High-dose vitamin D for pediatric short bowel syndrome with vitamin D insufficiency/deficiency

doi:10.3969/j.issn.1674-8115.2026.01.006

Abstract

Abstract:

Objective ·To explore the safety and efficacy of a single high-dose intramuscular injection of vitamin D in children with short bowel syndrome (SBS) complicated by vitamin D insufficiency/deficiency. Methods ·The retrospective study included 32 children with SBS complicated by vitamin D insufficiency/deficiency. When the serum 25-hydroxyvitamin D [25-(OH)D] concentration was lower than 50 nmol/L, a single intramuscular injection of 200 000 IU vitamin D2 was administered. Clinical data, including gender, age, primary disease, remaining length of the small intestine, presence of the ileocecal valve, and colonic integrity, were collected. Skin conditions at the intramuscular injection site and the levels of serum 25-(OH)D, calcium, phosphorus, and alkaline phosphatase before and one month after vitamin D supplementation were recorded. Results ·The median age at enrollment was 5.0 (3.0, 7.0) months. Intestinal atresia and necrotizing enterocolitis were the main causes of SBS, accounting for 28.13% and 21.88%, respectively. The average length of the remaining small intestine was (57.27±24.55) cm. Before vitamin D supplementation, 65.63% (21/32) of children had vitamin D deficiency and 34.38% (11/32) had vitamin D insufficiency. After supplementation, serum 25-(OH)D levels increased significantly compared with baseline (53.10 nmol/L vs. 28.87 nmol/L, P<0.001). In children with vitamin D insufficiency, the serum 25-(OH)D levels increased from 37.30 nmol/L to 58.51 nmol/L (P=0.010), while in those with vitamin D deficiency, the levels increased from 26.91 nmol/L to 44.82 nmol/L (P<0.001). Overall, 62.50% (20/32) of children achieved normal serum 25-(OH)D levels. Moreover, no complications, including vitamin D toxicity, hypercalcemia, skin induration, or local infection, were observed in any of the children. Conclusion ·A single high-dose (200 000 IU) intramuscular injection of vitamin D can safely and effectively improve the vitamin D level in children with SBS complicated by vitamin D insufficiency/deficiency.

Key words: short bowel syndrome (SBS), child, high-dose, vitamin D

CLC Number:

R574

Wu Qingqing, Cao Yi, Lu Lina, Tao Yijing, Feng Haixia, Yan Weihui, Wang Ying. High-dose vitamin D for pediatric short bowel syndrome with vitamin D insufficiency/deficiency[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 54-59.

Figures/Tables 5

TrendMD

References 33

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Brand	Vitamin D/ (×10^-2 µg·mL^-1)	Vitamin D/ (×10^-2 IU·mL^-1)
Alfare	1.01	40.4
Pepti Junior	1.30	52.0
Neocate	1.20	48.0
Alfamino	1.00	40.0
Alfamino Junior	2.00	80.0
Peptamen	1.43	57.2

Brand	Vitamin D/ (×10^-2 µg·mL^-1)	Vitamin D/ (×10^-2 IU·mL^-1)
Alfare	1.01	40.4
Pepti Junior	1.30	52.0
Neocate	1.20	48.0
Alfamino	1.00	40.0
Alfamino Junior	2.00	80.0
Peptamen	1.43	57.2

Item	Total (n=32)	Vitamin D deficiency group (n=21)	Vitamin D insufficiency group (n=11)	P value
Male/n(%)	18 (56.25)	12 (57.14)	6 (54.55)	0.673^①
GA/week	35.83±3.71	36.58±2.56	34.37±5.11	0.202^②
Birth weight/g	2625.17±782.83	2801.90±632.90	2287.73±952.79	0.077^②
Weight/kg	4.20 (3.19, 5.88)	4.20 (3.10, 5.75)	4.20 (3.45, 7.20)	0.696^③
Age/month	5.0 (3.0, 7.0)	3.0 (2.5, 5.5)	7.0 (5.0, 11.0)	0.016^③
Weight-for-age Z score	-3.55±2.25	-3.35±2.19	-3.95±2.43	0.484^②
Remnant small-bowel length/cm	57.27±24.55	53.0±19.10	64.10±31.33	0.270^②
Presence of the entire terminal ileum/n(%)	4 (12.50)	3 (14.29)	1 (9.09)	0.678^①
Presence of the ileocecal valve/n(%)	7 (21.88)	5 (23.81)	2 (18.18)	0.719^①
Presence of the entire colon/n(%)	8 (25.00)	6 (28.57)	2 (18.18)	0.526^①
Primary disease/n(%)				‒
Intestinal atresia	9 (28.13)	5 (23.81)	4 (36.36)
NEC	7 (21.88)	5 (23.81)	2 (18.18)
CSBS	3 (9.38)	2 (9.52)	1 (9.09)
Volvulus	3 (9.38)	1 (4.76)	2 (18.18)
Others	10 (31.25)	8 (38.10)	2 (18.18)

Item	Total (n=32)	Vitamin D deficiency group (n=21)	Vitamin D insufficiency group (n=11)	P value
Male/n(%)	18 (56.25)	12 (57.14)	6 (54.55)	0.673^①
GA/week	35.83±3.71	36.58±2.56	34.37±5.11	0.202^②
Birth weight/g	2625.17±782.83	2801.90±632.90	2287.73±952.79	0.077^②
Weight/kg	4.20 (3.19, 5.88)	4.20 (3.10, 5.75)	4.20 (3.45, 7.20)	0.696^③
Age/month	5.0 (3.0, 7.0)	3.0 (2.5, 5.5)	7.0 (5.0, 11.0)	0.016^③
Weight-for-age Z score	-3.55±2.25	-3.35±2.19	-3.95±2.43	0.484^②
Remnant small-bowel length/cm	57.27±24.55	53.0±19.10	64.10±31.33	0.270^②
Presence of the entire terminal ileum/n(%)	4 (12.50)	3 (14.29)	1 (9.09)	0.678^①
Presence of the ileocecal valve/n(%)	7 (21.88)	5 (23.81)	2 (18.18)	0.719^①
Presence of the entire colon/n(%)	8 (25.00)	6 (28.57)	2 (18.18)	0.526^①
Primary disease/n(%)				‒
Intestinal atresia	9 (28.13)	5 (23.81)	4 (36.36)
NEC	7 (21.88)	5 (23.81)	2 (18.18)
CSBS	3 (9.38)	2 (9.52)	1 (9.09)
Volvulus	3 (9.38)	1 (4.76)	2 (18.18)
Others	10 (31.25)	8 (38.10)	2 (18.18)

Route	Frequency	Total dose/μg
Vitamin D from intramuscular injection	Once	5 000.00
Vitamin D via PN	Daily	66.00 (52.69, 85.88)
Vitamin D via EN	Daily	75.27±38.35