Infant heart failure and vitamin D supplementation

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, 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.

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