COMMENTARY

5 Best of 2019: Most-Read Pediatrics Viewpoints

William T. Basco, Jr, MD, MS

Disclosures

January 21, 2020

Pediatricians Vote With Their Clicks: The 5 Most-Read Viewpoints of 2019

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. Have you learned what your colleagues learned this year? Find out!

#5: Time to Give Up on High-Dose Vitamin D in Infants?

Some data have suggested a potential link between vitamin D deficiency in women during pregnancy or their infants and later development of atopic diseases, though results have been inconsistent. So investigators in Finland performed a large randomized controlled trial of almost 1000 full-term infants to try and definitely answer this question. The babies were given either 10 µg (400 IU) or 30 µg (1200 IU) daily vitamin D during the first 12 months of life.

Bottom line: There were no differences between the two groups in rates of sensitization to food or airborne antigens, nor in development of allergic disease or wheezing. It seems we now have building evidence that in infants with sufficient levels of vitamin D, vitamin D supplementation at higher doses isn't going to prevent allergies.

Viewpoint

There may be more work still to be done to ascertain the value of aggressive vitamin D supplementation of infants, especially in newborns at risk for vitamin D deficiency. But the evidence seems to be mounting that supplementation with vitamin D doesn't promise an easy fix for the high levels of allergic sensitization found in many developed countries.

This is not to ignore the American Academy of Pediatrics vitamin D guidelines, which recommend that breastfed and partially breastfed infants be supplemented with 400 IU per day of vitamin D until they are ingesting sufficient amounts of the vitamin from either 1 quart a day of vitamin D-fortified formula or from solid food. But remember—that recommendation isn't about high-dose supplementation, but rather ensuring adequate intake of vitamin D.

For even more in-depth reading, check out the 2016 Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

Comments

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