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Results Overview

Observational Studies

Dr. McNally has lead two observational studies to look at vitamin D status in critical illness. The first study measured vitamin D levels in 326 children in 6 PICUs across Canada and found that 70% of children had vitamin D levels that were too low. Low vitamin D levels were associated with worse clinical outcomes. The second, a prospective longitudinal study, looked at vitamin D levels in children after heart surgery. This study showed that 85% of children have vitamin D levels that are too low following heart surgery. Vitamin D levels right after surgery were associated with a greater need for cardiovascular support.
 

 
Systematic reviews of published pediatric trials

To identify the best vitamin D doses to use in clinical trials in PICU, we identified all clinical trials (n>150) of high-dose vitamin D in children as part of a systematic review. These trials were used to evaluate how different dosing regimens affect vitamin D status, and confirmed that approved daily high-dose regimens require more than a month to bring low vitamin D levels back to normal. This review also showed that it was possible to normalize levels over a 48 to 72 hour period with a single loading dose of vitamin D (> 40000 IU), and that a dose based on weight would help prevent both under and over dosing.


Pilot Clinical Trial in Congenital Heart Disease
 
Dr. McNally designed a pilot clinical trial of vitamin D supplementation to determine whether pre-operative daily vitamin D supplementation, at Health Canada approved daily upper tolerable intake level, can safely prevent low vitamin D levels in children following heart surgery. Enrollment was completed in 2015. 
 


Pilot Randomized Controlled Trial of High Dose Vitamin D in Critically Ill Children

Dr. McNally designed a pilot dose evaluation clinical trial of high dose vitamin D supplementation to determine if high-dose vitamin D can safely and rapidly restore vitamin D levels in critically ill children within 7 days.. Enrollment was completed in November 2017.



Systematic review of pediatric observational studies

Dr. McNally and his team recently completed a systematic review and meta-analysis of observations studies in the pediatric intensive care unit. They found that approximately 50% of critically ill children have vitamin D deficiency at the time of PICU admission. They also found that vitamin D deficiency was associated with more severe illness, multiple organ dysfunction, and mortality in the PICU setting.
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