Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomised controlled trial
What this study found
Single-dose vitamin D3 did not shorten the initial pneumonia episode, but it reduced repeat pneumonia within 90 days in this high-deficiency setting. Recovery within 24 h was similar, with 13 (6%) versus 11 (5%) and mean time to recovery of 4.74 days versus 4.98 days (P = 0.17). Repeat pneumonia occurred in 92/204 (45%) versus 122/211 (58%), with relative risk 0.78 (95% CI 0.64 to 0.94; P = 0.01) and time to repeat episode hazard ratio 0.71 (95% CI 0.53 to 0.95; P = 0.02). No adverse events were observed; three children died during follow-up.
- Study & population
- Randomized controlled trial in young children with pneumonia treated at Maywand Teaching Hospital in Kabul, Afghanistan.
- Intervention
- Children in the active arm received a single oral dose of vitamin D3 (cholecalciferol) 100,000 IU, prepared in 1 mL of olive oil and given by syringe, in addition to standard antibiotic treatment.
- Key limitation
- The trial was conducted at a single hospital in Kabul and enrolled young children from a high-risk, likely vitamin D deficient population, which limits generalizability.
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Open PDFOriginal abstract
Aim Vitamin D has a role in regulating immune function and deficiency is a risk factor for childhood pneumonia. The authors investigated whether: (1) Supplementation of 100 000 IU of vitamin D3 (cholecalciferol) along with antibiotics reduces the duration of illness in children with pneumonia; (2) vitamin D3 supplementation reduces the risk of repeat episodes. Methods Design: Double-blind individually randomised placebo-controlled trial. Setting: Outpatient clinics and inpatient department in an inner-city Kabul hospital, Afghanistan. Participants: 453, 1–36 months old children, from an area with known high vitamin D deficiency, clinically diagnosed with non-severe or severe pneumonia (WHO’s IMCI diagnostic criteria) at the outpatient clinic from December 2006 to February 2007. Exclusions: Children diagnosed with rickets, other concurrent severe diseases, very severe pneumonia or wheeze. Intervention: Identical-looking syringes with unique identifiers containing vitamin D3 or placebo were randomised and administered orally at diagnosis with regular pneumonia treatment. Follow-up: Daily until signs of pneumonia resolved and then two-weekly for 3 months. Outcome measure: (1) Mean number of days recovery (resolution of IMCI signs of pneumonia) ascertained through daily home-visit or inpatient examinations; (2) incidence of repeat episodes of pneumonia from 14–90 days after the resolution of the index episode ascertained through two-weekly home visits and passive case detection at the outpatients. Results 224 received vitamin D3 and 229 placebo; randomisation successful with balanced background characteristics in the two arms. Intention to treat survival analysis: (1) No significant difference in the mean number of days to recovery between the vitamin D3 (4.74 days; SD 2.22) and placebo arms (4.98 days; SD 2.89), p=0.17. (2) Risk of a repeat episode of pneumonia within 90 days of supplementation lower in the vitamin D3 (92/204; 45%) compared to the placebo group (122/211; 58%) (RR 0.78; 95% CI 0.64 to 0.94; p=0.01). Vitamin D3 arm went longer without experiencing a repeat episode of pneumonia (mean 72 days vs 59 days; HR 0.71; 95% CI 0.53 to 0.95; p=0.02). Conclusion A single high-dose oral vitamin D3 supplementation to young children along with antibiotic treatment for pneumonia does not affect length of pneumonia, but reduces the risk of recurrence of pneumonia episodes.