Article Figures & Data
Figures
- Figure 1.
Proportion of Clinicians Who Would Recommend High-Dose Vitamin D Supplementation of the Mother, Direct Supplementation of the Infant, or Both Options If Each Provided Adequate Vitamin D Status in the Infant and Both Were Safe. Abbreviations: IC, infant-only clinicians; MIC, mother-and-infant clinicians.
Tables
IC (n = 168) MIC (n = 192) Total (n = 360) P-Value Gender 0.99 Female 129 (76.8%) 147 (76.6%) 276 (76.7%) Male 37 (22.0%) 43 (22.4%) 80 (22.2%) Prefer not to answer 2 (1.2%) 2 (1.0%) 4 (1.1%) Age (years) 0.16 Missing 0 1 1 18 to 29 25 (14.9%) 14 (7.3%) 39 (10.9%) 30 to 39 75 (44.6%) 94 (49.2%) 169 (47.1%) 40 to 49 38 (22.6%) 45 (23.6%) 83 (23.1%) 50 to 59 21 (12.5%) 29 (15.2%) 50 (13.9%) 60 to 69 9 (5.4%) 7 (3.7%) 16 (4.5%) 70+ 0 (0.0%) 2 (1.0%) 2 (0.6%) Level of training <0.001 Midwife (RN only) 0 (0.0%) 6 (3.1%) 6 (1.7%) Nurse Practitioner 14 (8.3%) 35 (18.2%) 49 (13.6%) Other (specify) 1 (0.6%) 5 (2.6%) 6 (1.7%) Physician Assistant 2 (1.2%) 16 (8.3%) 18 (5.0%) Physician, fellow 1 (0.6%) 1 (0.5%) 2 (0.6%) Physician, practicing 112 (66.7%) 106 (55.2%) 218 (60.6%) Physician, resident 38 (22.6%) 23 (12.0%) 61 (16.9%) Clinician type <0.001 Nurse Practitioner/Midwife 14 (8.3%) 41 (21.4%) 55 (15.3%) Physician 151 (89.9%) 130 (67.7%) 281 (78.1%) Other 3 (1.8%) 21 (10.9%) 24 (6.7%) Year in residency 0.54 N/A 131 169 300 First year 11 (29.7%) 5 (21.7%) 16 (26.7%) Second year 15 (40.5%) 8 (34.8%) 23 (38.3%) Third year or greater 11 (29.7%) 10 (43.5%) 21 (35.0%) Years in practice 0.23 Missing 39 24 63 Less than 5 years 31 (24.0%) 57 (33.9%) 88 (29.6%) 5 to 9 years 35 (27.1%) 43 (25.6%) 78 (26.3%) 10 to 19 years 35 (27.1%) 33 (19.6%) 68 (22.9%) 20 years or more 28 (21.7%) 35 (20.8%) 63 (21.2%) Primary practice Family Medicine 0 (0.0%) 160 (83.3%) 160 (44.4%) Neonatology 7 (4.2%) 0 (0.0%) 7 (1.9%) Newborn Nursery 10 (6.0%) 0 (0.0%) 10 (2.8%) Obstetrics/Gynecology 0 (0.0%) 26 (13.5%) 26 (7.2%) Primary Care Pediatrics 144 (85.7%) 0 (0.0%) 144 (40.0%) Other (specify) 7 (4.2%) 6 (3.1%) 13 (3.6%) Additional training in lactation medicine 0.03 Missing 0 2 2 No 132 (78.6%) 166 (87.4%) 298 (83.2%) Yes 36 (21.4%) 24 (12.6%) 60 (16.8%) Country of practice 0.04 United States 168 (100.0%) 187 (97.4%) 355 (98.6%) Other 0 (0.0%) 5 (2.6%) 5 (1.4%) Have own children 0.01 No 48 (28.6%) 32 (16.7%) 80 (22.2%) Yes 120 (71.4%) 160 (83.3%) 280 (77.8%) Clinician/partner provided breast milk to own infant 0.29 Missing 49 33 82 Not applicable 3 (2.5%) 1 (0.6%) 4 (1.4%) No 4 (3.4%) 9 (5.7%) 13 (4.7%) Yes 112 (94.1%) 149 (93.7%) 261 (93.9%) Clinician supplemented own infant or self/partner for the purpose of supporting own infant’s supplementation needs with vitamin D 0.56 Missing 49 32 81 Not applicable 2 (1.7%) 2 (1.3%) 4 (1.4%) Unsure 3 (2.5%) 6 (3.8%) 9 (3.2%) No 25 (21.0%) 44 (27.5%) 69 (24.7%) Yes 89 (74.8%) 108 (67.5%) 197 (70.6%) Age of your youngest child 0.59 Missing 49 32 81 Less than 13 years old 91 (76.5%) 113 (70.6%) 204 (73.1%) 13 to 18 years old 9 (7.6%) 19 (11.9%) 28 (10.0%) 19 to 30 years old 16 (13.4%) 25 (15.6%) 41 (14.7%) 31 to 40 years old 3 (2.5%) 3 (1.9%) 6 (2.2%) Abbreviations: IC, infant-only clinicians; MIC, mother-and-infant clinicians.
- Table 2.
Current Vitamin D Supplementation Prescribing Practices of Infant-Only Clinicians and Clinicians Who Care for Mothers and Infants
IC (n = 168) MIC (n = 192) Total (n = 360) P-Value Times have you seen a child with nutritional rickets <0.001 0 87 (51.8%) 184 (95.8%) 271 (75.3%) 1 to 2 54 (32.1%) 8 (4.2%) 62 (17.2%) 3 to 5 18 (10.7%) 0 (0.0%) 18 (5.0%) 6 to 10 6 (3.6%) 0 (0.0%) 6 (1.7%) 11 or more 3 (1.8%) 0 (0.0%) 3 (0.8%) Times have you seen a child with vitamin D toxicity 0.002 0 148 (88.1%) 189 (98.4%) 337 (93.6%) 1 to 2 16 (9.5%) 2 (1.0%) 18 (5.0%) 3 to 5 1 (0.6%) 1 (0.5%) 2 (0.6%) 6 to 10 1 (0.6%) 0 (0.0%) 1 (0.3%) 11 or more 2 (1.2%) 0 (0.0%) 2 (0.6%) How often you recommend vitamin D supplementation to exclusively breastfed infants? Median (IQR) 100 (100, 100) 100 (90, 100) 100 (95, 100) <0.001 How often you recommend vitamin D supplementation to partially breastfed infants or infants receiving less than 1000 mL of formula daily? Median (IQR) 90 (60.5, 100) 80 (30, 100) 84 (50, 100) 0.005 Why do you recommend vitamin D supplementation? Missing 1 15 16 To follow guideline recommendations 161 (96.4%) 161 (91.0%) 322 (93.6%) 0.04 Because vitamin D deficiency occurs in the region where I practice 73 (43.7%) 78 (44.1%) 151 (43.9%) 0.95 To prevent rickets 102 (61.1%) 57 (32.2%) 159 (46.2%) <0.001 Other 8 (4.8%) 4 (2.3%) 12 (3.5%) 0.20 Why do you not recommend vitamin D supplementation? Missing 168 179 347 I am not aware of any guideline recommendations to do so 4 (30.8%) 4 (30.8%) I have other priorities during the infant visit 1 (7.7%) 1 (7.7%) Breastfed infants can get vitamin D from mothers who take adequate vitamin D 2 (15.4%) 2 (15.4%) Other 9 (69.2%) 9 (69.2%) How do you recommend vitamin D supplementation be given? Missing 0 16 16 To infants via vitamin D drops 161 (95.8%) 158 (89.8%) 319 (92.7%) 0.03 To breastfeeding mothers via a prenatal vitamin only 3 (1.8%) 19 (10.8%) 22 (6.4%) <0.001 To breastfeeding mothers in doses higher than in a prenatal vitamin 32 (19.0%) 47 (26.7%) 79 (23.0%) 0.09 I discuss infant and maternal supplementation options and let the parents/caregivers choose 37 (22.0%) 61 (34.7%) 98 (28.5%) 0.009 I do not recommend vitamin D supplementation, but I encourage regular sunlight exposure 0 (0.0%) 2 (1.1%) 2 (0.6%) 0.17 Other 2 (1.2%) 5 (2.8%) 7 (2.0%) 0.28 Abbreviations: IC, infant-only clinicians; MIC, mother-and-infant clinicians; IQR, interquartile ratio.
- Table 3.
Vitamin D Supplementation Prescribing Preferences of Infant-Only Clinicians and Clinicians Who Care for Mothers and Infants
IC (n = 168) MIC (n = 192) Total (n = 360) P-Value If supplementing the mother or the infant each provided adequate vitamin D status in the infant and both were safe, which option do you think most parents/caregivers would prefer? 0.002 Supplementation of the infant 25 (14.9%) 14 (7.3%) 39 (10.8%) Supplementation of the mother 76 (45.2%) 121 (63.0%) 197 (54.7%) Both options would be equally preferred 67 (39.9%) 57 (29.7%) 124 (34.4%) Which option would lead to greater adherence? 0.005 Missing 0 1 1 Supplementation of the infant 35 (20.8%) 25 (13.1%) 60 (16.7%) Supplementation of the mother 83 (49.4%) 127 (66.5%) 210 (58.5%) Both options would lead to equal adherence 50 (29.8%) 39 (20.4%) 89 (24.8%) Which option would most likely promote breastfeeding? 0.002 Missing 1 0 1 Supplementation of the infant 6 (3.6%) 8 (4.2%) 14 (3.9%) Supplementation of the mother 61 (36.5%) 105 (54.7%) 166 (46.2%) Both options would equally promote breastfeeding 100 (59.9%) 79 (41.1%) 179 (49.9%) Which option would you recommend to families? 0.007 Supplementation of the infant 36 (21.4%) 23 (12.0%) 59 (16.4%) Supplementation of the mother 15 (8.9%) 34 (17.7%) 49 (13.6%) I would offer both and let the parent/caregiver choose 117 (69.6%) 135 (70.3%) 252 (70.0%) Abbreviations: IC, infant-only clinicians; MIC, mother-and-infant clinicians.
