TY - JOUR
T1 - Analytical Unreliability of 25 Hydroxy Vitamin D Measurements in Pre-Term Neonates
AU - Miller, Jessica J.
AU - Augustin, Roy
AU - Sepiashvili, Lusia
AU - Singh, Ravinder J.
AU - Bro, Eric
AU - Weishuhn, Karen
AU - Kotsopoulos, Kirsten
AU - Brennan, Joan
AU - Diambomba, Yenge
AU - Higgins, Victoria
AU - Nichols, Matthew
AU - Kulasingam, Vathany
AU - Beriault, Daniel R.
AU - Yip, Paul M.
AU - Taher, Jennifer
N1 - Publisher Copyright:
© 2023 American Association for Clinical Chemistry. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Background: Vitamin D supplementation is common practice for neonates and infants due to limited stores of vitamin D at birth. Although not commonly encountered, vitamin D toxicity can occur due to over-supplementation. However, toxic concentrations are often not included in method validation experiments, and assays often are not validated in the neonatal population. Methods: We compared serial 25 hydroxy vitamin D [25(OH)D] measurements in pre-term neonates receiving 25(OH)D supplementation and identified 12 patients wherein concentrations of 25(OH)D were above 50 ng/mL (125 nM) that required additional investigations as the 25(OH)D results did not match the clinical picture. Available samples were compared across 4 immunoassay platforms (LIAISON XL, Roche Cobas e602, Abbott Alinity i, and Siemens Centaur XP) and LC-MS/MS. Results: Concentrations of 25(OH)D observed on one individual immunoassay platform (LIAISON XL) fluctuated substantially between subsequent blood draws in select neonates with elevated concentrations. Serum samples from these patients showed variable agreement between LC-MS/MS and other immunoassay platforms. These fluctuations were not explained by the presence of 3-epimer-25(OH)D or 24,25(OH)2D. Conclusions: Although we were unable to identify a cause for the variable elevated results, our findings suggest that neonatal 25(OH)D measurements alone should not be used for assessment of nutritional monitoring, and that clinical correlation and other laboratory parameters including ionized calcium should be considered.
AB - Background: Vitamin D supplementation is common practice for neonates and infants due to limited stores of vitamin D at birth. Although not commonly encountered, vitamin D toxicity can occur due to over-supplementation. However, toxic concentrations are often not included in method validation experiments, and assays often are not validated in the neonatal population. Methods: We compared serial 25 hydroxy vitamin D [25(OH)D] measurements in pre-term neonates receiving 25(OH)D supplementation and identified 12 patients wherein concentrations of 25(OH)D were above 50 ng/mL (125 nM) that required additional investigations as the 25(OH)D results did not match the clinical picture. Available samples were compared across 4 immunoassay platforms (LIAISON XL, Roche Cobas e602, Abbott Alinity i, and Siemens Centaur XP) and LC-MS/MS. Results: Concentrations of 25(OH)D observed on one individual immunoassay platform (LIAISON XL) fluctuated substantially between subsequent blood draws in select neonates with elevated concentrations. Serum samples from these patients showed variable agreement between LC-MS/MS and other immunoassay platforms. These fluctuations were not explained by the presence of 3-epimer-25(OH)D or 24,25(OH)2D. Conclusions: Although we were unable to identify a cause for the variable elevated results, our findings suggest that neonatal 25(OH)D measurements alone should not be used for assessment of nutritional monitoring, and that clinical correlation and other laboratory parameters including ionized calcium should be considered.
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U2 - 10.1093/jalm/jfad033
DO - 10.1093/jalm/jfad033
M3 - Article
C2 - 37473432
AN - SCOPUS:85169998808
SN - 2576-9456
VL - 8
SP - 856
EP - 870
JO - Journal of Applied Laboratory Medicine
JF - Journal of Applied Laboratory Medicine
IS - 5
ER -