Introduction: At risk groups for vitamin D deficiency have long been identified, including the chronically ill. According to guidelines published by the European Society of Endocrinology (ESPE, 2002), the American Academy of Paediatrics (AAP, 2008) and the Endocrine Society (ENDO, 2011), vitamin D levels should be measured in chronically ill or at risk patients. We aimed to test the current knowledge of these guidelines amongst consultants in a large tertiary hospital.
Methods: A questionnaire was emailed to all 176 consultants at Birmingham Childrens Hospital. We asked whether they i) routinely check vitamin D levels in chronically ill and at risk patients, and if, how often, ii) routinely supplement chronically ill or at risk patients with vitamin D, iii) if prescribed, which daily dose and duration they choose, and when levels are rechecked, iv) are aware that vitamin D supplementation doses differ from treatment doses, and that exclusively breastfed infants should receive vitamin D supplements.
Results: Of 27 responses (15% response rate), 12 consultants (44%) routinely screen at risk patients. Frequency of screening was inconsistent among specialities (3 monthly to annually). Three specialities routinely supplement vitamin D in at risk patients, one however assuming alfacalcidol was vitamin D. Seventy percent of consultants based their doses on BNF recommendations and levels are rechecked in 68weeks by 29%, 3 months by 35%, and 6 months by 11%. 80% were aware that vitamin D treatment and supplement doses differ. Only 8/26 (30%) were aware that exclusively breast fed babies need vitamin D supplementation.
Conclusion: Despite established international guidelines (AAP, ESPE, and ENDO), the knowledge on screening children who are chronically ill or otherwise at risk for vitamin D deficiency was poor within our institution. Regional and national guidelines are needed to improve the long term health of chronically ill children and at risk groups.