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J Pediatr Infect Dis 2022; 17(04): 182-187
DOI: 10.1055/s-0042-1750312
Original Article

Severity of Pediatric COVID-19: Role of Vitamin D

May Fouad Nassar 
1   Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Mohamed Farouk Allam
2   Department of Family Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Samer Hamed ElKhayat
3   Faculty of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
,
Yasser Wagih Darwish
4   Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Mennatallah Osama Shata
1   Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract

Objective Vitamin D has many immune benefits and because its deficiency impacts most age groups, it became a nutrient of interest in the coronavirus disease 2019 (COVID-19) era. The objective of this study was to highlight the contribution of vitamin D status to the disease severity of hospitalized pediatric patients suffering from COVID-19 infection.

Methods This was a cross-sectional study that was conducted on 42 children with documented positive polymerase chain reaction for COVID-19 infection. Detailed history taking and thorough clinical examination were done for each recruited patient. Besides the laboratory and radiological assessment done for COVID-19 patients, 25 hydroxy vitamin D levels [25(OH) D] in the serum were estimated using enzyme linked immunosorbent assay.

Results Using the cutoff level of 10 ng/mL, only 40% of the patients were below this level and 60% had their vitamin D level more than or equal to 10 ng/mL. Significantly more patients of the first group needed oxygen support (denoting more severe COVID-19 infection and lung involvement). The older the patients, the more evident was vitamin D deficiency among them, and 25(OH) D values were not correlated to weight for length nor weight categories in the studied series of patients suffering from COVID-19.

Conclusion Vitamin D deficiency affects the severity of pediatric COVID-19 infection in hospitalized patients. It is prudent to advise vitamin D level assessment in such cases and promptly manage the patients accordingly. We recommend further studies to assess the effect of vitamin D supplementation on the clinical outcome of COVID-19 in the pediatric population and other vulnerable groups.

Keywords

children - COVID-19 - hydroxy vitamin D - severity - cross-sectional study

Supplementary Material



Publication History

Received: 31 January 2022

Accepted: 30 April 2022

Article published online:
15 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 World Health Organization. Coronavirus disease 2019 (COVID-19) situation report–51. World Health Organization, 11 March 2020. Accessed May 17, 2022 at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf
    PubMed
  • 2 Li Q, Guan X, Wu P. et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med 2020; 382 (13) 1199-1207
    CrossrefPubMedGoogle Scholar
  • 3 Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41 (02) 145-151
    PubMedGoogle Scholar
  • 4 Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395 (10237): 1607-1608
    CrossrefPubMedGoogle Scholar
  • 5 Verdoni L, Mazza A, Gervasoni A. et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395 (10239): 1771-1778
    CrossrefPubMedGoogle Scholar
  • 6 Marik PE, Kory P, Varon J. Does vitamin D status impact mortality from SARS-CoV-2 infection?. Med Drug Discov 2020; 6: 100041
    CrossrefPubMedGoogle Scholar
  • 7 Grant WB, Lahore H, McDonnell SL. et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients 2020; 12 (04) 988
    CrossrefPubMedGoogle Scholar
  • 8 Merzon E, Tworowski D, Gorohovski A. et al. Low plasma 25(OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study. FEBS J 2020; 287 (17) 3693-3702
    CrossrefPubMedGoogle Scholar
  • 9 Yılmaz K, Şen V. Is vitamin D deficiency a risk factor for COVID-19 in children?. Pediatr Pulmonol 2020; 55 (12) 3595-3601
    CrossrefPubMedGoogle Scholar
  • 10 Binkley N, Ramamurthy R, Krueger D. Low vitamin D status: definition, prevalence, consequences, and correction. Endocrinol Metab Clin North Am 2010; 39 (02) 287-301
    CrossrefPubMedGoogle Scholar
  • 11 Shen K, Yang Y, Wang T. et al; China National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, China, Group of Respirology, Chinese Pediatric Society, Chinese Medical Association,, Chinese Medical Doctor Association Committee on Respirology Pediatrics,, China Medicine Education Association Committee on Pediatrics,, Chinese Research Hospital Association Committee on Pediatrics,, Chinese Non-government Medical Institutions Association Committee on Pediatrics,, China Association of Traditional Chinese Medicine, Committee on Children's Health and Medicine Research, China News of Drug Information Association, Committee on Children's Safety Medication, Global Pediatric Pulmonology Alliance. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr 2020; 16 (03) 223-231
    CrossrefPubMedGoogle Scholar
  • 12 Saggese G, Vierucci F, Prodam F. et al. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. Ital J Pediatr 2018; 44 (01) 51
    CrossrefPubMedGoogle Scholar
  • 13 Federal Commission for Nutrition. Vitamin D deficiency: evidence, safety, and recommendations for the Swiss population. Expert report of the FCN. Zurich: Federal Office for Public Health; 2012
    Google Scholar
  • 14 Braegger C, Campoy C, Colomb V. et al; ESPGHAN Committee on Nutrition. Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013; 56 (06) 692-701
    CrossrefPubMedGoogle Scholar
  • 15 Shah K, Varna VP, Pandya A, Saxena D. Low vitamin D levels and prognosis in a COVID-19 pediatric population: a systematic review. QJM 2021; 114 (07) 447-453
    CrossrefPubMedGoogle Scholar
  • 16 Abu Shady MM, Youssef MM, Salah El-Din EM. et al. Predictors of Serum 25-Hydroxyvitamin D concentrations among a sample of Egyptian schoolchildren. ScientificWorldJournal 2016; 2016: 8175768
    CrossrefPubMedGoogle Scholar
  • 17 Hendawy LA, Botros RM, Sabry IM, Abromia MM, Marzouk HA, Radwan RA. Vitamin D and linear growth in a sample of Egyptian adolescents. Egypt J Hosp Med 2020; 81 (03) 1666-16671
    CrossrefPubMedGoogle Scholar
  • 18 Vierucci F, Del Pistoia M, Fanos M. et al. Vitamin D status and predictors of hypovitaminosis D in Italian children and adolescents: a cross-sectional study. Eur J Pediatr 2013; 172 (12) 1607-1617
    CrossrefPubMedGoogle Scholar
  • 19 Stagi S, Pelosi P, Strano M. et al. Determinants of vitamin D levels in Italian children and adolescents: a longitudinal evaluation of cholecalciferol supplementation versus the improvement of factors influencing 25(OD)D status. Int J Endocrinol 2014; 2014: 583039
    CrossrefPubMedGoogle Scholar
  • 20 Mansbach JM, Ginde AA, Camargo Jr CA. Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D?. Pediatrics 2009; 124 (05) 1404-1410
    CrossrefPubMedGoogle Scholar
  • 21 Torkaman M, Abolghasemi H, Amirsalari S. et al. Comparison of the vitamin D status of children younger and older than 2 years in Tehran: are supplements really necessary?. Int J Endocrinol Metab 2016; 14 (02) e34676
    CrossrefPubMedGoogle Scholar
  • 22 Wei F, Wang Z, Wang J, Xu H, Zhou H. Serum vitamin D levels among children aged 0-12 years in the first affiliated hospital of Harbin Medical University, China. J Public Health (Oxf) 2018; 40 (04) 721-726
    CrossrefPubMedGoogle Scholar
  • 23 Andıran N, Çelik N, Akça H, Doğan G, Vitamin D. Vitamin D deficiency in children and adolescents. J Clin Res Pediatr Endocrinol 2012; 4 (01) 25-29
    CrossrefPubMedGoogle Scholar
  • 24 Cashman KD, Dowling KG, Škrabáková Z. et al. Vitamin D deficiency in Europe: pandemic?. Am J Clin Nutr 2016; 103 (04) 1033-1044
    CrossrefPubMedGoogle Scholar
  • 25 Wang Z, Joshi A, Leopold K. et al. Association of vitamin D deficiency with COVID-19 infection severity: systematic review and meta-analysis. Clin Endocrinol (Oxf) 2022; 96 (03) 281-287
    CrossrefPubMedGoogle Scholar
  • 26 Weir EK, Thenappan T, Bhargava M, Chen Y. Does vitamin D deficiency increase the severity of COVID-19?. Clin Med (Lond) 2020; 20 (04) e107-e108
    CrossrefPubMedGoogle Scholar
  • 27 Imai Y, Kuba K, Rao S. et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature 2005; 436 (7047): 112-116
    CrossrefPubMedGoogle Scholar
  • 28 Lansiaux É, Pébaÿ PP, Picard JL, Forget J. Covid-19 and vit-d: disease mortality negatively correlates with sunlight exposure. Spat Spatio-Temporal Epidemiol 2020; 35: 100362
    CrossrefPubMedGoogle Scholar
  • 29 Whittemore PB. COVID-19 fatalities, latitude, sunlight, and vitamin D. Am J Infect Control 2020; 48 (09) 1042-1044
    CrossrefPubMedGoogle Scholar
  • 30 Xu Y, Baylink DJ, Chen CS. et al. The importance of vitamin d metabolism as a potential prophylactic, immunoregulatory and neuroprotective treatment for COVID-19. J Transl Med 2020; 18 (01) 322
    CrossrefPubMedGoogle Scholar