1 Pediatric Critical Care Medicine, Pediatric Cardiology and Biostatistics, University of Arkansas for Medical Sciences Arkansas Children’s Hospital, Little Rock.
Recent advances in cardiac care have dramatically decreased in-hospital mortality rates among children with cardiac disease. However, despite improvement in mortality rates, morbidity in these patients continues to be high, which results in prolonged cardiac intensive care unit (CICU) and hospital length of stay (LOS). Patients with complex congenital or acquired heart disease are not able to synthetize vitamin D provided that they are not exposed to the sun, they are bed rest confined, on multiple drugs and have feeding intolerance. Objectives: To evaluate the levels of vitamin D and intact PTH in chronic patients during their hospital course in the CICU. Design: Retrospective observational study from 2008 to 2014, including 265 children with LOS greater than six weeks, with single ventricle physiology requiring surgery, or with acquired heart disease. Serum Vitamin D, and intact PTH were determined by chemiluminescent competitive immunoassay and chemiluminescent immunometric methods respectively, after 6 weeks in the hospital, and then monthly thereafter. Results: We identified vitamin D deficiency in 33 %, and insufficiency on 8 % patients, using a vitamin D level less than 10 ng/ml, as cut off point for deficiency, and less than 20 ng/ml for insufficiency, with normal range 20-58.6 ng/ml. Elevated PTH (greater than 65 pg/ml) was identified in 60% of the cases. After starting the initiative of checking vitamin D and intact PTH levels, we have seen an increase on checking vitamin D and PTH levels from 12% and 10% respectively to 50%, and it is now almost a routine in our unit to check levels. We also found a trend of increasing vitamin D levels after starting supplements, between 25-50% increase in the subsequent months, except for patients with feeding intolerance. The intact PTH also showed a trend of decreasing when vitamin D level increased. The median LOS was 60 to 80 days , with minimal change over the last years, which continues to be concerning on theses chronic patients that could develop bone disease and poor growth. Conclusions: Complex cardiovascular disease is associated prolonged LOS in the hospital, and low levels of vitamin D. These patients should be followed to ensure normal development and calcification of the bones, and avoid osteopenia and pathologic fractures.