A 20-month-old girl born premature was diagnosed with necrotizing enterocolitis and underwent small-bowel resection. She also suffered total parenteral nutrition (TPN)-induced liver failure and received a liver transplant. The patient continues to be hospitalized for feeding intolerance, which is slowly improving. She remains on TPN and receives lipids and minute amounts of breast milk via a feeding tube. Her gross motor skills are improving, but she cannot bear weight or pull herself up to a standing position. I am concerned about osteoporosis secondary to organ transplant, TPN, and steroid therapy. The patient’s calcium levels are within normal limits. There are no signs or symptoms of vitamin C deficiency. Should vitamin D levels be obtained?
—DEBBIE POPOVICH, MSN, ARNP, CPNP, Gainesville, Fla.

Vitamin D deficiency is common in children with osteoporosis and osteopathic findings secondary to chronic illness. Levels should be monitored and supplementation provided at or above the American Academy of Pediatrics-recommended guidelines of 400 mg/day (Pediatrics. 2008;122:1142-1152). The best indicator of total body stores of vitamin D is serum concentration of 25-hydroxyvitamin D. Studies are still needed to determine the effect of vitamin D supplementation on bone mineral density in children with osteopenia or osteoporosis (Pediatrics. 2008;121:e1585-e1590).
—Julee B. Waldrop, MS, PNP (124-3)