# Impact of a Nutrition Protocol on Vitamin D Supplementation in a Pediatric Intensive Care Unit: A Retrospective Cohort Study

## TL;DR

A nutrition protocol improved vitamin D supplementation practices in a pediatric intensive care unit, but some age groups still received less than recommended.

## Contribution

This study demonstrates how implementing a nutrition protocol can increase vitamin D supplementation in critically ill children.

## Key findings

- Vitamin D supplementation increased by 95 IU per day after the nutrition protocol was introduced.
- 95% of patients received vitamin D after the protocol, compared to 77% before.
- Supplementation was less than recommended for children over one year old despite the protocol.

## Abstract

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric critically ill patients and is a potentially modifiable risk factor during critical illness. There are no established national or international recommendations for vitamin D supplementation in Pediatric Intensive Care Unit (PICU) patients. Objectives: This monocentric study aims to compare the practices regarding vitamin D supplementation before and after the introduction of a nutrition protocol (NP). Methods: We retrospectively analyzed vitamin D administration (time from PICU admission to initiation, amount of supplementation, accordance with existing guidelines) in children aged 0 to 16 who were admitted to the PICU of Lausanne University Hospital for more than 48 h the year before and the year after the introduction of a NP. Results: Vitamin D supplementation increased after NP introduction (95 IU per day more, p < 0.0001). More patients received vitamin D during their stay (95% after vs. 77% before, p < 0.0001). The dose adhered to NP recommendations for children under 12 and was higher for older children. According to Swiss guidelines for the general pediatric population, vitamin D supplementation was accurate in children under one year old before and after NP implementation. However, it was less than recommended for patients over one year old. Conclusions: The implementation of a NP significantly enhanced the scope of vitamin D supplementation. This study also highlights the practical limitations in meeting the recommended requirements with certain galenic formulations.