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小儿科(2008年9月-2009年5月)
2014-03-04 15:23   审核人:

1. J Pediatr. 2009 May 14. [Epub ahead of print]                         Related Articles, Links

系统性红斑狼疮患儿维生素D缺乏伴有比较大的身体质量指数与疾病活动性
Hypovitaminosis D is Associated with Greater Body Mass Index and Disease Activity in Pediatric Systemic Lupus Erythematosus

Wright TB, Shults J, Leonard MB, Zemel BS, Burnham JM

Department Of Pediatrics (T.W.), Division of Rheumatology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Pediatrics, Divisions of Rheumatology (J.B.), Nephrology (M.L.), and Gastroenterology And Nutrition (B.Z.), The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics (T.W., J.S., M.L., J.B.), University of Pennsylvania School of Medicine, Philadelphia, PA; and University of Pennsylvania School of Medicine (J.S., M.L., B.Z., J.B.), Philadelphia, PA.

OBJECTIVES: To determine whether pediatric systemic lupus erythematosus (SLE) is associated with alterations in the vitamin D-parathyroid hormone (PTH) axis and to assess the relation between vitamin D deficiency and SLE activity. STUDY DESIGN: 25-hydroxy vitamin D [25(OH)D], 1,25-dihydroxy vitamin D [1,25(OH)(2)D], and intact PTH were measured in subjects with SLE (n = 38) and healthy controls (n = 207), ages 5 to 21 years. Vitamin D status and its relation with disease activity were assessed using multivariable logistic and linear regression. RESULTS: Severe vitamin D deficiency (25(OH)D <10 ng/ml) was observed in a significantly higher proportion of subjects with SLE (36.8% vs 9.2%, P < .001). In SLE, the odds ratio (OR) for severe deficiency was 2.37 (P = .09), adjusting for age, sex, race, and season. However, for each 1 SD greater body mass index (BMI) z-score, 25(OH)D levels were 4.2 ng/mL lower (P = .01) in SLE, compared with controls. Adjusting for 25(OH)D levels, SLE was associated with significantly lower 1,25(OH)(2)D (P < .001) and intact PTH levels (P = .03). Greater SLE disease activity index scores were observed in those with 25(OH)D <20 ng/mL (P = .01). CONCLUSIONS: SLE was associated with vitamin D deficiency, particularly among those subjects with SLE who were overweight. Future studies should assess the effect of vitamin D supplementation on skeletal and nonskeletal outcomes in SLE.

 

2. Mil Med. 2009 Mar;174(3):302-7.                                       Related Articles, Links

军事医生补充维生素D的壁垒
Barriers to vitamin D supplementation among military physicians

Sherman EM, Svec RV

Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.

OBJECTIVE: We surveyed military pediatricians and family physicians about barriers to vitamin D supplementation. METHODS: We obtained lists of uniformed members of the American Academy of Pediatrics (AAP) and American Academy of Family Practice (AAFP). Three hundred individuals were randomly selected from each group and surveyed about: (1) practice habits; (2) vitamin D use and barriers to supplementation; (3) demographic factors. RESULTS: Pediatricians were 40% more likely to be aware of AAP recommendations about vitamin D (p < 0.001) and 40% more likely to prescribe vitamin D to exclusively breastfed infants (p < 0.001). The most common reason for not recommending vitamin D was the belief that breastfed infants received adequate sunlight. CONCLUSIONS: Most military pediatricians supplement breastfed infants with vitamin D. Military family physicians are less likely to supplement breastfed infants and are targets for educational interventions. Many physicians mistakenly believe that adequate sunlight exposure prevents vitamin D deficiency, another focus for future interventions.

 

3. Curr Opin Clin Nutr Metab Care. 2009 May;12(3):287-92.             Related Articles, Links

一岁婴儿的维生素D需求
Vitamin D requirements in the first year of life

Mimouni FB, Shamir R

Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel. fmimouni@post.tau.ac.il

PURPOSE OF REVIEW: To understand the basis for current recommendations for vitamin D supplementation in childhood and the differences between the recommendations published by major expert committees, using the Medline engine of the US National Library of Medicine and the National Institutes of Health. RECENT FINDINGS: Recent recommendations published by major national expert committees are essentially based on expert opinion (a relatively low level of evidence). Randomized controlled trials are very few, and there are no systematic reviews or meta-analyses on the topic. Most trials have examined the question of whether a specific daily vitamin D dose is capable or not to prevent rickets (by studying surrogate markers of rickets). There are no trials that have systematically attempted to determine the upper limit of daily vitamin D dose beyond which its toxic effects may appear. Whether or not outcomes such as osteoporosis (or low bone mass) and specific types of cancer may be prevented by 'generous' vitamin D supplementation is unclear and mostly based on indirect epidemiologic data not clearly substantiated by randomized controlled trials SUMMARY: The dose of daily vitamin D supplements needed to prevent rickets is probably much lower than that recommended by most expert committees. Whether higher doses of daily vitamin D supplements may or may not prevent other poor outcomes such as adult osteoporosis or specific types of cancer is not yet known.

 

4. Ann Pharmacother. 2009 Apr;43(4):714-20. Epub 2009 Mar 31.            Related Articles, Links

白血病和淋巴瘤患儿的骨质疏松症/骨量减少治疗
Treatment of osteoporosis/osteopenia in pediatric leukemia and lymphoma.

Bryant ML, Worthington MA, Parsons K

Children's Hospital, Birmingham, AL, USA. michele.bryant@chsys.org

OBJECTIVE: To evaluate the efficacy and safety of various treatment options for osteopenia and osteoporosis secondary to cancer treatment in pediatric patients undergoing cancer therapy. DATA SOURCES: A systematic search of PubMed (1949-November 2008) and International Pharmaceutical Abstracts (to November 2008) was conducted using the following search terms: osteoporosis, osteopenia, pediatrics, cancer, neoplasms, chemotherapy, bisphosphonates, calcium, vitamin D, calcitonin, and physical therapy. STUDY SELECTION AND DATA EXTRACTION: All prospective studies that evaluated various osteoporosis treatment options in pediatric patients undergoing chemotherapy were included. Results from studies evaluating bisphosphonates and other treatments in children with osteoporosis due to other causes were also included if important safety and efficacy data were provided. Most commonly reported primary efficacy endpoints included comparisons of bone density parameters measured before and after treatment. DATA SYNTHESIS: Four clinical studies and 2 case reports describing treatment with bisphosphonates, specifically alendronate and pamidronate, for osteoporosis or osteopenia in pediatric cancer patients were identified. Results from the trials showed that these medications were efficacious in reducing bone mineral density loss during cancer therapy and were well tolerated in this special population. Primary efficacy endpoints included improvements in Z-scores measured by dual-energy X-ray absorptiometry scans. The most commonly reported adverse effects included hypocalcemia, mild stomach upset, and infusion-related hyperpyrexia. Four additional clinical trials involving the treatment of osteoporosis or osteopenia in children and adolescents who developed bone degeneration after chronic steroid therapy are also included. In these trials, treatment options such as calcitonin, and calcium and vitamin D supplementation were also shown to be beneficial. CONCLUSIONS: The clinical trials published to date are limited to only a few conducted in small populations of patients diagnosed with lymphoblastic leukemia or non-Hodgkin's lymphoma. However, alendronate and pamidronate both appeared to be effective options in improving bone mineral density scores with minimal adverse effects.

 

5. Curr Opin Allergy Clin Immunol. 2009 Apr;9(2):141-5.                        Related Articles, Links

学龄前儿童的哮喘:下一个挑战
Asthma in preschool children: the next challenge

Saglani S, Bush A

Department of Respiratory Paediatrics, National Heart & Lung Institute, Imperial College, London, UK.

PURPOSE OF REVIEW: To describe a prospective classification for preschool wheezers according to temporal symptom pattern, and summarize findings relating to the management of viral wheeze and the use of short-term therapy for intermittent severe wheeze. RECENT FINDINGS: Phenotypes defined from cohort studies should only be applied retrospectively at school age. A new classification that can be applied prospectively is discussed. The importance of early rhinovirus-induced wheezing as a risk factor for asthma has become apparent. However, there is no benefit from short-course oral steroids for acute viral wheeze in the majority of cases. There is conflicting evidence for the role of intermittent montelukast or inhaled steroids in the treatment of acute, intermittent wheeze. A link between reduced vitamin D intake during pregnancy and increased preschool wheeze in offspring has emerged, suggesting a potential role for vitamin D supplementation in primary prevention. SUMMARY: On the basis of current evidence, a trial of bronchodilators is first-line therapy for viral wheeze, and maintenance montelukast or inhaled steroids may be considered in preschool wheezers with persistent symptoms and risk factors for future asthma. No disease-modifying therapies are available. New therapeutic options for preschool wheezing disorders are desperately needed.

 

6. J Bone Miner Metab. 2009 Mar 17. [Epub ahead of print]             Related Articles, Links

烧伤后患者标准多种维生素补充没有改善维生素D不足
Standard multivitamin supplementation does not improve vitamin D insufficiency after burns

Klein GL, Herndon DN, Chen TC, Kulp G, Holick MF

Department of Pediatrics, University of Texas Medical Branch, Children's Hospital Room 3.270, 301 University Boulevard, Galveston, TX, 77555-0352, USA, gklein@utmb.edu.

Children suffering severe burns develop progressive vitamin D deficiency because of inability of burned skin to produce normal quantities of vitamin D(3) and lack of vitamin D supplementation on discharge. Our study was designed to determine whether a daily supplement of a standard multivitamin tablet containing vitamin D(2) 400 IU (10 mug) for 6 months would raise serum levels of 25-hydroxyvitamin D [25(OH)D] to normal. We recruited eight burned children, ages 5-18, whose families were deemed reliable by the research staff. These children were given a daily multivitamin tablet in the hospital for 3 months in the presence of a member of the research staff and then given the remainder at home. At 6 months, the subjects returned for measurements of serum levels of 25(OH)D,1,25-dihydroxyvitamin D [1,25(OH)(2)D], intact parathyroid hormone (iPTH), Ca, P, albumin, and total protein as well as bone mass by dual energy X-ray absorptiometry. Serum 25(OH)D levels were compared to a group of seven age-matched burned children studied at an earlier date without the vitamin supplement but with the same method of determination of 25(OH)D at 6 months post-burn. In addition, the chewable vitamins were analyzed for vitamin D(2) content by high performance liquid chromatography. Serum concentration of 25(OH)D was 21 +/- 11(SD) ng/ml (sufficient range 30-100) with only one of the eight children having a value in the sufficient range. In comparison, the unsupplemented burn patients had mean serum 25(OH)D level of 16 +/- 7, P = 0.33 versus supplemented. Serum levels of 1,25(OH)(2)D, iPTH, Ca, P, albumin, and total protein were all normal in the supplemented group. Vitamin D(2) content of the chewable tablets after being saponified and extracted was 460 +/- 20 IU. Bone mineral content of the total body and lumbar spine, as well as lumbar spine bone density, failed to increase as expected in the supplemented group. No correlations were found between serum 25(OH)D levels and age, length of stay, percent body surface area burn or third-degree burn. Supplementation of burned children with a standard multivitamin tablet stated to contain 400 IU of vitamin D(2) failed to correct the vitamin D insufficiency.

 

7. Pediatrics. 2009 Mar;123(3):797-803.                         Related Articles, Links

多种族的青少年人群的维生素D缺乏的新定义:美国第三次全国健康和营养调查
Implications of a new definition of vitamin D deficiency in a multiracial us adolescent population: the National Health and Nutrition Examination Survey III

Saintonge S, Bang H, Gerber LM

Weill Cornell Medical College, Department of Public Health, 411 E 69th St, New York, NY 10021, USA. ssaint@med.cornell.edu

OBJECTIVE: In children, vitamin D deficiency can interfere with bone mineralization, leading to rickets. In adults, it is linked to cardiovascular disease, insulin resistance, and hypertension. Accurate estimates of the prevalence of vitamin D deficiency are complicated by the lack of consensus as to optimal vitamin D status. Currently, individuals with serum 25-hydroxyvitamin D levels of <11 ng/mL are classified as vitamin D deficient. Experts collectively have proposed that minimum levels be at least 20 ng/mL. Our objectives were to (1) determine the national prevalence of vitamin D deficiency in adolescents by using both the current and recommended cutoffs and (2) examine the implications of the new recommendation after adjustment for various factors. METHODS: Data were obtained from National Health and Nutrition Examination Survey III, a cross-sectional survey administered to a nationally representative sample of noninstitutionalized civilians aged 2 months and older. Analyses were restricted to 2955 participants aged 12 to 19 with serum 25-hydroxyvitamin D levels. Relationships between serum 25-hydroxyvitamin D levels and sociodemographic variables were evaluated by using logistic regression. RESULTS: Changing the definition of vitamin D deficiency from <11 to <20 ng/mL increased the prevalence from 2% to 14%. After adjustment for all covariates, non-Hispanic black adolescents had 20 times the risk of serum 25-hydroxyvitamin D <20 ng/mL compared with non-Hispanic white adolescents. The risk of deficiency was more than double for females compared with males. An inverse relationship between weight and serum 25-hydroxyvitamin D levels was found. Overweight adolescents had increased risk of deficiency compared with normal-weight adolescents. CONCLUSIONS: There was a disproportionate burden of vitamin D deficiency in the non-Hispanic black adolescent population. Routine supplementation and monitoring of serum levels should be considered. Females and overweight adolescents are at increased risk. The consequences of chronic vitamin D deficiency in adolescents should be prospectively investigated.

 

8. Public Health Nutr. 2009 Feb 23:1-9. [Epub ahead of print]               Related Articles, Links

幼儿的维生素D缺乏:在阳光充足的南太平洋地区发病率
Vitamin D deficiency in early childhood: prevalent in the sunny South Pacific

Grant CC, Wall CR, Crengle S, Scragg R

1Department of Paediatrics, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.

OBJECTIVE: To estimate the prevalence of and risk factors for vitamin D deficiency in young urban children in Auckland, New Zealand, where there is no routine vitamin D supplementation. DESIGN: A random sample of urban children. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D <27.5 nmol/l (<11 ng/ml). Logistic regression analysis was used to calculate odds ratios and, from these, relative risks (RR) and 95 % confidence intervals were estimated. SETTING: Auckland, New Zealand (36 degrees 52'S), where the daily vitamin D production by solar irradiation varies between summer and winter at least 10-fold. SUBJECTS: Children aged 6 to 23 months enrolled from 1999 to 2002. RESULTS: Vitamin D deficiency was present in forty-six of 353 (10 %; 95 % CI 7, 13 %). In a multivariate model there was an increased risk of vitamin D deficiency associated with measurement in winter or spring (RR = 7.24, 95 % CI 1.55, 23.58), Pacific ethnicity (RR = 7.60, 95 % CI 1.80, 20.11), not receiving any infant or follow-on formula (RR = 5.69, 95 % CI 2.66, 10.16), not currently receiving vitamin supplements (RR = 5.32, 95 % CI 2.04, 11.85) and living in a more crowded household (RR = 2.36, 95 % CI 1.04, 4.88). CONCLUSIONS: Vitamin D deficiency is prevalent in early childhood in New Zealand. Prevalence varies with season and ethnicity. Dietary factors are important determinants of vitamin D status in this age group. Vitamin D supplementation should be considered as part of New Zealand's child health policy.

 

9. Pediatr Res. 2009 Jan 28. [Epub ahead of print]                             Related Articles, Links

维生素D连接到儿科感染和免疫功能
The Vitamin D Connection to Pediatric Infections and Immune Function

Walker VP, Modlin RL

Department of Pediatrics [V.P.W.], Department of Microbiology [R.L.M.], Department of Medicine [R.L.M.], David Geffen School of Medicine at UCLA Los Angeles, CA 90095.

Over the past twenty years, a resurgence in vitamin D deficiency and nutritional rickets has been reported throughout the world, including the United States. Inadequate serum vitamin D concentrations have also been associated with complications from other health problems, including tuberculosis, cancer (prostate, breast and colon), multiple sclerosis and diabetes. These findings support the concept of vitamin D possessing important pleiotropic actions outside of calcium homeostasis and bone metabolism. In children, an association between nutritional rickets with respiratory compromise has long been recognized. Recent epidemiological studies clearly demonstrate the link between vitamin D deficiency and the increased incidence of respiratory infections. Further research has also elucidated the contribution of vitamin D in the host defense response to infection. However, the mechanism(s) by which vitamin D levels contribute to pediatric infections and immune function has yet to be determined. This knowledge is particularly relevant and timely, because infants and children appear more susceptible to viral rather than bacterial infections in the face of vitamin D deficiency. The connection between vitamin D, infections and immune function in the pediatric population indicates a possible role for vitamin D supplementation in potential interventions and adjuvant therapies.

 

10. Pediatrics. 2009 Jan;123(1):e121-6.                                          Related Articles, Links

Erratum in: Pediatrics. 2009 May;123(5):1437.

感染艾滋病毒的儿童和青少年双月一次口服维生素D3对血清25(OH)D浓度的影响
Effect of bimonthly supplementation with oral cholecalciferol on serum 25-hydroxyvitamin D concentrations in HIV-infected children and adolescents

Arpadi SM, McMahon D, Abrams EJ, Bamji M, Purswani M, Engelson ES, Horlick M, Shane E

Sergievsky Center, College of Physicians and Surgeons, New York, NY 10032, USA. sma2@columbia.edu

OBJECTIVE: Vitamin D insufficiency occurs commonly in HIV-infected youth in the United States. In light of the importance of vitamin D for skeletal and nonskeletal health, including innate immunity, developing methods for improving vitamin D status in HIV-infected children and adolescents is an important area of clinical research. The objective of this study was to evaluate the effect of administration of oral cholecalciferol, 100,000 IU every 2 months, and 1 g/day calcium on serum 25-hydroxyvitamin D concentrations, serum and urine calcium, and HIV disease progression during a 12-month period. METHODS: HIV-infected children and adolescents who were aged 6 to 16 years were randomly assigned to receive vitamin D (100,000 IU bimonthly) and calcium (1 g/day; n = 29) or double placebo (n = 27). Serum 25-hydroxyvitamin D concentrations as measured by radioimmunoassay, albumin-corrected calcium concentrations, and spot urinary calcium-creatinine ratios were determined monthly. RESULTS: No abnormalities in serum calcium concentration were observed. One participant who received placebo developed hypercalciuria. No group differences were seen in the change in CD4 count or CD4% or viral load during 12 months. The overall mean monthly serum 25-hydroxyvitamin D concentrations were higher in the group that received vitamin D and calcium than in the placebo group, as was the monthly serum 25-hydroxyvitamin D area under the curve. After completing 12 months of study, 2 (6.7%) participants in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration <20 ng/mL compared with 14 (50%) in the placebo group. Twelve (44.4%) in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration of > or =30 ng/mL compared with 3 (11.1%) in the placebo group. CONCLUSIONS: Administration of oral cholecalciferol to HIV-infected children and adolescents at a dosage of 100,000 IU every 2 months, together with 1 g/day calcium, is safe and results in significant increases in serum 25-hydroxyvitamin D concentrations.

 

11. J Paediatr Child Health. 2008 Dec;44(12):681-5.                             Related Articles, Links

囊性纤维化年轻患者的骨密度及相关因素
Bone mass density and associated factors in cystic fibrosis patients of young age

Douros K, Loukou I, Nicolaidou P, Tzonou A, Doudounakis S

Third Department of Pediatrics, Athens University Medical School, University General Hospital Attikon, Athens, Greece.

AIM: To investigate bone mineral status in young cystic fibrosis (CF) patients and determine risk factors related with the development of low bone mineral density (BMD). METHODS: We determined, in 81 patients with CF, 4 to 23-years-old, BMD as well as factors, which are thought to play a role in the development of reduced BMD. RESULTS: BMD Z-score was between -1 and -2.5 in 27 (33%) and lower than -2.5 in 9 (11%). Means of BMD Z-score were lower than the expected value of 0 in the three groups of children, adolescents and young adults (P = 0.004; P < 0.001; P = 0.048, respectively), but they did not differ among them (P = 0.114). Analysis showed that Shwachman-Kulczycki (SK) score, gender and levels of 25-hydroxy-vitamin D were significant predictors of BMD Z-score. Significant also was the interaction between gender and SK score. CONCLUSIONS: Our study supports that BMD may be reduced from a young age in CF patients though this needs to be confirmed using true volumetric measures of BMD. This defect is related to disease severity with males being more vulnerable. Inefficient levels of vitamin D are very common and contribute significantly to impaired bone health. The latter finding underlines the need for higher supplementation doses.

                                                                                                              (摘自Vitamin D Today)

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