Department of Health and Human Services

Vitamin D deficiency in neonates

Key messages

  • Vitamin D deficiency is common in our population and therefore in pregnant women. In order to prevent vitamin D deficiency in infants, pregnant women at risk should be screened and treated for vitamin D deficiency in the first trimester.
  • Screening of the newborn's vitamin D status is not required. It is the mother's status that should be assessed.
  • Hypocalcaemia secondary to vitamin D deficiency should be considered as a cause of seizures in newborns of mothers with risk factors for vitamin D deficiency.

Risk factors for maternal vitamin D deficiency

Risk factors for maternal vitamin D deficiency include:

Diagnosis of vitamin D deficiency in the mother

Definition of deficiency

Vitamin D deficiency is defined as:

Antenatal management of the mother

Antenatal management of the mother includes:

Depending on the vitamin D level, supplementation should be commenced and continued throughout pregnancy and lactation. A maternal dose of at least 1000U/d of cholecalciferol should be adequate for mild deficiency, but a higher dose will be appropriate for women with moderate to severe deficiency.

Note: Most pregnancy and BF multivitamins do not contain 1000 units/dose eg: Elevit and Blackmore's pregnancy and BF Gold both contain only 500 units/day of cholecalciferol when taken at the recommended dose. If a pregnant woman is vitamin D deficient, a vitamin D supplement in addition to the standard pregnancy multivitamin preparation will therefore be required.

Signs of vitamin D deficiency in newborns

Signs of vitamin D deficiency include:

Postnatal management of the infant at risk of vitamin D deficiency

These at risk infants include:

Asymptomatic infants at risk for vitamin D deficiency should routinely be started on a vitamin D supplement in the first days of life.

Management of symptomatic hypocalcaemia:

Preparations for vitamin D supplementation

This dose is a physiological dose and the potential for hypervitaminosis D is negligible.

Note: Do not use Pentavite with Iron, as this contains about 1/20th the amount of vitamin D per ml.

The supplement is commenced as soon as tolerating feeds after birth and continued for the first 12 months of life. Vitamin D supplementation is not required in infants that are fully formula fed.

Stoss therapy (high dose vitamin D therapy)

Further comments

If a mother was identified as at risk and treated for vitamin D deficiency in early pregnancy, the infant should be commenced on a vitamin D supplement (at least 400IU/d), regardless of subsequent maternal levels. There is no role for a vitamin D assay in the infant at any stage, unless there are overt symptoms of hypocalcaemia (seizures) or rickets.

If a mother is at risk of vitamin D deficiency, but did not have screening, or was not adherent with vitamin D supplementation in pregnancy, the management is the same as above. A vitamin D assay in the baby is generally not required, as it is unlikely to change management and as the assay is not a good reflection of vitamin D stores. The exception would be if the maternal levels reflect severe deficiency (< 10nmol/l), which puts the infant at significant risk of hypocalcaemia and osteopenia. The management of such cases should be discussed with a paediatrician/paediatric endocrinologist. The mother's low vitamin D should be treated postnatally in its own right.

It is not necessary to initiate vitamin D supplementation in an otherwise healthy term newborn, with no infant or maternal risk factors, on the basis of not having a vitamin D level for the mother.

All parents should receive information about vitamin D and the importance of adhering to suggested supplementation. Just like immunisation, the topic should be discussed antenatally, during the birthing admission, as part of the discharge check and at the 6 week review.

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