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Infant heart failure and vitamin D supplementation

Posted on: February 28, 2012   by  John Cannell, MD

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Heart failure is a condition where the body can’t pump enough blood to meet the needs of its body. When we think of heart failure, we think of older persons whose heart has worn out, not 4-month-old infants. However, chronic congestive heart failure is a real and existing problem for infants all over the world. That is why we should laud Professor Soad Shedeed in Egypt, who conducted the first randomized controlled trial (the highest standard of proof in medical science) using vitamin D in infants with heart failure. These infants usually either die or get a heart transplant.

Shedeed SA. Vitamin D Supplementation in Infants With Chronic Congestive Heart Failure. Pediatr Cardiol. 2012 Feb 18. [Epub ahead of print]

In about 60% of his 80 cases, the infants simply had heart muscles that did not work for an unknown reason, called idiopathic cardiomyopathy. The other 40% were born with holes in their hearts, causing heart failure and were hopefully waiting for surgery. All 80 infants had severe heart failure with ejection fractions in the 30th percentile (how much blood you can empty out of the heart with each beat). Normal fraction percentage is about 55-60%.

After randomly assigning the children to one of two groups, he gave 40 of the 80 infants 1,000 IU/day of vitamin D and the other 40 infants placebo, being careful to keep using standard heart failure treatment for all the infants. He also measured three kinds of inflammatory molecules, before and after the treatment in both groups of kids. His findings were nothing short of miraculous.

In the vitamin D group, some of the ejection fractions became normal, effectively treating (in conjunction with standard treatment) heart failure in some of the infants by definition. These findings were statistically significant compared to the placebo group. The average ejection fraction went from 36% to 52 % after only three months on vitamin D, clinically and statistically significant compared to placebo plus standard treatment, which increased fraction from 37% to 43%.

In the vitamin D infants, vitamin D levels went from 13 ng/ml to 33 ng/ml, and the authors commented that they probably should have given more than 1,000 IU/day. In addition, the inflammatory molecules did what you’d expect; the vitamin D quelled the inflammation.

So we have a relatively large randomized controlled trial (80 infants is a lot for an infantile heart failure study), published in an excellent journal with serious results. I can’t overstate the importance of this study. This is the kind of study that needs to influence clinical practice. This is the kind of study that doctors all over the world ought to be aware of. This is the kind of study that the press needs to know about.

4 Responses to Infant heart failure and vitamin D supplementation

  1. tierrainc@email.com

    Another study showing the importance of Vitamin D for healthy early developement. I have put together a web site that is trying to educate the Detroit Metro Area about the importance of Vitamin D in reducing risky births. Detroit had the highest percentage of risky births in the US for a large metro area (a report from the Ann E Casey foundation four years ago). I will add this study to the web site, http://www.d4detroit.org. I will be in Washington, DC next week to discuss these issues including the recent reports in this newsletter on rickets and child abuse. HHS reported several weeks ago about the high number of child abuse incidents of children under one years of age compared to older ages and the higher frequency among Medicaid recipeints. I suspect some of these could be rickets.

    • Brant Cebulla

      Thanks for sharing tierrainc.

  2. John

    Wow. This study ought to give a serious push to getting the word out on Vitamin D. Just think of all the little babies who have died or had the most serious surgery a little tyke can have because dermatologists told us to stay out of the sun without first investigating the possible adverse consequences of doing so. Dr. Cannell, I salute you for getting on top of this years ago and helping bring attention to it. That a psychologist like you has had a major insight unknown to others by PAYING ATTENTION, NOTICING, and THINKING about something outside of his specialty confirms what an Australian doctor showed us years ago; that if you’re smart, if you observe, and if you think about what you observe, you can have insights that people in that discipline have not had. The Australian doctor was a GP and got the idea that stomach ulcers were caused by H. pylori bacteria. After successfully CURING, not treating, his ulcer patients with antibiotics, he tested it on himself and almost died as a result. He swallowed a glass of H. pylori, got horribly sick, lay on the floor vomiting blood, called an early halt to his experiment, and was forced to give himself the antibiotic earlier than planned. He recovered quickly. He reported his findings and applied to present his paper at some major medical conference in the US which I’ve forgotten. There were something aboutr 200 applications to speak and present papers there and ALL were approved but his. He was JUST A GP; couldn’t have a clue about something the experts had rejected long before. Everyone KNEW the stomach was too acidic for bacteria to survive. Okay, they didn’t know it, they assumed it. It had never been tested but these experts all agreed and that was that. Well, our Australian hero was right and the experts were wrong. Of course it took a much longer time for the truth to be accepted and disseminated than necessary, and that goes a long way to explain why you have had so much trouble convincing the experts they are wrong. You’re JUST A PSYCHOLOGIST.

  3. hlahore@gmail.com

    Thanks Dr. Cannell for pointing out this excellent article. I had read only the abstract and was not impressed.
    Have made a web page for the study, summarizing the results, graphing the results, suggesting better still that the mother had an adequate vitamin D during pregnancy – so that there would have been less congestive heart failure in the first place.
    Web page also has lots of links to related subjects: mothers, Cardiovascular, etc.
    http://www.vitamindwiki.com/tiki-index.php?page_id=2441

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