This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Our main goal is to improve the skeletal health of children with cerebral palsy (CP), a population with a high lifetime risk of fractures. In this study we seek pilot funding to examine the prevalence of vitamin D (vit D)insufficiency and deficiency in children with CP in the greater Hartford area. This is a necessary step before a planned intervention trial of vit D in children with CP. Vit D sufficiency is a requirement for normal bonemineralization, and plays roles in muscle strength, regulation of cell differentiation and immune function. Consequently, it is desireable to prevent vit D insufficiency/deficiency in children in general. Children with CPmay be at higher risk for vit D deficiency because of limited exposure to unfiltered sunlight, impaired nutrition because of swallowing dysfunction and use of anticonvulsants that increase vit D breakdown. In addition, vitD deficiency is more prevalent in Northern latitudes, even among healthy children. In consequence, children with CP in the greater Hartford area may be at particular risk for vit D insufficiency/deficiency. However, there are no prevalence data concerning the sufficiency of vit D stores in children with CP in our geographical area. Our anecdotal clinical experience indicates that children with CP frequently have reduced serum 25 (OH) vit D, an indicator of vit D reserves. Therefore, we hypothesize that children with CP in the Hartford area have a higher prevalence of vit D deficiency than healthy children. To test this hypothesis, we aim to measure serum 25 (OH) vit D in children with CP and their unaffected, healthy siblings living in the same household. Seasonal differences will be examined, since vit D stores tend to decrease in colder, dimmer months. We will invite children with CP who are followed at the Special Kids Support Center (SKSC) at the Connecticut Children's Medical Center (CCMC) to participate. These children are well characterized clinically, including use ofanticonvulsants. Multiple clinical specialists will assess these children. Children with CP will have motor function assessment during the study visit at SKSC and a clinical nutritionist will obtain data on calcium and vit D intake. The PI will exclude primary and secondary bone diseases. Children with vit D deficiency will be treated with oral vit D. This screening study will provide pilot data for a subsequent intervention trial that aims to find the optimal dose of enteral vit D to restore normal vit D status in children wit CP. Timely identification and treatment of vit D deficiency will improve bone health in these fragile individuals.
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