title: Vitamin D Levels in Infants With Biliary Atresia: Pre- and Post-Kasai Portoenterostomy.
abstract: Infants with biliary atresia (BA) are at high risk of vitamin D deficiency. We aimed to determine the prevalence and factors influencing vitamin D levels at presentation and post-Kasai portoenterostomy (KPE).
  
  
  
  Single-centre retrospective review of infants with BA who underwent KPE. Pre- and postoperatively 25-hydroxyvitamin D (25-OHVD), liver and bone biochemistry data were collected. 25-OHVD levels <10 and 10 to 20 ng/mL were defined as vitamin D "deficiency" and "insufficiency," respectively.
  
  
  
  One hundred twenty-nine infants with BA (isolated n = 101, developmental n = 28, and white n = 79; non-white n = 50) were included in this study. At presentation, 75 of 92 (81%) were vitamin D deficient and only 1 infant had a level >20 ng/mL. Median 25-OHVD levels were 5(2-23), 17(2-72), 15(2-80), 17(2-69), and 23(2-98) ng/mL at pre-KPE, 1, 4, 6, and 12 months postoperation. There was no difference in 25-OHVD levels between the isolated and developmental groups with BA. Pre-KPE, white infants had significantly higher levels than non-white infants (6[2-23] vs 3[2-14] ng/mL, P = 0.01). Post-KPE 25-OHVD levels correlated well with liver and bone biochemical variables (eg, at 6 months: bilirubin rs = -0.34; P < 0.001, alkaline phosphatase rs = -0.46; P < 0.00001, and phosphate rs = 0.49; P < 0.00001).
  
  
  
  25-OHVD deficiency is invariable at presentation in infants with BA, irrespective of its likely aetiology, and is more severe in non-white infants. Despite routine parenteral and enteral supplementation, low 25-OHVD levels persist post KPE especially in icteric infants. More aggressive vitamin D supplementation and monitoring in this population is paramount.
authors.affiliation: *Department of Paediatric Surgery †Department of Paediatric Hepatology, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ng
authors.forename: Anu
authors.initials: A
authors.lastname: Paul
authors.forename: Naomi
authors.initials: N
authors.lastname: Wright
authors.forename: Nedim
authors.initials: N
authors.lastname: Hadzic
authors.forename: Mark
authors.initials: M
authors.lastname: Davenport
mesh_terms: D001656:Biliary Atresia / Q000097:blood / Q000150:complications / Q000601:surgery*; D015519:Bone Density; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008131:London / Q000453:epidemiology; D008297:Male; D011171:Portoenterostomy, Hepatic; D011184:Postoperative Period; D057234:Preoperative Period; D015995:Prevalence; D012189:Retrospective Studies; D014804:Vitamin B Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D014807:Vitamin D / Q000097:blood*
chemical_list: D014807:Vitamin D