Vitamin D Status After Cardiopulmonary Bypass in Children With Congenital Heart Disease

Deficiency in 25-hydroxyvitamin D (25OHD) is associated with increased morbidity and mortality in the critically ill. Children who underwent surgery for congenital heart disease under cardiopulmonary bypass (CPB) are typically deficient in 25OHD. It is unclear whether this deficiency is due to CPB. We hypothesized that CPB reduces the levels of 25OHD in children with congenital heart disease. We conducted a prospective observational study on children aged 2 months to 17 years who underwent CPB. Serum was collected at 3 time points: immediately before, immediately after surgery, and 24 hours after surgery. 25-Hydroxyvitamin D, 1,25-dihydroxyvitamin D, 1,25(OH)(2)D, vitamin D binding protein, and albumin levels were measured. Levels were compared using repeated measures analysis of variance. We enrolled 20 patients, 40% were deficient in 25OHD with levels <20 ng/mL prior to surgery. Mean (+/- standard deviation) of 25OHD at the 3 time points was 21.3 +/- 8 ng/mL, 19 +/- 5.8 ng/mL, and 19.5 +/- 6.6 ng/mL, respectively (P = .02). The decrease in 25OHD was observed primarily in children with sufficient levels of 25OHD, with mean levels at the 3 time points: 26.8 +/- 4.2 ng/mL, 21.5 +/- 5.7 ng/mL, and 23.0 +/- 4.9 ng/mL, respectively (P < .001). Calculated means of free fraction of 25OHD at the 3 time points were 6.2 +/- 2.8 pg/mL, 5.8 +/- 2.2 pg/mL, and 5.5 +/- 2.4 pg/mL, respectively, (P = .04). Mean levels of 1,25(OH)(2)D were 63.7 +/- 34.9 ng/mL, 53.2 +/- 30.6 ng/mL, and 67.7 +/- 23.5 ng/mL (P = .04). Vitamin D binding protein and albumin levels did not significantly change. Cardiopulmonary bypass decreases 25OHD by reducing the free fraction. Current investigations are geared to establish whether vitamin D deficiency is associated with outcomes and if treatment is appropriate.