الفهرس 
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Abstract
Dissertation Abstract : Background : Vitamin D deficiency has been reported to be widely prevalent in critically ill children from ICUs worldwide. According to the studies, the prevalence of vitamin D deficiency has ranged anywhere from 30 to 70 %. Although one would expect that in the tropics with greater sun exposure, vitamin D deficiency would be less as compared to that from the temperate regions of the world, the prevalence reported from the tropical countries is similar. Whether vitamin D deficiency affects illness severity and clinical outcomes has been the subject of much debate in the pediatric as well as the adult population. While in few of these studies, it has been associated with greater illness severity at presentation, increased need for inotropes, mechanical ventilation, duration of stay and even mortality. A handful of studies have investigated vitamin D supplementation in ICU patients. The aim of the work: to evaluate the effect of vitamin D supplementation on clinical improvement and outcome of critically ill children. Type of study : Prospective cohort study. Materials and Methods: Our study was conducted in MUCH on 30 critically ill children admitted to PICU to estimate the effect of vitamin D supplementation on their clinical condition and outcome, the study also included control group formed of 30 healthy children came to general clinic of MUCH for routine follow up or minor illness. Samples of Ca, Ph, ALK, and vitamin D were taken from the children of the control group and were estimated at the lab of MUCH. All the children of patient group were given a daily dose of 1400 IU of cholecalciferol for 3 months starting from day of admission. Serum levels of Ca, Ph, Alk and vitamin D were estimated for patient group at day of admission and 3 months after. Results: 56.7% of the patient group were vitamin D deficient at time of admission to PICU. 43.3% of the patient group were hypocalcemic and 63.3% were hypophosphatemic at time of admission to PICU. PRISM III score was calculated at time of admission and after 3 months, length of PICU stay was counted at day of discharge and outcome was documented either as died or discharged. Patient and control groups were matched as regarding age and sex. There was no significant relation between vitamin D level and PRISM score at admission, length of PICU stay or outcome. Our results showed a significant increase in levels of Ca, Ph, Alk and vitamin D after supplementation with vitamin D for 3 months, it also showed a significant relation between improvement of level of vitamin D and PRISM III score after 3 months. Five children of the patient group have died, they had a significant higher length of PICU stay and lower level of vitamin D after 3 months compared to the discharged children. Conclusion: Vitamin D deficiency is common among critically ill children as well as hypocalcemia and hypophosphatemia, Supplementation of critically ill children with vitamin D is associated with improvement of their clinical condition. Recommendations: Screening of vitamin D status should be done among all children admitted to PICU. Vitamin D is modifiable risk factor affecting clinical condition in children admitted to PICU, so it can be used as an adjuvant therapy in those patients. Further randomized control studies with appropriately powered sample size to assess long term effect of vitamin D supplementation on clinical condition and outcome are warranted.