Abstract
ABSTRACT: Infants with extrahepatic biliary atresia (EHBA) commonly develop rickets in infancy, whereas long-term survivors with EHBA commonly develop osteopenia with increasing age. We evaluated baseline vitamin D (D2 and D3), 25-OH vitamin D2 and D3, 1,25(OH)2 vitamin D, bone mineral content, and vitamin D2 and 25- OH vitamin D3 absorption in six infants and children (age 4-22 mo) with EHBA whose portoenterostomy failed to produce bile flow (group 1) and five infants and children (age 10/12 to 8-4/12 y) with EHBA whose portoenterostomy repair led to good postoperative bile flow (group 2). Baseline serum vitamin D2 and D3 were undetectable in all subjects in group 1 despite supplements of 2500-5000 IU/day, whereas all group 2 subjects given supplements (doses 400-5000 IU/d) had measurable levels. Baseline serum 25-OH vitamin D was less than 15 ng/mL in five of six (three with rickets) in group 1, whereas only one in group 2 had concentrations less than 15 ng/mL. A significantly blunted rise of vitamin D2 above baseline and reduced area under the absorption curve after 1000 IU/kg vitamin D2 were found in group 1 patients compared to group 2 (both p < 0.01), and five pediatric controls (both p < 0.01). The peak change and area under the absorption curve for serum 25-OH vitamin D3 from baseline after 10μg/kg 25-OH vitamin D3 were significantly reduced for group 1 (both at least p < 0.05) and group 2 compared to controls (both p < 0.05). Malabsorption of supplemental doses of vitamin D compromises their efficacy to prevent rickets in infants with EHBA with poor bile flow after portoenterostomy. Despite severe malabsorption of vitamin D, we suggest that oral 25-OH vitamin D may be absorbed sufficiently to prevent rickets.
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Heubi, J., Hollis, B. & Tsang, R. Bone Disease in Chronic Childhood Cholestasis II. Better Absorption of 25-OH Vitamin D than Vitamin D in Extrahepatic Biliary Atresia. Pediatr Res 27, 26–31 (1990). https://doi.org/10.1203/00006450-199001000-00006
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DOI: https://doi.org/10.1203/00006450-199001000-00006