200370 Pediatrician failure to follow the AAP's 2003 vitamin D guidelines in infants

Tuesday, November 10, 2009: 12:50 PM

Xena Grossman, MS, RD , Division of General Pediatrics, Boston Medical Center, Boston, MA
Supriya Mehta, MHS, PhD , School of Public Health, University of Illinois Chicago, Chicago, IL
Radha Sadacharan , Division of General Pediatrics, Boston Medical Center, Boston, MA
Michael F. Holick, PhD, MD , Dept of Medicine/Endocrinology, Nutrition and Diabetes, Boston University School of Medicine, Boston, MA
Howard Bauchner, MD, MPH , Division of General Pediatrics, Boston University School of Medicine, Boston, MA
Anne Merewood, PhD, MPH, IBCLC , Division of General Pediatrics, Boston Medical Center, Boston, MA
Background: In 2008, the American Academy of Pediatrics (AAP) revised their 2003 guidelines on vitamin D supplementation, recommending an increase from 200 IU/day (2003), to 400 IU/day (2008). Breastfed infants receive supplementation as multivitamin drops; non-breastfed infants receive supplementation via formula. The 2003 AAP guidelines recommended vitamin drops for infants consuming <500 mL/day of vitamin D fortified formula.

Objective: To determine whether a cohort of infants was supplemented according to the 2003 AAP guidelines

Methods: From 2004-2007, we enrolled 193 newborns at an urban Boston hospital. Between 2-3 months, we obtained data on infant feeding status; on prescription of vitamin D supplements, and on dose, as well as demographic information.

Results: Data were available on 173 infants; 92 were consuming < 500 mL/day of formula (exclusively breastfed or mostly breastfed). Of these, 45 (49%) were not prescribed any supplement; 14 (15%) were prescribed the supplement but took it fewer than 5 times a week, and 33 (36%) were prescribed a supplement which they took at least 5 days a week. In 96% of cases, when multivitamins were prescribed, the prescribed dose was “1cc a day”. All multivitamins contained 400 IU in 1cc.

Conclusion: Only 2% of breastfed/mostly breastfed infants were supplemented per 2003 AAP guidelines. Almost half of infants were not prescribed supplements, and 96% of infants who were prescribed supplements were prescribed twice the amount recommended. Increasing AAP vitamin D supplementation guidelines will not improve vitamin D status if pediatricians fail to follow the guidelines.

Learning Objectives:
Explain the AAP's 2008 guidelines for neonatal vitamin D prescription. List differences between the 2003 and 2008 AAP guidelines for neonatal vitamin D prescription. Identify current neonatal prescribing practices for vitamin D.

Keywords: Vitamins, Infant Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I directed the study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.