Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  29 (2025)
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 27 , ISSUE 7 ( July, 2023 ) > List of Articles

PEDIATRIC CRITICAL CARE MEDICINE

Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience

Surjeet Kumar, Manjinder Singh Randhawa, Manoj Rohit Kumar, Naresh Sachdeva, Muralidharan Jayashree

Keywords : Inotropes, Intensive care units, Pediatric intensive care units, Vitamin D deficiency

Citation Information : Kumar S, Randhawa MS, Kumar MR, Sachdeva N, Jayashree M. Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience. Indian J Crit Care Med 2023; 27 (7):510-514.

DOI: 10.5005/jp-journals-10071-24484

License: CC BY-NC 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: To describe the clinical profile, treatment details, intensive care needs, and long-term outcome of children with dilated cardiomyopathy (DCM) associated with Vitamin D deficiency (VDD). Materials and methods: Case records of 14 children with DCM associated with VDD [25(OH)D3 levels <20 ng/mL] admitted to the pediatric intensive care unit (PICU) of a tertiary care teaching hospital between January 2017 and December 2021 were retrospectively analyzed for clinical features, echocardiographic findings, treatment details, intensive care needs, and outcomes. Results: The median (IQR) age was 6 (2–9) months and 71% (n=10) were males. The common modes of presentation included respiratory distress or failure (78.6%), congestive cardiac failure (71.4%), cardiogenic shock (37.5%), and seizures and encephalopathy (14.3% each). The median (IQR) serum calcium was 8.7 (7–9.5) mg%, ionized calcium 0.7 (0.7–1.1) mmol/L, alkaline phosphatase 343 (316–415) IU/L, phosphate 3.5 (2.6–4.5) mg%, PTH 115 (66–228) pg/mL, and 25(OH)D3 5 (3–7) ng/mL. The median (IQR) left ventricular ejection fraction (LVEF) at admission was 22 (17–25)%. The treatment included intravenous calcium infusion (35.7%), vitamin D supplementation in all (57.1% parenteral and 42.9% oral), mechanical ventilation (35.7%), and vasoactive drugs (57.1%). There was no mortality. The median (IQR) duration of PICU and hospital stay was 76 (31–98) hours and 6 (4.7–10) days, respectively. Out of 14 children, 10 (71.4%) were followed-up till median (IQR) of 10 (7–58) months. All were asymptomatic and had normal LEVF (except one had residual moderate mitral regurgitation). Conclusion: Vitamin D deficiency is a potentially treatable and reversible cause of DCM in children.

HTML PDF Share
  1. Tomar M, Radhakrishnan S, Shrivastava S. Myocardial dysfunction due to hypocalcemia. Indian Pediatr 2010;47(9):781–783. DOI: 10.1007/s13312-010-0117-z.
  2. Maiya S, Sullivan I, Allgrove J, Yates R, Malone M, Brain C, et al. Hypocalcaemia and vitamin D deficiency: An important, but preventable, cause of life-threatening infant heart failure. Heart 2008;94(5):581–584. DOI: 10.1136/hrt.2007.119792.
  3. Sanyal D, Raychaudhuri M. Infants with dilated cardiomyopathy and hypocalcemia. Indian J Endocrinol Metab 2013;17(Suppl 1):S221–S223. DOI: 10.4103/2230-8210.119578.
  4. Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, Perez-Rossello J, et al. Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med 2008;162(6):505–512. DOI: 10.1001/archpedi.162.6.505.
  5. Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, et al. Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013;56(6):692–701. DOI: 10.1097/MPG.0b013e31828f3c05.
  6. Angurana SK, Angurana RS, Mahajan G, Kumar N, Mahajan V. Prevalence of vitamin D deficiency in apparently healthy children in north India. J Pediatr Endocrinol Metab 2014;27(11–12):1151–1156. DOI: 10.1515/jpem-2013-0387.
  7. Puri S, Marwaha RK, Agarwal N, Tandon N, Agarwal R, Grewal K, et al. Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr 2008;99(4):876–882. DOI: 10.1017/S0007114507831758.
  8. Khadilkar A, Kajale N, Oza C, Oke R, Gondhalekar K, Patwardhan V, et al. Vitamin D status and determinants in Indian children and adolescents: A multicentre study. Sci Rep 2022;12(1):16790. DOI: 10.1038/s41598-022-21279-0.
  9. Siddiqee MH, Bhattacharjee B, Siddiqi UR, Rahman MM. High burden of hypovitaminosis D among the children and adolescents in South Asia: A systematic review and meta-analysis. J Health Popul Nutr 2022;41(1):10. DOI: 10.1186/s41043-022-00287-w.
  10. Angurana SK, Mahajan V. Vitamin D deficiency among healthy children in developing countries: An epidemic being recognized. Public Health Nutr 2016;19(8):1526–1527. DOI: 10.1017/S1368980015002487.
  11. Dayal D, Kumar S, Sachdeva N, Kumar R, Singh M, Singhi S. Fall in vitamin D levels during hospitalization in children. Int J Pediatr 2014;2014:291856. DOI: 10.1155/2014/291856.
  12. Kubsad P, Ravikiran SR, Bhat KG, Kamath N, Kulkarni V, Manjrekar PA, et al. Hypovitaminosis D and parathyroid hormone response in critically ill children with sepsis: A case-control study. Indian J Crit Care Med 2021;25(8):923–927. DOI: 10.5005/jp-journals-10071-23913.
  13. Asilioglu N, Cigdem H, Paksu MS. Serum vitamin D status and outcome in critically ill children. Indian J Crit Care Med 2017;21(10):660–664. DOI: 10.4103/ijccm.IJCCM_153_17.
  14. Angurana SK, Guglani V. Severe vitamin D deficiency at admission and shock reversal in children with septic shock. J Intensive Care Med 2018;33(1):56–57. DOI: 10.1177/0885066617714771.
  15. Angurana SK, Guglani V. Vitamin D deficiency in critically ill. Indian J Crit Care Med 2017;21(8):541–542. DOI: 10.4103/ijccm.IJCCM_224_17.
  16. Angurana SK, Attri SV. Is vitamin D deficiency linked to critical illness? Indian Pediatr 2017;54(2):160–161. PMID: 28285297.
  17. Razavi Khorasani N, Moazzami B, Zahedi Tajrishi F, Mohammadpour Z, Rouhi F, Alizadeh-Navaei R, et al. The association between low levels of vitamin D and clinical outcomes in critically-ill children: A systematic review and meta-analysis. Fetal Pediatr Pathol 2020;39(6):503–517. DOI: 10.1080/15513815.2019.1675832.
  18. Brown J, Nunez S, Russell M, Spurney C. Hypocalcemic rickets and dilated cardiomyopathy: Case reports and review of literature. Pediatr Cardiol 2009;30(6):818–823. DOI: 10.1007/s00246-009-9444-z.
  19. Kim BG, Chang SK, Kim SM, Hwang JS, Jung JW. Dilated cardiomyopathy in a 2 month-old infant: A severe form of hypocalcemia with vitamin D deficient rickets. Korean Circ J 2010;40(4):201–203. DOI: 10.4070/kcj.2010.40.4.201.
  20. Gupta P, Tomar M, Radhakrishnan S, Shrivastava S. Hypocalcemic cardiomyopathy presenting as cardiogenic shock. Ann Pediatr Cardiol 2011;4(2):152–155. DOI: 10.4103/0974-2069.84655.
  21. Elidrissy AT, Munawarah M, Alharbi KM. Hypocalcemic rachitic cardiomyopathy in infants. J Saudi Heart Assoc 2013;25(1):25–33. DOI: 10.1016/j.jsha.2012.11.003.
  22. Yilmaz O, Kilic O, Ciftel M, Hakan N. Rapid response to treatment of heart failure resulting from hypocalcemic cardiomyopathy. Pediatr Emerg Care 2014;30(11):822–823. DOI: 10.1097/PEC.0000000000000269.
  23. Velayuthan S, Gungor N, McVie R. Hypocalcemic cardiomyopathy as initial presentation of primary hypoparathyroidism. Pediatr Int 2014;56(4):e23–e25. DOI: 10.1111/ped.12378.
  24. Elidrissy AT, Alharbi KM, Mufid M, AlMezeni I. Rachitic hypocalcemic cardiomyopathy in an infant. J Saudi Heart Assoc 2017;29(2):143–147. DOI: 10.1016/j.jsha.2016.05.001.
  25. Uday S, Fratzl-Zelman N, Roschger P, Klaushofer K, Chikermane A, Saraff V, et al. Cardiac, bone and growth plate manifestations in hypocalcemic infants: Revealing the hidden body of the vitamin D deficiency iceberg. BMC Pediatr 2018;18(1):183. DOI: 10.1186/s12887-018-1159-y.
  26. Tissot C, Singh Y, Sekarski N. Echocardiographic evaluation of ventricular function – For the neonatologist and pediatric intensivist. Front Pediatr 2018;6:79. DOI: 10.3389/fped.2018.00079.
  27. Aryafar M, Kord Varkaneh H, Kathirgamathamby V, Fotovati Z, Mahdavi M, khaleghparast S. Comparison of Vitamin D status between infants with dilated cardiomyopathy and infants with other congenital heart diseases. Iranian Heart J 2022;23(1):160–171.
  28. From Indian Academy of Pediatrics ‘Guideline for Vitamin D, Calcium in Children Committee, Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, et al. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) Guidelines. Indian Pediatr 2017;54(7):567–573. DOI: 10.1007/s13312-017-1070-x.
  29. Gupta P, Dabas A, Seth A, Bhatia VL, Khadgawat R, Kumar P, et al. Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets. Indian Pediatr 2022;59(2):142–158. PMID: 34969941.
  30. Raafat DM, El-Asheer OM, Mahmoud AA, Darwish MM, Osman NS. Vitamin D status in children with ipathic dilated cardiomyopathy. J Child Sci 2021;11(01):e120–e124. DOI: 10.1055/s-0041-1731076.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.