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Does vitamin D status predict outcome of severe pneumonia among children?

Posted on: July 17, 2017   by  Missy Sturges & John Canell, MD


A recent study published by the Pediatric Research journal found low vitamin D status is an independent risk factor for treatment failure and delayed recovery of severe pneumonia among Nepalese children.

Pneumonia is a lower respiratory tract infection that causes the air sacs in the lungs to become inflamed, potentially leading to fluid accumulation in the lungs. Symptoms of this infection include chest pain, fever, wheezing, shortness of breath, coughing with phlegm and fatigue. Viruses, bacteria or fungi typically cause pneumonia and individuals with a compromised immune system are more likely to develop the infection.

Each year, between 148 and 161 million children are diagnosed with pneumonia throughout the world. Furthermore, pneumonia is the leading cause of death in children under the age of 5 years, causing an estimated 1.6 million deaths each year.

Research suggests that lower respiratory tract infections occur more frequently during the winter months, a time when vitamin D production is lowest. Since vitamin D helps regulate the innate and adaptive immune system, researchers theorize that it may play an important role in preventing and treating pneumonia.

Last year, a meta analysis of 2,279 children found that those with pneumonia are three times more likely to be vitamin D deficient. However, there remains a lack of consensus regarding the optimal vitamin D status to protect against infection. Therefore, a recent study aimed to determine whether vitamin D status may predict illness duration and treatment outcome among children with severe pneumonia.

The researchers conducted a secondary analysis of data from a randomized double blind, placebo controlled trial (RCT) of children with severe pneumonia in Kanti Children’s hospital, Kathmand. A total of 568 children between 2-35 months old who were hospitalized with severe pneumonia were included in the study. The researchers observed the participants 25(OH)D levels. Those with vitamin D levels below 20 ng/ml (50 nmol/l) were considered deficient, levels between 20-29 ng/ml (50-74.9 nmol/l) were considered insufficient and levels of 30 ng/ml (75 nmol/l) or greater were considered sufficient.

The researchers evaluated whether the patients experienced treatment failure and a prolonged duration of hospitalization for pneumonia. Treatment failure was defined as requiring secondary therapy to treat the infection or developing complications requiring surgical intervention or admission to the intensive care unit (ICU). Patients were considered to have a prolonged illness when they reached 96 hours without clinical improvement.

Here is what the researchers discovered:

  • A total of 31.5% of children had insufficient vitamin D levels, and 11.8% of children were vitamin D deficient.
  • Children with vitamin D levels below 20 ng/ml experienced an increased risk for treatment failure and prolonged recovery time compared to those with levels > 30 ng/ml (p = 0.003 and p = 0.009, respectively).
  • Children with viral pneumonia and 25(OH)D levels below 24 ng/ml experienced an increased odds of treatment failure and prolonged illness duration for each unit that 25(OH)D levels decreased.

The researchers concluded,

Our findings indicate that low vitamin D status (25(OH)D < 50 nmol/L) is an independent risk factor for treatment failure and delayed recovery of severe lower respiratory infections in children.”

This study provides further evidence that maintaining healthy vitamin D levels is crucial in supporting the body’s ability to fight infection. The large sample size and well-defined diagnosis of severe pneumonia increases the strength of these findings. However, the researchers noted that the lack of data regarding the patient’s vitamin D levels before the onset of infection limits their ability to determine if vitamin D status is affected during an acute phase infection. Additionally, due to its observational design, researchers are unable to prove whether a causal relationship exists.

The researchers stated,

“The results should be confirmed by placebo controlled trials that could target children with pneumonia and confirmed viral etiology.”


Sturges, M. & Cannell, JJ. Does vitamin D status predict severe pneumonia outcome among children? The Vitamin D Council Blog & Newsletter, 7/2017.


Haugen, J., Basnet, S., Hardang, I et al. Vitamin D status is associated with treatment failure and duration of illness in Nepalese children with severe pneumonia, Pediatric Research, 2017.

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