Vitamin D Supplementation for Severe Pneumonia – A Randomized Controlled Trial.

ABSTRACT

Objective: To determine the role of oral vitamin D supplementation for resolution of severe pneumonia in under-five children. Design: Randomized, double blind, placebo-controlled trial. Setting: Inpatients from a tertiary care hospital. Participants: Two hundred children [mean (SD) age 13.9 (11.7) months; boys 120] between 2 months to 5 years with severe pneumonia. Pneumonia was diagnosed in the presence of fever, cough, tachypnea (as per WHO cut-offs) and crepitations. Children with pneumonia and chest indrawing or at least one of the danger sign (inability to feed, lethargy, cyanosis) were diagnosed as having severe pneumonia. The two groups were comparable for baseline characteristics including age, anthropometry, socio-demographic profile, and clinical and laboratory parameters. Intervention Oral vitamin D (1000 IU for <1 year and 2000 IU for >1 year) (n=100) or placebo (lactose) (n=100) once a day for 5 days, from enrolment. Both the groups received antibiotics as per the Indian Academy of Pediatrics guidelines, and supportive care (oxygen, intravenous fluids and monitoring). Outcome variables Primary time to resolution of severe pneumonia. Secondary duration of hospitalization and time to resolution of tachypnea, chest retractions and inability to feed. Results: Median duration (SE, 95% CI) of resolution of severe pneumonia was similar in the two groups [vitamin D 72 (3.7, 64.7- 79.3) hours; placebo 64 (4.5, 55.2-72.8) hours]. Duration of hospitalization and time to resolution of tachypnea, chest retractions, and inability to feed were also comparable between the two groups. Conclusion: Short-term supplementation with oral vitamin D (1000-2000 IU per day for 5 days) has no beneficial effect on resolution of severe pneumonia in under-five children. Further studies need to be conducted with higher dose of Vitamin D or longer duration of supplementation to corroborate these findings.