in JAMA in the fall sought to determine whether vitamin D supplementation in preterm black infants could decrease the risk for recurrent wheezing.[1] The primary outcome was parental report of recurrent wheezing before the children reached 12 months of adjusted age. A total of 300 babies were randomly assigned, and equal numbers completed the trial (approximately 135 per group). Approximately 37% of the infants had a family history of food allergy. Over two thirds came from families with a history of eczema, and in both groups, more than 60% of infants had a family history of asthma. The sustained-supplementation group received 400 IU of cholecalciferol daily until they were 6 months adjusted age, in addition to any dietary vitamin D they might consume. The comparison group received 400 IU/day initially but discontinued the supplement when their dietary intake reached at least 200 IU/day of vitamin D.

The children who received sustained supplementation had a lower frequency of recurrent wheezing (31.1%) compared with the limited-supplementation group (41.8%; relative risk, 0.66; 95% confidence interval [CI], 0.47-0.94; P =.02).

Other outcomes were also less common in the sustained-supplementation group, including a diagnosis of asthma or eczema, but these differences did not reach statistical significance. Other secondary outcomes, such as emergency department (ED) visits for respiratory conditions, any pediatrician visit, or any sick visit to the pediatrician, were virtually identical between the two groups.

The authors concluded that among black infants who were born preterm, sustained supplementation with at least 400 IU/day of vitamin D through 6 months adjusted age reduced the risk for recurrent wheezing by 12 months of age.

Viewpoint

I don't think I anticipated that this would be the most read of 2018, but I suspect it reflects the fact that asthma is such a common pediatric condition, and any opportunity to reduce it would be welcome! There was an excellent accompanying editorial that reviewed some of the potential mechanisms by which vitamin D may improve lung health, including potential anti-inflammatory and proimmunogenicity effects.[2] The editorialist also reviewed some of the other recent randomized trials that examined the effect of maternal supplementation with vitamin D on the incidence of atopic illnesses in the offspring. A 2016 Cochrane review examining the link between vitamin D and asthma provides more in-depth information.[3]

Comments

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