Vitamin D supplementation among Bangladeshi children under-five years of age hospitalised for severe pneumonia: A randomised placebo controlled trial

Fahmida Chowdhury, Abu Sadat Mohammad Sayeem Bin Shahid, Mosharrat Tabassum, Irin Parvin, Probir Kumar Ghosh, Mohammad Iqbal Hossain, Nur Haque Alam, A S G Faruque, Sayeeda Huq, Lubaba Shahrin, Nusrat Homaira, Zakiul Hassan, Zubair Akhtar, S Mah-E-Muneer, George J Fuchs, Tahmeed Ahmed, Mohammod Jobayer Chisti, Fahmida Chowdhury, Abu Sadat Mohammad Sayeem Bin Shahid, Mosharrat Tabassum, Irin Parvin, Probir Kumar Ghosh, Mohammad Iqbal Hossain, Nur Haque Alam, A S G Faruque, Sayeeda Huq, Lubaba Shahrin, Nusrat Homaira, Zakiul Hassan, Zubair Akhtar, S Mah-E-Muneer, George J Fuchs, Tahmeed Ahmed, Mohammod Jobayer Chisti

Abstract

Introduction: Vitamin D is important for its immunomodulatory role and there is an independent association between vitamin D deficiency and pneumonia. We assessed the effect of vitamin D supplementation on the outcome in children hospitalized for severe pneumonia.

Methods: This was a randomised, double blinded, placebo-controlled clinical trial in children aged >2-59 months with severe pneumonia attending Dhaka Hospital, icddr,b. Children received age-specific megadose of vitamin D3 (20,000IU: <6 months, 50,000 IU: 6-12 months, 100,000 IU:13-59 months) or placebo on first day and 10,000 IU as maintenance dose for next 4 days or until discharge (if discharged earlier) along with standard therapy. This trial is registered at ClinicalTrials.gov, number NCT02185196.

Findings: We enrolled 100 children in placebo group and 97 in vitamin D group. On admission, 50 (52%) and 49 (49%) of children in vitamin D and placebo groups, respectively were vitamin D deficient. Among children with a sufficient serum vitamin D level on admission, a lower trend for duration of resolution of severe pneumonia in hours [72(IQR:44-96)vs. 88(IQR:48-132);p = 0.07] and duration of hospital stay in days [4(IQR:3-5)vs.5(IQR:4-7);P = 0.09] was observed in vitamin D group compared to placebo. No beneficial effect was observed in vitamin D deficient group or irrespective of vitamin D status.

Conclusion: Age-specific mega dose of vitamin D followed by a maintenance dose shown to have no statistical difference between the two intervention groups, however there was a trend of reduction of time to recovery from pneumonia and overall duration of hospital stay in under-five children with a sufficient serum vitamin D level on hospital admission.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Vitamin D trial profile showing…
Fig 1. Vitamin D trial profile showing participant enrollment.
Fig 2. Age adjusted hazard ratios and…
Fig 2. Age adjusted hazard ratios and outcome duration in hour by treatment groups.
Foot Note: p-values are >0.05 and indicates that there is no significant interaction observed between vitamin D status (deficient/sufficient) in children and vitamin D treatment groups for each endpoint.

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