Vitamin D Levels and Clinical Severity in Pediatric COVID 19 Patients

• Association of low vitamin D levels has been well established in COVID -19 patients since the start of the pandemic. The same could not be extrapolated to the pediatric COVID 19 patients, as the infection is reported to be rarely seen in childhood and commonly affects ≥15 years old (She J, 2020); however, the number of pediatric COVID-19 cases has increased rapidly with the global spread of the infection (Jenco, 2021) (Priscilla Idele, 2020). Although the clinical course was also found to be milder in children, serious disease has been found to be prevalent in about 3- 10% of the affected population. (Dong Y, 2020)
• Vitamin D has been proven to increase the expression of genes associated with ant oxidation, strengthen cellular immunity, and balance adaptive immunity (Cantorna, 2010). To explore the same association in pediatric population few studies have come up.

• A retrospective study (Elvan Bayramoğlu, 2021)done in 103 patients (without any comorbidities which might have affected the clinical course of COVID 19 disease) between the age of 1 years to 18 years. Among the population included 55.6% and 37.5% of the children were found to be deficient, insufficient respectively. The comparison of patients according to vitamin D levels (normal, insufficient, and deficient groups) revealed that 55.8% of the deficient group, 17.1% of the insufficient group, and 15.8% of the sufficient group applied with a moderate-to-severe clinical course (vitamin D deficiency was associated with six times an increase in having a moderate-to-severe clinical course according to the logistic regression). Lower vitamin D group also showed higher inflammatory markers like CRP, fibrinogen and a lower lymphocyte count. Also the deficiency was found to be more strongly correlated to severity in comparison to insufficiency of Vitamin D. Therefore, vitamin D deficiency may have a role in hyperinflammation and an associated low lymphocyte count in COVID-19.
• A greater number of adolescents and children were found to be vitamin D deficient which could be explained due to low sun exposure because of reduction in the outdoor time of children since the beginning of the pandemic owing to lockdown in the country. Thus given relationship between vitamin D levels and the clinical severity of the COVID-19 in this study, prophylactic vitamin D supplementation to adolescents should be considered during the COVID-19 pandemic (Panfili, 2021).

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References

1. Cantorna, M. (2010). Mechanisms underlying the effect of vitamin D on the immune system. Proceedings of the Nutrition Society, 69(3):286–289.
2. Dong Y, M. X. (2020). Epidemiology of COVID-19 among children in China. Pediatrics , 145(6):e20200702.
3. Elvan Bayramoğlu, G. A. (2021). The association between vitamin D levels and the clinical severity and inflammation markers in pediatric COVID-19 patients: single-center experience from a pandemic hospital. European Journal of Pediatrics.
4. Jenco, M. (2021). Children make up nearly 21% of new COVID-19 cases. American Academy of Paeditrics .
5. Panfili, F. M. (2021). Possible role of vitamin D in Covid-19 infection in pediatric population. Journal of endocrinological investigation, 44(1), 27–35.
6. Priscilla Idele, D. A. (2020). COVID-19 may pose greater risk to children than originally thought. Unicef -data and research