Approaches of pediatricans to vitamin D deficiency and insufficiency

Introduction and Aim: This study aims to identify the approaches of pediatricians toward patients diagnosed with vitamin D deficiency or insufficiency, reveal possible malpractices in pediatricians, and minimize these malpractices by providing necessary training to pediatricians. Material and Method: This survey research was conducted to identify the approaches of pediatricians toward patients diagnosed with vitamin D deficiency or insufficiency. The study was conducted on 185 actively working pediatricians who agreed to participate in the research voluntarily in Adıyaman, Turkey, and surrounding provinces between November 1st, 2022, and February 1st, 2023. Results: A total of 185 pediatricians participated in the study. Among the participants, 100 (54.1%) were female, and 85 (45.9%) were male. The mean age was 36.3±4.8 years. Their number of working years in the profession was 10.4±4.7 years on average. The question "Which tests do you use for the diagnosis of vitamin D deficiency?" was responded as 25(OH)vitamin D by 98.2% of the participants, phosphorus by 88%, calcium by 88%, parathyroid hormone by 62.6%, wrist radiography by 27.5%, magnesium by 5%, 1,25-Dihydroxy-vitamin D by 4.8%. To the question "At what level do you consider vitamin D insufficiency?" 49.7% answered <30 ng/ml, 41.6% answered <20 ng/ml, 5.4% answered <15 ng/ml, 2.2% answered <50 ng/ml and 1.1% answered <5 ng/ml. To the question "At what level do you consider vitamin D deficiency?", 54.6% answered <20 ng/ml, 29.2% <15 ng/ml, 9.7% <30 ng/ml, 2.7% <50 ng/ml, 2.2% <5 ng/ml, 1.1% <12 ng/ml, and 0.5% <10 ng/ml. To the question "When is the best time for sun exposure to synthesize vitamin D through the skin?", 139 (75.1%) of the participants answered between 10:00-15:00, 28 (15.1%) answered 15:00-17:00, 16 (8.6%) answered 07:00-10:00, and 2 (1.1%) answered 10:00-12:00. To the question "Which preparation do you prefer for treatment?", 159 (85.9%) answered drops, 24 (13%) ampoules, and 2 (1.1%) answered pills. To the question "How do you treat vitamin D deficiency or insufficiency?" 90 (48.6%) answered 1000- 2000 IU/day for 6 weeks, 47 (25.4%) answered 2000-5000 IU/day for 6 weeks, 26 (14.1%) answered 50000 IU/day once a week for 6 weeks, 18 (9.7%) answered Stoss therapy (150000-300000 IU/day), and 2 participants (1.1%) responded that the treatment depends on age. To the question "In which cases do you prefer parenteral treatment?", 54 (29.2%) answered "Patients with malabsorption", and 29 (15.3%) answered as "I never used". To the question "In which cases do you administer D vitamin treatment in a hospital setting?", 58 participants (31.4%) answered "If there are symptoms", and 29 (15.7%) answered "If there were symptoms and there was no family compliance." To the question "To which patients do you recommend vitamin D prophylaxis?", 181 participants (97.4%) answered "Patients < 1-year-old", 146 (78.5%) answered "Those with chronic diseases", 130 (70%) answered "Those living in a high-risk geography", and 116 (62.4%) answered "Those with chronic drug use". To the question "In which cases of vitamin D deficiency would you refer the patient to an advanced institution?", 67 participants (36.2%) answered "In case of non- response to treatment and if symptomatic (rickets)", 34 (18.4%) answered "In case of non-response to treatment", and 29 participants (15.7%) answered "If symptomatic (rickets)." To the question "When do you reassess the patient?", 106 (57.3%) answered "After 3 months", and 52 (28.1%) answered "After 1 month". To the question "Is it necessary to discontinue vitamin D prophylaxis in children with early fontanelle closure?", 168 (90.8%) answered "No", and 17 (9.1%) answered "Yes". To the question, "How long do you recommend vitamin D prophylaxis?", 37 participants (20%) answered "3 months", 30 (16.1%) answered "1 year", and 17 (8.8%) answered "up to 1 year of age". Conclusion: In this study, responses regarding the practices of pediatricians reflect their self-reports rather than actual practices. However, the frequency of vitamin D supplementation recommended by the pediatricians who participated in our study is subjected to selection bias, recall bias, and reporting biases, which are among the limitations inherent to any scale. Keywords: Vitamin D deficiency, Vitamin D insufficiency, Pediatricians