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Mohamed SA, Kamel NR, Fouda AE, Elhawary RE, Abdelmegeid MA. Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study. Ital J Pediatr 2024; 50:101. [PMID: 38762477 PMCID: PMC11102628 DOI: 10.1186/s13052-024-01665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/28/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Sepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country. METHODS This case-control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture. RESULTS Forty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml). CONCLUSION In the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).
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Affiliation(s)
- Shereen A Mohamed
- Pediatrics Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Nermin R Kamel
- Pediatrics Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aya E Fouda
- Pediatrics Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rabab E Elhawary
- Clinical Pathology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Abdelmegeid
- Pediatrics Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Darnifayanti D, Rizki DR, Amirah S, Abdurrahman MF, Akmal M, Abdulmadjid SN, Yusuf S, Iqhrammullah M. Association between vitamin D receptor gene variants and neonatal sepsis: A systematic review and meta-analysis. J Infect Public Health 2024; 17:518-526. [PMID: 38306913 DOI: 10.1016/j.jiph.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/27/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024] Open
Abstract
The objective of this systematic review and meta-analysis was elucidating the association of VDR SNPs (FokI, TaqI, BsmI, BgII, and ApaI) with neonatal sepsis. Literature search was performed to retrieve records published until August 2nd, 2023 (PROSPERO registration: CRD42023451355). Meta-analysis was carried out to determine the pooled estimates for Odds Ratio (OR). A total of four studies were included with 500 neonates (250 sepsis cases and 250 healthy controls). There was an association observed between TaqI SNP with neonatal sepsis for CT vs. CC+TT (OR=1.95) and TT vs CT+CC (OR=0.40). Moreover, the pooled estimates also suggested that CC vs. CT+TT (OR= 0.37) and C vs. T (OR=0.66) of FokI SNP were significantly associated with neonatal sepsis. SNP of BgII was found to be significantly associated with neonatal sepsis, but only reported in a single study.
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Affiliation(s)
- Darnifayanti Darnifayanti
- Graduate School of Mathematics and Applied Sciences, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; Pediatric Department, Hospital of dr. Zainoel Abidin, Banda Aceh 24415, Indonesia; Pediatric Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia.
| | - Diva Rayyan Rizki
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia.
| | - Shakira Amirah
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
| | | | - Muslim Akmal
- Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia.
| | - S N Abdulmadjid
- Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh 23243, Indonesia.
| | - Sulaiman Yusuf
- Pediatric Department, Hospital of dr. Zainoel Abidin, Banda Aceh 24415, Indonesia; Pediatric Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia.
| | - Muhammad Iqhrammullah
- Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh 23123, Indonesia.
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Abdelmaksoud SR, Mostafa MAA, Khashaba RA, Assar E. Lower Vitamin D Level as a Risk Factor for Late Onset Neonatal Sepsis: An Observational Case-Control Study. Am J Perinatol 2024; 41:143-149. [PMID: 34839468 DOI: 10.1055/s-0041-1740074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the relation of neonatal and maternal vitamin D and late-onset sepsis (LOS). STUDY DESIGN One-hundred twenty term neonates along with their mothers were enrolled in this case-control study. Sixty neonates who were admitted in the neonatal intensive care unit by LOS and had not been previously admitted for last 48 hours and did not receive antibiotics or vitamin D were enrolled as cases (sepsis) group. On the other hand, 60 healthy term neonates were referred as control group. Maternal and neonatal serum 25-OH vitamin D levels were assessed in both the cohorts. RESULTS Maternal and neonatal 25-OH vitamin D levels in cases (17.2 and 16.1 ng/mL, respectively) were significantly lower than in controls (22.7 and 21 ng/mL, respectively) p = 0.001. In the study group, the neonatal 25-OH vitamin D was negatively correlated with C-reactive protein and length of hospital stay (r = -0.616 and -0.596, respectively) p <0.001 for both. With a cut-off value of 12.9 ng/mL, the specificity and positive predictive value of neonatal vitamin D were 83.3 and 74.4%, respectively. The odds ratio was 1.088 (95% CI = 1.034-1.144)) for LOS in vitamin D-deficient neonates. CONCLUSION Neonates with higher vitamin D level are at lower risk of LOS than those with vitamin D deficiency. Maternal vitamin D correlates with neonatal vitamin D. These data suggest that maternal vitamin supplementation during pregnancy may lower the risk of LOS. KEY POINTS · Neonatal and maternal vitamin D deficiency increase risk of LOS.. · Neonatal vitamin D correlates with maternal vitamin D.. · Neonatal vitamin D is independent predictor for LOS..
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Affiliation(s)
| | | | - Rana Atef Khashaba
- Department of Clinical Pathology and Chemistry, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Effat Assar
- Department of Pediatrics, Benha Faculty of Medicine, Benha University, Benha, Egypt
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Laborie S, Bonjour M, Bacchetta J, Mauras M, Butin M. Is 25OH Vitamin D Excess before 36 Weeks Corrected Age an Independent Risk Factor for Bronchopulmonary Dysplasia or Death? Nutrients 2023; 15:4423. [PMID: 37892498 PMCID: PMC10610390 DOI: 10.3390/nu15204423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Low 25-Hydroxyvitamin D (25(OH)D) in preterm infants is a risk factor for bronchopulmonary dysplasia (BPD), but increased supplementation failed to demonstrate a beneficial effect on BPD. In neonatal animal models, deficiency and excessive vitamin D exposure have been associated with increased mortality and histological alterations in the lung evocative of BPD. Our hypothesis is that 25(OH)D levels ≥ 120 nmol/L are also a risk factor for BPD or death. This retrospective single-center cohort study included only infants born at <31 weeks gestational age without major malformations with at least a determination of 25(OH)D at <36 weeks corrected age and no determination <50 nmol/L. Routine 25(OH)D determination was performed at 1 month and monthly thereafter. A total of 175 infants were included. Infants with BPD or who died had a significantly lower term and weight, but a similar frequency of 25(OH)D ≥120 nmol/L (50.5% vs. 43.9%, p = 0.53). The logistic regression identified weight (OR 0.997, 95% CI [0.995-0.998]) and term (OR 0.737, 95% CI [0.551-0.975]) as significantly associated with BPD or death; the occurrence of excessive 25(OH)D was not significantly associated (OR 1.029, 95% CI [0.503-2.093]). The present study did not demonstrate any significant association between excessive 25(OH)D after one month of age and BPD or death.
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Affiliation(s)
- Sophie Laborie
- Service de Réanimation Néonatale et Néonatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France;
| | - Maxime Bonjour
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France;
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69373 Lyon, France;
| | - Justine Bacchetta
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69373 Lyon, France;
- Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France
- INSERM 1033, Prévention des Maladies Osseuses, 69372 Lyon, France
| | - Mathilde Mauras
- Service Pédiatrie B, Hôpital Nord, CHU de Saint-Etienne, 42270 Saint Priest en Jarez, France;
| | - Marine Butin
- Service de Réanimation Néonatale et Néonatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France;
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69373 Lyon, France;
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon, 69365 Lyon, France
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Taiorazova GB, Alimbayeva AR, Tanatarov SZ, Smailova ZK. A Modern Look at the Development of Intrauterine Pneumonia in Premature Newborns: Literature Review. Respir Physiol Neurobiol 2023; 314:104073. [PMID: 37178744 DOI: 10.1016/j.resp.2023.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Infectious diseases such as malaria, pneumonia, diarrhea and preventable neonatal diseases are common causes of death in children. Globally, neonatal mortality is 44% (2.9 million) annually, with up to 50% of babies dying within the first day of life. Pneumonia kills between 750000 and 1.2 million infants in the neonatal period each year in developing countries. Premature birth, pneumonia, and labor complications are common causes of neonatal mortality. The objective of the study is to present the general characteristics of congenital pneumonia, vitamin D deficiency and micronutrient deficiencies in premature infants. To date, numerous studies confirm the relationship between the inadequate supply of the body with macro- and microelements and the development of diseases of varying severity, including metabolic disorders. Based on this, primary screening, aimed at identifying metabolic disorders of macro- and microelements and further drug correction, should become the main concept for the management of patients in modern times.
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Affiliation(s)
- Gulnara B Taiorazova
- Department of Pediatrics and Medical Rehabilitation named after D.M. Tusupova, Semey Medical University, Semey, Republic of Kazakhstan.
| | - Aliya R Alimbayeva
- Department of Pediatrics and Medical Rehabilitation named after D.M. Tusupova, Semey Medical University, Semey, Republic of Kazakhstan
| | - Sayat Z Tanatarov
- Department of Аnesthesiology, Resuscitation and Narcology, Semey Medical University, Semey, Republic of Kazakhstan
| | - Zhanargul K Smailova
- Department of Biochemistry and Chemical Disciplines named after Doctor of Medical Sciences, Professor S.O. Tapbergenov, Semey Medical University, Semey, Republic of Kazakhstan
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Vitamin D Deficiency: An Underestimated Factor in Sepsis? Int J Mol Sci 2023; 24:ijms24032924. [PMID: 36769240 PMCID: PMC9917708 DOI: 10.3390/ijms24032924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Vitamin D is an important immune modulator that is linked to infection susceptibility. It has been suggested that vitamin D deficiency plays a role in sepsis and septic shock because vitamin-D-related pathways are associated with various immunological, endocrine, and endothelial functions. Previous research has yielded inconclusive results regarding the link between mortality and vitamin D deficiency in sepsis patients. In patients with sepsis and severe vitamin D deficiency, an adequate vitamin D concentration may reduce mortality. Randomized controlled trials to assess the influence of vitamin D supplementation on clinical outcomes in sepsis patients with vitamin D deficiency are uncommon. We will provide an overview of the current knowledge about the relationship between vitamin D and sepsis in this review, as well as consider the potential value of vitamin D supplementation in this situation.
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The role of vitamin D receptor gene polymorphism in the development of necrotizing enterocolitis. Pediatr Res 2023:10.1038/s41390-022-02426-9. [PMID: 36596941 DOI: 10.1038/s41390-022-02426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vitamin D and its receptor (VDR) effects on the gastrointestinal system are among its most critical multisystemic effects. METHODS This study aimed to reveal that VDR gene polymorphisms may constitute a risk factor for necrotizing enterocolitis (NEC). VDR Fok1-Bsm1-Apa single-nucleotide polymorphisms were analyzed in the NEC group (n = 74) and the control group (n = 147). Among 1112 babies at and below 36 weeks of gestational age who were hospitalized between January 2013 and December 2016 with a diagnosis of prematurity, 74 of a total of 148 patients who developed NEC during follow-up (NEC group) were included in the study. When NEC was diagnosed according to clinical and radiological findings and staged using Modified Bell criteria, 9 (12.1%) of 74 babies were stage 1A, 13 (17.5%) stage 1B, and 5 (6.7%) stage 2A, 33 (44.5%) stage 2B, 7 (9.4%) stage 3A, 7 (9.4%) stage 3B. Of 964 babies who did not develop NEC during follow-up, 147 were included as the control group in the study. Genotyping of VDR polymorphisms was assayed by real-time PCR. From 221 premature babies in the NEC and control groups, 2 ml peripheral blood was taken appropriately and meticulously into an EDTA tube. DNA was isolated from these blood samples. DNA amplification was performed using a thermal cycler (Applied Biosystems GeneAmp PCR System 9600). RESULTS When the two groups were compared in terms of the prevalence of VDR Fok1 C/T genotype, it was found that TT genotype increased the risk of NEC by 2.697 times, and there was a significant relationship between TT genotype and the risk of NEC (p = 0.041). Multivariable logistic regression analysis was performed in terms of gestational age, birth weight, VDR gene polymorphism data between NEC and the control group. According to the analysis results, TT polymorphism, increased the risk of disease 4.5 times (p = 0.033). CONCLUSION Fok 1 C > T polymorphism in the VDR gene plays a role in the development of NEC. Identifying the risk groups by detecting gene polymorphisms that cause increased susceptibility to NEC may assist in the follow-up of these patients and in making early treatment decisions for them. IMPACT In this study examining the non-bone effects of the genetic differences in vitamin D metabolism in premature babies, Fok 1 polymorphism has been observed to be an essential risk factor for NEC. This is the first study in our country that has investigated the relationship between VDR gene polymorphism and necrotizing enterocolitis among the Turkish population. Identifying the risk groups by detecting gene polymorphisms that cause increased susceptibility to NEC may assist in the monitoring of these patients and in making early treatment decisions for them.
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Newton DA, Baatz JE, Chetta KE, Walker PW, Washington RO, Shary JR, Wagner CL. Maternal Vitamin D Status Correlates to Leukocyte Antigenic Responses in Breastfeeding Infants. Nutrients 2022; 14:1266. [PMID: 35334923 PMCID: PMC8952362 DOI: 10.3390/nu14061266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
It is unknown if vitamin D (vitD) sufficiency in breastfeeding mothers can lead to physiological outcomes for their children that are discernible from infant vitD sufficiency per se. In a 3-month, randomized vitD supplementation study of mothers and their exclusively breastfeeding infants, the effects of maternal vitD sufficiency were determined on infant plasma concentrations of 25-hydroxyvitamin D (i.e., vitD status) and 11 cytokines. An inverse correlation was seen between maternal vitD status and infant plasma TNF concentration (r = −0.27; p < 0.05). Infant whole blood was also subjected to in vitro antigenic stimulation. TNF, IFNγ, IL-4, IL-13, and TGFβ1 responses by infant leukocytes were significantly higher if mothers were vitD sufficient but were not as closely correlated to infants’ own vitD status. Conversely, IL-10 and IL-12 responses after antigenic challenge were more correlated to infant vitD status. These data are consistent with vitD-mediated changes in breast milk composition providing immunological signaling to breastfeeding infants and indicate differential physiological effects of direct-infant versus maternal vitD supplementation. Thus, consistent with many previous studies that focused on the importance of vitD sufficiency during pregnancy, maintenance of maternal sufficiency likely continues to affect the health of breastfed infants.
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Affiliation(s)
- Danforth A. Newton
- Department of Pediatrics/Neonatology, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC 29425, USA; (J.E.B.); (K.E.C.); (P.W.W.); (R.O.W.); (J.R.S.); (C.L.W.)
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Byun SY, Bae MH, Lee NR, Han YM, Park KH. Association between vitamin D deficiency at one month of age and bronchopulmonary dysplasia. Medicine (Baltimore) 2021; 100:e27966. [PMID: 35049200 PMCID: PMC9191292 DOI: 10.1097/md.0000000000027966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
Vitamin D deficiency is common and increases the likelihood of neonatal morbidities in preterm infants. This study assessed vitamin D levels at 1 month of age after 4 weeks of vitamin D supplementation and determined the association between vitamin D levels and neonatal morbidities.This retrospective study included preterm infants with birth weight <1500 g or gestational age <32 weeks born in our hospital between January 2018 and December 2019. They were administered 400 IU of oral vitamin D supplementation after birth according to our policy. The infants were then divided into sufficient (≥20 ng/mL) and deficient (<20 ng/mL) groups according to their serum vitamin D levels at 1 month of age.The vitamin D deficient and sufficient groups included 49 and 41 patients, respectively. The mean gestational age and birth weight. GHT in the vitamin D deficient group were 29.1 ± 2.1 weeks and 1216.1 ± 308.1 g, respectively, and 30.0 ± 1.7 weeks and 1387.6 ± 350.8 g, respectively, in the sufficient group. No significant differences were observed between the 2 groups in demographic and clinical outcomes except for bronchopulmonary dysplasia (BPD), which occurred significantly more often in the vitamin D-deficient group (odds ratio 2.21; 95% confidence interval, 1.85-2.78; P = .02).The results of our study suggest that vitamin D deficiency at 1 month of age is associated with BPD in preterm infants.
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Affiliation(s)
- Shin Yun Byun
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Hye Bae
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Na Rae Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Young Mi Han
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Dogan P, Ozkan H, Koksal N, Celebi S, Bagci O, Topcu M, Guney Varal I. The Role of Low 25-Hydroxyvitamin D Levels in Preterm Infants with Late-Onset Sepsis. Fetal Pediatr Pathol 2021; 40:571-580. [PMID: 32065014 DOI: 10.1080/15513815.2020.1725941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IntroductionWe investigated the association between low 25-hydroxyvitamin D (25-OHD) levels and late-onset sepsis (LOS) in preterm infants (<37 weeks). Methods: Infants with culture-proven LOS were the study group, infants without LOS were the controls. 25-OHD levels were compared between these groups. Low vitamin D was defined as 25-OHD ≤15 ng/ml. Maternal 25-OHD levels were compared to their infant's level. Results: 108 infants were included. The study group was significantly younger (p = 0.02) with significantly lower 25-OHD levels (p < 0.001). Multivariable logistic regression analyses revealed that infants with low 25-OHD levels were 7.159 (95%CI: 1.402-36.553, p = 0.018) times more likely to develop LOS. A positive correlation was detected between maternal and neonatal 25-OHD levels for both study and control groups (r = 0.425, p = 0.009; r = 0.739, p < 0.001, respectively). Conclusions: Low 25-OHD levels are associated with an increased risk of developing LOS development in preterm infants.
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Affiliation(s)
- Pelin Dogan
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Hilal Ozkan
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Nilgun Koksal
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Solmaz Celebi
- Faculty of Medicine, Department of Pediatrics, Division of Infectious Diseases, Uludag University, Bursa, Turkey
| | - Onur Bagci
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Merve Topcu
- Faculty of Medicine, Department of Pediatrics, Uludag University, Bursa, Turkey
| | - Ipek Guney Varal
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
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Kamsiah K, Hasibuan BS, Arto KS. The Relationship between Vitamin D Levels and Clinical Outcomes of Neonatal Sepsis in Haji Adam Malik Hospital Medan, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Vitamin D deficiency in neonates is associated with neonatal sepsis incidence. It is also significantly correlated to the increased risk in the outcomes of sepsis, such as mortality, length of hospital stay, and use of ventilatory support.
AIM: The aim of the study is to observe the relationship between Vitamin D levels and clinical outcomes of sepsis in the neonatal unit.
METHODS: An analytical cross-sectional study was conducted to neonates in neonatology Haji Adam Malik hospital from June 2019 to February 2020. A Chi-square test was carried out to observe the relationship between Vitamin D levels and sepsis outcomes, and a Mann-Whitney test was done to assess the significance between Vitamin D levels and length of hospital stay.
RESULTS: Among 41 full-term and pre-term neonates, there were 75.6% (31/41) neonates with Vitamin D deficiency, while 24.4% (10/41) had normal Vitamin D levels and did not suffer from deficiency. The relationship of Vitamin D levels with mortality, use of ventilatory support, length of stay, and blood culture was p = 0.660 (95% confidence interval [CI] = 0.810–1.677), p = 0.013 (p < 0.05), p = 0.940 (median 21 days), and p =0.712 (95% CI = 0.623–1.353), respectively.
CONCLUSION: Vitamin D deficiency had a significant relationship with ventilatory support requirement as one of the sepsis outcomes in neonates.
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Hagag AA, El Frargy MS, Houdeeb HA. Therapeutic Value of Vitamin D as an Adjuvant Therapy in Neonates with Sepsis. Infect Disord Drug Targets 2021; 20:440-447. [PMID: 31241441 DOI: 10.2174/1871526519666190626141859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 01/25/2023]
Abstract
Sepsis is unusual systemic reaction to an ordinary infection, and it probably represents a pattern of response by the immune system to the injury. Vitamin D is a fat-soluble steroid hormone that contributes to the maintenance of normal calcium homeostasis and skeletal mineralization. Vitamin D has an important role in the regulation of both innate and adaptive immune systems. AIM OF THE WORK The current study aimed to evaluate the therapeutic value of vitamin D supplementation as an adjuvant therapy in neonates with sepsis. SUBJECTS AND METHOD This study included 60 neonates with sepsis who were randomly divided into 2 equal groups; group I: 30 neonates with sepsis who received antibiotic only, Group II: 30 neonates with sepsis who received antibiotic therapy and vitamin D. This study also included 30 healthy neonates as a control group. For all patients and controls, serum level of 25 (OH) vitamin D and highly sensitive C reactive protein (hs-CRP) were immunoassayed. RESULTS There is no significant difference between groups I, II and controls regarding weight, gestational age, sex and mode of delivery. There were significant differences between groups I and II in sepsis score and hs-CRP after 3, 7, 10 days of treatment (p values for sepsis score were 0.009, 0.006, 0.004 respectively and for hs-CRP were 0.015, 0.001, 0.001 respectively). There was a significant difference in immature /total (I/T) ratio after 7, and 10 days of treatment (p value= 0.045, 0.025, respectively,) while there was no significant difference in immature /total (I/T) ratio after 3 days of treatment (p value = 0.624).Serum 25(OH) vitamin D levels were significantly lower in neonates with sepsis (group I and II) than the controls (p value < 0.05, while there were no significant differences between the three groups considering serum calcium and phosphorus levels (P =1.000, 1.000, respectively). Isolated organisms from blood culture in neonates with sepsis (group I and group II) were most commonly B- hemolytic streptococci, E-coli, hemophilus influenza and staphylococcus aurous. There was a significant negative correlation between hs-CRP and serum 25 (OH) vitamin in group II on entry (r = - 0.832 and P value = 0.001) and after 2 weeks (r = - 0.590 and P value = 0.021). ROC curve of specificity and sensitivity of 25 (OH) vitamin D level in prediction of early-onset neonatal sepsis showed that cutoff value of vitamin D was ≤20 ng/ml, sensitivity was 100%, specificity was 73%, positive predictive value was 73%, negative predictive value was 100% and accuracy was 87. CONCLUSION AND RECOMMENDATION Serum 25 (OH) vitamin D levels of neonates with the early onset neonatal sepsis were significantly lower than the healthy controls. Vitamin D supplementation improved sepsis score and decrease high levels of hs-CRP; this reflects the role of vitamin D as a target therapy for neonatal sepsis. Further studies are warranted to confirm the therapeutic value of vitamin D in neonatal sepsis.
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Affiliation(s)
- Adel A Hagag
- Pediatric Department, Faculty of Medicine, Tanta University, Egypt
| | | | - Hoassam A Houdeeb
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Egypt
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He M, Cao T, Wang J, Wang C, Wang Z, Abdelrahim MEA. Vitamin D deficiency relation to sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and duration of mechanical ventilation in critically ill children: A meta-analysis. Int J Clin Pract 2021; 75:e13908. [PMID: 33280208 DOI: 10.1111/ijcp.13908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Vitamin D deficiency in children is related to the augmented risk of bone illnesses, but its effect on critically ill children is still conflicting. This meta-analysis study was performed to assess the relationship between vitamin D deficiency in children and sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and duration of mechanical ventilation in critically ill children. METHODS Through a systematic literature search up to June 2020, 16 studies with 2382 children, 1229 children of them with vitamin D deficiency, were found recording relationships between vitamin D deficiency and sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and/or duration of mechanical ventilation. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated between vitamin D deficiency children to non-vitamin D deficiency children on the different outcomes in critically ill children using the dichotomous or continuous methods with a random or fixed-effect model. RESULTS The vitamin D deficiency children category had significantly higher sepsis (OR, 2.35; 95% CI, 1.19-4.63, P = .01); paediatric risk of mortality III score (OR, 2.19; 95% CI, 1.13-4.25, P = .02); higher length of hospital stay (OR, 4.26; 95% CI, 0.81-7.70, P = .02); higher duration of mechanical ventilation (OR, 1.89; 95% CI, 0.22-3.56, P = .03) compared with that in the non-vitamin D deficiency children. However, the need for ventilation support in vitamin D deficiency children did not significantly differ from non-vitamin D deficiency children (OR, 2.00; 95% CI, 0.98-4.07, P = .06) with relatively higher results in vitamin D deficiency children. CONCLUSIONS Vitamin D deficiency in children might have an independent relationship with higher sepsis, paediatric risk of mortality III score, length of hospital stay, and duration of mechanical ventilation. The relation was relative with a higher risk in need for ventilation support with vitamin D deficiency children. This relationship encouraged us to recommend testing vitamin D levels in all critically ill children and providing them with supplemental vitamin D as prophylaxis.
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Affiliation(s)
- Mingyi He
- Emergency Department, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Tao Cao
- Emergency Department, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Jing Wang
- Emergency Department, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Changyuan Wang
- Emergency Department, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Zheng Wang
- Emergency Department, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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14
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Yu W, Ying Q, Zhu W, Huang L, Hou Q. Vitamin D status was associated with sepsis in critically ill children: A PRISMA compliant systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23827. [PMID: 33466129 PMCID: PMC7808475 DOI: 10.1097/md.0000000000023827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/16/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sepsis leads to the high mortality in critically ill infants and children. It is still controversial whether vitamin D deficiency was associated with the incidence of sepsis. Thus we designed the systematic review and meta-analysis. METHODS The Ovid Medline, Embase, PubMed, and Cochrane library were systematically searched until April 5, 2020. The 25 hydroxyvitamin D (25-OHD) level was recorded and set 20 ng/mL as cut-off in cohort study to divide the lower and higher 25-OHD group. The odds ratio (OR) and 95% confidence intervals (CIs) were calculated for comparing the impact of vitamin D deficiency on the incidence of sepsis in critically ill children. RESULTS A total of 27 studies were included with 17 case-control studies and 10 cohort studies. In those case-control studies, the maternal 25-OHD level and neonatal 25-OHD level in sepsis group was significant lower than non-sepsis group (P < .001). The percentage of severe vitamin D deficiency was significant higher in sepsis group comparing to non-sepsis group (odds ratio [OR] = 2.66, 95% CI = 1.13-6.25, P < .001). In those cohort studies, the incidence of sepsis in lower 25-OHD group was 30.4% comparing with 18.2% in higher 25-OHD level group. However, no statistical significant difference in terms of mechanical ventilation rate and 30-day mortality. CONCLUSION We demonstrated that critically ill infants and children with sepsis could have a lower 25-OHD level and severe vitamin D deficiency comparing to those without sepsis. Future studies should focus on the association of vitamin D supplement and the occurrence of sepsis in critically ill children.
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Affiliation(s)
- Weijie Yu
- Department of Pediatrics, The Second Affiliated Hospital of Jiaxing University, Zhejiang Province
| | - Qinlai Ying
- Department of Pediatrics, The Second Affiliated Hospital of Jiaxing University, Zhejiang Province
| | - Wen Zhu
- Department of Pediatrics, The Second Affiliated Hospital of Jiaxing University, Zhejiang Province
| | - Lisu Huang
- Department of Pediatric Infectious Diseases, Xinhua Hospital, Shanghai Jiaotong University, P.R. China
| | - Qiuying Hou
- Department of Pediatrics, The Second Affiliated Hospital of Jiaxing University, Zhejiang Province
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Workneh Bitew Z, Worku T, Alemu A. Effects of vitamin D on neonatal sepsis: A systematic review and meta-analysis. Food Sci Nutr 2021; 9:375-388. [PMID: 33473300 PMCID: PMC7802542 DOI: 10.1002/fsn3.2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/26/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Vitamin D deficiency is a major public health concern of pregnant women and neonates worldwide, affecting more than half of neonates. Studies report inconsistent and inconclusive effects of vitamin D treatment on neonatal sepsis. This study aimed to provide conclusive evidence regarding the effect of maternal and cord blood vitamin D levels on neonatal sepsis. Data were retrieved from the electronic database (Web of Science, Scopus, CINAHL [EBSCOhost], ProQuest, EMBASE [Ovid], PubMed, Emcare, MEDLINE [Ovid], and gray literature sources [World cat, Mednar, Google scholar and Google]). Joanna Briggs Institute quality assessment tool was utilized for quality assessment while analysis was performed using Open Meta-analyst, Comprehensive Meta-analysis version 3.3.070, and Review Manager version 5.3 software. From the 18 studies included in the study, the overall prevalence of vitamin D deficiency among neonates was 61% (95% CI: 44.3, 77.7); 79.4% (95% CI: 71.6, 87.3) of neonates with sepsis were vitamin D deficient as were 43.7% (23.4, 63.9) of sepsis-free neonates. Neonates born from mothers with low vitamin D levels were at greater risk of developing neonatal sepsis with a weighed mean difference of -8.57 ng/ml (95% CI: -13.09, -4.05). Similarly, neonates with low cord vitamin D levels were at risk for neonatal sepsis with a mean difference of -8.78 ng/ml (95% CI:-11.58, -5.99). The incidence of EONS in full-term newborns was significantly associated with low maternal and cord blood vitamin D levels with weighed mean differences of -11.55ng/ml (95% CI: -17.63, -5.46) & -11.59 ng/ml (95% CI:-16.65, -6.53), respectively. Low levels of vitamin D both in the cord blood and maternal blood were significantly associated with neonatal sepsis. Hence, vitamin D supplementation for pregnant women and newborns could decrease neonatal sepsis.
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Affiliation(s)
| | - Teshager Worku
- School of Nursing and MidwiferyCollege of Health and Medical SciencesHaramaya UniversityHararEthiopia
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16
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Callaby R, Hurst E, Handel I, Toye P, Bronsvoort BMDC, Mellanby RJ. Determinants of vitamin D status in Kenyan calves. Sci Rep 2020; 10:20590. [PMID: 33239727 PMCID: PMC7688966 DOI: 10.1038/s41598-020-77209-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022] Open
Abstract
Vitamin D plays a critical role in calcium homeostasis and in the maintenance and development of skeletal health. Vitamin D status has increasingly been linked to non-skeletal health outcomes such as all-cause mortality, infectious diseases and reproductive outcomes in both humans and veterinary species. We have previously demonstrated a relationship between vitamin D status, assessed by the measurement of serum concentrations of the major vitamin D metabolite 25 hydroxyvitamin D (25(OH)D), and a wide range of non-skeletal health outcomes in companion and wild animals. The aims of this study were to define the host and environmental factors associated with vitamin D status in a cohort of 527 calves from Western Kenya which were part of the Infectious Disease of East African Livestock (IDEAL) cohort. A secondary aim was to explore the relationship between serum 25(OH)D concentrations measured in 7-day old calves and subsequent health outcomes over the following 12 months. A genome wide association study demonstrated that both dietary and endogenously produced vitamin D metabolites were under polygenic control in African calves. In addition, we found that neonatal vitamin D status was not predictive of the subsequent development of an infectious disease event or mortality over the 12 month follow up period.
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Affiliation(s)
- Rebecca Callaby
- The Epidemiology, Economics and Risk Assessment (EERA) Group, The Roslin Institute and The Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, EH25 9RG, Midlothian, UK
- Centre for Tropical Livestock Genetics and Health (CTLGH), The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, EH25 9RG, UK
| | - Emma Hurst
- The Vitamin D Animal Laboratory (VitDAL), The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, EH25 9RG, Midlothian, UK
| | - Ian Handel
- The Epidemiology, Economics and Risk Assessment (EERA) Group, The Roslin Institute and The Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, EH25 9RG, Midlothian, UK
| | - Phil Toye
- International Livestock Research Institute and Centre for Tropical Livestock Genetics and Health, Nairobi, Kenya
| | - Barend M de C Bronsvoort
- The Epidemiology, Economics and Risk Assessment (EERA) Group, The Roslin Institute and The Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, EH25 9RG, Midlothian, UK
- Centre for Tropical Livestock Genetics and Health (CTLGH), The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, EH25 9RG, UK
| | - Richard J Mellanby
- The Vitamin D Animal Laboratory (VitDAL), The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, EH25 9RG, Midlothian, UK.
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Ma L, Geng LM, Zhou XH. [A comparative analysis of the efficacy of two vitamin D supplementation regimens in preterm infants: a prospective randomized controlled study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1061-1065. [PMID: 33059801 PMCID: PMC7568995 DOI: 10.7499/j.issn.1008-8830.2005062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the effect of different vitamin D supplementation regimens on the nutritional status of vitamin D on day 28 after birth in preterm infants with a gestational age of <34 weeks. METHODS A total of 59 preterm infants with a gestational age of <34 weeks who were born from October 2018 to October 2019 were enrolled and divided into an observation group with 30 infants and a control group with 29 infants. The infants in the observation group received a single-dose intramuscular injection of vitamin D3 (10 000 IU/kg), while those in the control group received oral vitamin D3 drops (900 IU/d) for 25 days. Venous blood samples were collected within 48 hours after birth (before vitamin D3 supplementation) and on day 28 after birth to measure the serum 25-hydroxyvitamin D [25(OH)D] level. RESULTS Within 48 hours after birth, the prevalence rate of vitamin D deficiency (≤15 ng/mL) was 78% among the 59 preterm infants. There were no significant differences in the serum 25(OH)D level and the prevalence rate of vitamin D deficiency between the two groups (P>0.05). Compared with the control group on day 28 after birth, the observation group had a significantly higher serum 25(OH)D level (P<0.05) and a significantly lower prevalence rate of vitamin D deficiency (P<0.05). There were no cases of vitamin D overdose or poisoning. CONCLUSIONS In preterm infants with a gestational age of <34 weeks, single-dose intramuscular injection of 10 000 IU/kg vitamin D3 can significantly increase serum 25(OH)D level on day 28 after birth and safely and effectively reduce the prevalence rate of vitamin D deficiency.
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Affiliation(s)
- Li Ma
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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18
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Matejek T, Zemankova J, Malakova J, Cermakova E, Skalova S, Palicka V. Severe vitamin D deficiency in preterm infants: possibly no association with clinical outcomes? J Matern Fetal Neonatal Med 2020; 35:1562-1570. [PMID: 32482110 DOI: 10.1080/14767058.2020.1762560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The primary objective of this study was to compare clinical outcomes of very low birth weight (VLBW) infants with 25-hydroxy vitamin D [25(OH)D] levels <25 nmol/l in umbilical cord blood versus VLBW infants with 25(OH)D levels in cord blood >25 nmol/l. The secondary objective was to evaluate umbilical cord vitamin D as a risk factor for respiratory distress syndrome (RDS) in preterm infants.Methods: We examined 25(OH)D levels in umbilical cord blood and in infants' serum at discharge from the neonatal intensive care unit. We evaluated the associations between severe vitamin D deficiency and various laboratory findings and clinical outcomes.Results: Eighty one infants with birth weight less than 1500 g met the entry criteria for this study and were divided to groups according to umbilical cord blood vitamin D [Group A: 25(OH)D < 25 nmol/l; 10 ng/ml and Group B: 25(OH)D > 25 nmol/l; 10 ng/ml]. Overall, 81.5% of the infants had a 25(OH)D level <50 nmol/L and 44.4% had a level <25 nmol/L. The laboratory findings and the subsequent clinical outcomes were comparable in infants in both groups (non-significant difference). Only the infants in the 25(OH)D 25 nmol/L group had a lower calcium in urine at age 28 d (p=.0272). In addition, we found in this study that umbilical cord vitamin D level does not lead to a higher or lower risk of RDS (odds ratio 1.044; 95% confidence interval 0.349-0.88; p=.0771).Conclusions: In our prospective cohort study, we found no significant association between vitamin D status and selected clinical outcomes when using a cut-off of 25 nmol/l (severe vitamin D deficiency) in preterm infants.
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Affiliation(s)
- Tomas Matejek
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jana Zemankova
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jana Malakova
- Faculty of Medicine Hradec Kralove, Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Eva Cermakova
- Faculty of Medicine Hradec Kralove, Computer Technology Center, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Sylva Skalova
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vladimir Palicka
- Faculty of Medicine Hradec Kralove, Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Behera CK, Sahoo JP, Patra SD, Jena PK. Is Lower Vitamin D Level Associated with Increased Risk of Neonatal Sepsis? A Prospective Cohort Study. Indian J Pediatr 2020; 87:427-432. [PMID: 32056191 DOI: 10.1007/s12098-020-03188-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the effect of maternal/ neonatal vitamin D levels on culture positive neonatal sepsis. METHODS This prospective cohort study was conducted in the NICU of a tertiary care teaching hospital in Odisha, Eastern India from January 2015 through December 2016. Forty (40) neonates with culture positive sepsis were included in the study group. Forty (40) healthy neonates admitted for evaluation of neonatal jaundice who are similar in gender, gestational age, postnatal age and without any clinical signs of sepsis were recruited as control group after informed consent. Vitamin D level (25 OH D) was assessed in the neonates and their mothers in both the groups. RESULTS Neonatal 25 OH vitamin D level in the study group (12.71 ± 2.82 ng/ml) was significantly lower than in the control group (25.46 ± 7.02 ng/ml). The Odds ratio was 273 (95% CI 30.39-2451.6) for culture positive sepsis in neonates with vitamin D deficiency/insufficiency. Mothers of septic neonates had significantly lower 25 OH vitamin D level (20.92 ± 3.92 ng/ml) than the mothers of healthy neonates in control group (27.31 ± 6.83 ng/ml). The Odds ratio was 4.71 (95% CI 1.69-13.1) for culture positive sepsis in babies born to mothers with vitamin D deficiency/insufficiency. CONCLUSIONS Neonates with vitamin D deficiency/insufficiency are at higher risk for developing sepsis than those with sufficient vitamin D levels. Lower vitamin D levels in mothers is also associated with increased risk of sepsis in the neonates.
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Affiliation(s)
- Chinmay Kumar Behera
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | | | - Pratap Kumar Jena
- KIIT School of Public Health, KIIT University, Bhubaneswar, Odisha, India
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Stankus T. Reviews of Science for Science Librarians: Vitamins and Trace Elements that May Be Preventive or Ameliorating in This Age of Contagion. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/0194262x.2020.1753630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Tony Stankus
- Health Sciences, University of Arkansas Libraries, Fayetteville, Arkansas, USA
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Oliver C, Watson C, Crowley E, Gilroy M, Page D, Weber K, Messina D, Cormack B. Vitamin and Mineral Supplementation Practices in Preterm Infants: A Survey of Australian and New Zealand Neonatal Intensive and Special Care Units. Nutrients 2019; 12:E51. [PMID: 31878077 PMCID: PMC7019934 DOI: 10.3390/nu12010051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022] Open
Abstract
Preterm infants are at increased risk of micronutrient deficiencies as a result of low body stores, maternal deficiencies, and inadequate supplementations. The aim of this survey was to investigate current vitamin and mineral supplementation practices and compare these with published recommendations and available evidence on dosages and long-term outcomes of supplementations in preterm infants. In 2018, a two-part electronic survey was emailed to 50 Australasian Neonatal Dietitians Network (ANDiN) member and nonmember dietitians working in neonatal units in Australia and New Zealand. For inpatients, all units prescribed between 400 and 500 IU/day vitamin D, compared to a recommended intake range of 400-1000 IU/day. Two units prescribed 900-1000 IU/day at discharge. For iron, 83% of respondents prescribed within the recommended intake range of 2-3 mg/kg/day for inpatients. Up to 10% of units prescribed 6 mg/kg/day for inpatients and at discharge. More than one-third of units reported routine supplementations of other micronutrients, including calcium, phosphate, vitamin E, and folic acid. There was significant variation between neonatal units in vitamin and mineral supplementation practices, which may contribute to certain micronutrient intakes above or below recommended ranges for gestational ages or birth weights. The variations in practice are in part due to differences in recommended vitamin and mineral intakes between expert groups and a lack of evidence supporting the recommendations for supplementations.
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Affiliation(s)
- Colleen Oliver
- Department of Dietetics and Nutrition, The Royal Women’s Hospital, Melbourne, VIC 3052, Australia
| | - Caitlin Watson
- Department of Dietetics and Nutrition, Monash Children’s Hospital, Melbourne, VIC 3168, Australia;
| | - Elesa Crowley
- Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, NSW 2340, Australia;
- Department of Dietetics and Nutrition, Tamworth Rural Referral Hospital, Tamworth, NSW 2340, Australia
| | - Melissa Gilroy
- Department of Dietetics and Food Services, Mater Group, South Brisbane, QLD 4101, Australia; (M.G.); (D.P.)
| | - Denise Page
- Department of Dietetics and Food Services, Mater Group, South Brisbane, QLD 4101, Australia; (M.G.); (D.P.)
| | - Katrina Weber
- Department of Dietetics and Nutrition, Fiona Stanley Hospital, Perth, WA 6150, Australia; (K.W.); (D.M.)
| | - Deanna Messina
- Department of Dietetics and Nutrition, Fiona Stanley Hospital, Perth, WA 6150, Australia; (K.W.); (D.M.)
| | - Barbara Cormack
- Department of Dietetics and Nutrition, Starship Child Health, Auckland City Hospital, Auckland 1023, New Zealand;
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
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Agrawal A, Gupta A, Shrivastava J. Role of Vitamin-D Deficiency in Term Neonates with Late-Onset Sepsis: A Case-Control Study. J Trop Pediatr 2019; 65:609-616. [PMID: 31006010 DOI: 10.1093/tropej/fmz021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To find the relationship between vitamin-D levels and late-onset sepsis (LOS) in term neonates. METHODS This case-control study was conducted in neonatal intensive care unit of a tertiary care teaching institution in central India. Full-term neonates with culture-proven LOS were taken as cases. Maternal and neonatal demography, clinical examination and investigations were recorded. Correlation of vitamin-D deficiency (<20 ng/ml) with LOS was assessed. RESULTS Total 225 term neonates including 175 cases and 50 controls were included. Maternal and neonatal demographic profile was comparable. The mean vitamin-D level in cases (12.28 ± 6.11 ng/ml) was significantly lower than that in controls (14.88 ± 7.2 ng/ml) (p = 0.002). Total 151 (86.29%) neonates out of 175 cases and 37 (74%) out of 50 controls had the vitamin-D deficiency (p = 0.00003). On multiple regression analysis, neonatal sepsis (p = 0.00003) was found to be significantly associated with vitamin-D deficiency. CONCLUSION This study shows that vitamin-D deficiency in term neonates may predispose them to LOS.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Aekta Gupta
- Department of Pediatrics, Gandhi Medical College, Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Jyotsna Shrivastava
- Department of Pediatrics, Gandhi Medical College, Hamidia Hospital, Bhopal, Madhya Pradesh, India
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Early-Onset Neonatal Sepsis. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Despite the great progress made in neonatal and perinatal medicine over the last couple of decades, sepsis remains one of the main causes of morbidity and mortality. Sepsis in pediatric population was defined at the Pediatric Sepsis Consensus Conference in 2005. There is still no consensus on the definition of neonatal sepsis. Neonatal sepsis is a sepsis that occurs in the neonatal period. According to the time of occurrence, neonatal sepsis can be of early onset, when it occurs within the first 72 hours of birth and results from vertical transmission, and of late onset, in which the source of infection is found most often in the environment and occurs after the third day of life. The most common causes of early-onset sepsis are Group B Streptococcus (GBS) and E. coli. Risk factors can be mother-related and newborn-related. Clinical symptoms and signs of sepsis are quite unspecific. The dysfunction of different organs may imitate sepsis. On the other hand, infectious and non-infectious factors may exist simultaneously. The start of the antimicrobial therapy in any newborn with suspected sepsis should not be delayed. Pentoxifylline may have potential benefits in preterm newborns with sepsis. The only proven intervention that has been shown to reduce the risk of early-onset neonatal sepsis is intrapartum intravenous antibiotic administration to prevent GBS infection. It is still a great challenge to discontinue antibiotic treatment in non-infected newborns as soon as possible, because any extended antibiotic use may later be associated with other pathological conditions.
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Xiao D, Zhang X, Ying J, Zhou Y, Li X, Mu D, Qu Y. Association between vitamin D status and sepsis in children: A meta-analysis of observational studies. Clin Nutr 2019; 39:1735-1741. [PMID: 31495735 DOI: 10.1016/j.clnu.2019.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The consequences of vitamin D deficiency regarding sepsis in children remain controversial. We conducted a meta-analysis of studies evaluating the association between vitamin D status and sepsis in children. METHODS We used EMBASE, Ovid Medline and Cochrane Library to conduct a meta-analysis of studies published in English before November 21, 2017. RESULTS Among 1146 initially identified studies, we included 13 studies according to predefined inclusion criteria comprising 975 patients and 770 control participants. According to a random effects model, the mean difference in 25(OH)D levels (nmol/L) between participants with sepsis (444) and controls (528) was (mean difference, -18.55; 95% confidence interval (CI), -19.45 to -17.66, p < 0.05). The association between vitamin D deficiency and sepsis was significant, with an odds ratio (OR) = 1.13 (95% CI, 1.18 to 1.50, p < 0.05). Factors that could explain differences in the results include the study location/medical conditions, study design, 25(OH)D assay methods, diagnostic sepsis at different ages, diagnostic criteria for sepsis, and sepsis with comorbidities. CONCLUSIONS The association between vitamin D deficiency/lower 25(OH)D levels and sepsis was significant in children and neonates. Further studies are required to confirm the results by considering more confounders.
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Affiliation(s)
- Dongqiong Xiao
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
| | - Xiaoyan Zhang
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
| | - Junjie Ying
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
| | - Yan Zhou
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
| | - Xihong Li
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
| | - Dezhi Mu
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
| | - Yi Qu
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
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Saboute M, Yavar R, Kashaki M, Khaledi FK, Khalesi N, Rohani F. Investigation of association between maternal 25-OH vitamin D serum levels and neonatal early onset sepsis in newborns by evaluating key factors. Lipids Health Dis 2019; 18:153. [PMID: 31299987 PMCID: PMC6626329 DOI: 10.1186/s12944-019-1095-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background The goal of this study was to evaluate the relationship between maternal 25-OH Vitamin D serum levels and neonatal early-onset sepsis in newborns by the effective factors. Methods A case-control study was done and 64 neonates hospitalized in Akbar Abadi Hospital (Tehran- Iran; 2016) and their mothers were enrolled. The case group consisted of 32 NICU term hospitalized neonates due to neonatal early-onset sepsis. Thirty-two term newborns that referred to hospital for rule out hyperbilirubinemia during the first 72 h of life were also considered as the control. Results Sixty- four mothers with mean age 28.76 ± 6.60 years and mean gestational age 39.64 ± 1.62 weeks entered the study. There was a significant correlation between sepsis and older age of mothers and low Apgar score (P-value = 0.02, 0.01 respectively). The maternal vitamin D serum level was reversely correlated with neonatal sepsis occurrence (P-value = 0.03). There was a significant correlation between maternal vitamin D supplement intake during pregnancy and lower risk for neonatal sepsis (P-value = 0.003). Conclusion The level of maternal serum Vitamin D was inversely correlated with neonatal sepsis occurrence and intake of vitamin D supplement during pregnancy could decrease the risk of early neonatal sepsis.
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Affiliation(s)
- Maryam Saboute
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Rahman Yavar
- Department of genetics, Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mandana Kashaki
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemeh Kazemi Khaledi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nasrin Khalesi
- Department of Pediatrics, Ali Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran. .,Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farzaneh Rohani
- Pediatric Growth and Development Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Pediatric Endocrinology and Metabolic Diseases, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Teixeira HC, Dias LDS, Bizarro HDDS, Castro JMDA. Efeitos contrastantes da vitamina D sobre a resposta imune inata e adquirida e seu impacto na recuperação da tuberculose. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.22232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A vitamina D é um hormônio essencial para o organismo, podendo ser obtida da dieta ou, principalmente, gerada pela pele após exposição à luz solar ultravioleta B. Na sua forma ativa (1,25(OH)2D) ela controla a absorção de cálcio e fósforo do intestino para a corrente sanguínea e participa de diversos processos celulares e fisiológicos. A ligação da 1,25(OH)2D ao receptor da vitamina D (VDR) presente em diversas células, como as células do sistema imunológico, induz a transcrição de genes que podem, por exemplo, modular a resposta imune inata e adquirida. A deficiência de vitamina D ou do VDR é associada a problemas de saúde como desordens esqueléticas, hipertensão, doenças cardiovasculares, diabetes mellitus, dislipidemias, doenças autoimunes e doenças infecciosas. Neste sentido, a suplementação com vitamina D tem sido proposta como uma possível medida preventiva, podendo ser aplicada em muitas patologias, em especial na tuberculose. Principal causa de morte por um único agente infeccioso, a tuberculose é responsável por cerca de 1,3 milhões de óbitos por ano no mundo. Publicações recentes apontam efeitos diversos da vitamina D na resposta imune inata e adquirida. A 1,25(OH)2D3 na presença do interferon (IFN)-γ é capaz de aumentar a atividade bactericida do macrófago contra o M. tuberculosis, aumentando a produção de peptídios antimicrobianos e estimulando a autofagia, favorecendo assim a lise de bacilos localizados em fagossomos. Por outro lado, a vitamina D em linfócitos T mostra efeito tolerogênico que favorece o controle de respostas inflamatórias excessivas. Neste trabalho de revisão são apresentados estudos recentes envolvendo efeitos da vitamina D na resposta imune inata e adquirida. Além disso, considerações sobre deficiência de vitamina D e maior risco de contrair tuberculose, e efeitos contrastantes da suplementação com vitamina D na prevenção e tratamento da TB, são discutidos.
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Cariolou M, Cupp MA, Evangelou E, Tzoulaki I, Berlanga-Taylor AJ. Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis. BMJ Open 2019; 9:e027666. [PMID: 31122993 PMCID: PMC6538078 DOI: 10.1136/bmjopen-2018-027666] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and investigate its association with mortality in children with acute or critical conditions. DESIGN Systematic review and meta-analysis of observational studies. DATA SOURCES PubMed, OVID, Google Scholar and the Cochrane Library searched until 21 December 2018. ELIGIBILITY CRITERIA Studies of children hospitalised with acute or critical conditions who had blood 25(OH)D levels measured. DATA EXTRACTION AND SYNTHESIS We obtained pooled prevalence estimates of 25(OH)D deficiency and ORs for mortality. We calculated 95% CI and prediction intervals and investigated heterogeneity and evidence of small-study effects. RESULTS Fifty-two studies were included. Of 7434 children, 3473 (47.0%) were 25(OH)D deficient (<50 nmol/L). The pooled prevalence estimate of 25(OH)D deficiency was 54.6% (95% CI 48.5% to 60.6%, I2=95.3%, p<0.0001). Prevalence was similar after excluding smaller studies (51.5%). In children with sepsis (18 studies, 889 total individuals) prevalence was 64.0% (95% CI 52.0% to 74.4%, I2=89.3%, p<0.0001) and 48.7% (95% CI 38.2% to 59.3%; I2=94.3%, p<0.0001) in those with respiratory tract infections (RTI) (25 studies, 2699 total individuals). Overall, meta-analysis of mortality (18 cohort studies, 2463 total individuals) showed increased risk of death in 25(OH)D deficient children (OR 1.81, 95% CI 1.24 to 2.64, p=0.002, I2=25.7%, p=0.153). Four (22.0%) of the 18 studies statistically adjusted for confounders. There were insufficient studies to meta-analyse sepsis and RTI-related mortality. CONCLUSIONS Our results suggest that 25(OH)D deficiency in acute and critically ill children is high and associated with increased mortality. Small-study effects, reverse causation and other biases may have confounded results. Larger, carefully designed studies in homogeneous populations with confounder adjustment are needed to clarify the association between 25(OH)D levels with mortality and other outcomes. PROSPERO REGISTRATION NUMBER CRD42016050638.
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Affiliation(s)
- Margarita Cariolou
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Meghan A Cupp
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Evangelos Evangelou
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Ioanna Tzoulaki
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Antonio J Berlanga-Taylor
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
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Youssef MAM, Zahran AM, Hussien AM, Elsayh KI, Askar EA, Farghaly HS. In neonates with vitamin D deficiency, low lymphocyte activation markers are risk factors for infection. Paediatr Int Child Health 2019; 39:111-118. [PMID: 30375272 DOI: 10.1080/20469047.2018.1528755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Vitamin D has regulatory effects on different cells of the immune system and low levels are associated with several immune-mediated diseases. Aim: To investigate the association between neonatal 25-hydroxy vitamin D (25-OHD) level and the expression of lymphocyte activation markers (HLA-DR, CD69, CD25, CD45RA) on T-lymphocyte subpopulations and its impact in neonatal infection. Methods: 25-OHD level was measured in the cord blood of 56 neonates and their mothers using an enzyme immune-assay method. Based on the 25-OHD level, infants were categorised into four groups: severe deficiency (n = 7), moderate deficiency (n = 21), mild deficiency (n = 15) and normal 25-OHD level (n = 13). Mothers were classified into deficient (n = 18), insufficient (n = 21) and normal levels (n = 17). T-lymphocyte subpopulations and lymphocyte activation markers were investigated using flow cytometry. Results: There was a positive correlation between maternal and cord blood 25-OHD levels (r = 0.503, p = 0.001). The group with severe 25-OHD deficiency had the significantly lowest level of total lymphocytes, CD3+ T lymphocytes, CD4+ T-helper and CD8+ T-cytotoxic lymphocytes and CD4+CD45RA+ naïve T-cells compared with the other groups. The frequencies of CD8+CD25+, CD4+CD25+ and CD4+HLA-DR+ activated T-lymphocytes were significantly lower in the severe, moderate and mild deficiency groups than in the normal group. Seven of 43 (16.27%) infants with 25-OHD deficiency were admitted with sepsis to the neonatal intensive care unit and there were no cases of sepsis in the normal 25-OHD group. Conclusion: Vitamin D deficiency is associated with a reduction of lymphocyte subsets and altered T-lymphocyte activation which are considered to be risk factors for neonatal infection.
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Affiliation(s)
| | - Asmaa M Zahran
- b Clinical Pathology Department, South Egypt Cancer Institute , Assiut University , Assiut , Egypt
| | | | - Khalid I Elsayh
- a Children Hospital, Faculty of Medicine , Assiut University , Egypt
| | - Eman A Askar
- a Children Hospital, Faculty of Medicine , Assiut University , Egypt
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Sankar J, Ismail J, Das R, Dev N, Chitkara A, Sankar MJ. Effect of Severe Vitamin D Deficiency at Admission on Shock Reversal in Children With Septic Shock: A Prospective Observational Study. J Intensive Care Med 2019; 34:397-403. [PMID: 28335672 DOI: 10.1177/0885066617699802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
OBJECTIVES: To evaluate the association of severe vitamin D deficiency with clinically important outcomes in children with septic shock. METHODS: We enrolled children ≤17 years with septic shock prospectively over a period of 6 months. We estimated 25-hydroxyvitamin D [25 (OH) D] levels at admission and 72 hours. Severe deficiency was defined as serum 25 (OH) <10 ng/mL. We performed univariate and multivariate analysis to evaluate association with clinically important outcomes. RESULTS: Forty-three children were enrolled in the study. The prevalence of severe vitamin D deficiency was 72% and 69% at admission and 72 hours, respectively. On univariate analysis, severe vitamin D deficiency at admission was associated with lower rates of shock reversal, 74% (23) versus 25% (3); relative risk (95% confidence interval [CI]): 2.9 (1.09-8.08), at 24 hours and greater need for fluid boluses (75 vs 59 mL/kg). On multivariate analysis, nonresolution of shock at 24 hours was significantly associated with severe vitamin D deficiency after adjusting for other key baseline and clinical variables, adjusted odds ratio (95% CI): 12 (2.01-87.01); 0.01. CONCLUSION: The prevalence of severe vitamin D deficiency is high in children with septic shock admitted to pediatric intensive care unit. Severe vitamin D deficiency at admission seems to be associated with lower rates of shock reversal at 24 hours of ICU stay. Our study provides preliminary data for planning interventional studies in children with septic shock and severe vitamin D deficiency.
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Affiliation(s)
- Jhuma Sankar
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Javed Ismail
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Das
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishanth Dev
- 2 Department of Medicine, PGIMER, Dr RML Hospital, New Delhi, India
| | - Anubhuti Chitkara
- 3 Department of Biochemistry PGIMER, Dr RML Hospital, New Delhi, India
| | - M Jeeva Sankar
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Matejek T, Navratilova M, Zaloudkova L, Malakova J, Maly J, Skalova S, Palicka V. Vitamin D status of very low birth weight infants at birth and the effects of generally recommended supplementation on their vitamin D levels at discharge. J Matern Fetal Neonatal Med 2019; 33:3784-3790. [PMID: 30810408 DOI: 10.1080/14767058.2019.1586873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: To evaluate vitamin D status in mothers and their very low birth weight infants (VLBW) at birth (umbilical cord blood) and at discharge with currently recommended supplementation of vitamin D.Methods: Ninety-four infants with birth weight less than 1500 g completed the study. The total daily vitamin D intake was 800-1000 IU. We examined 25-hydroxyvitamin-D [25(OH)D] levels in maternal serum before labor, in cord blood, and in infants' serum at discharge.Results: Median (IQR) serum 25(OH)D was 21 (14-36) nmol/l [8 (6-15) ng/ml] in cord blood, and 46 (37-60) nmol/l [18 (15-24) ng/ml] at discharge. Serum 25(OH)D was <50 nmol/L in 71.3% of mothers, in 91.5% of cord blood samples, and in almost 60% of preterm newborns at discharge (after 8 weeks of supplementation). Serum 25(OH)D was <75 nmol/L in 88.3% of mothers, in 97.9% of cord blood samples, and in 91.4% of preterm newborns at discharge.Conclusions: In our cohort, we found that due to the very high prevalence of 25(OH)D deficiency among mothers, the current generally recommended dose of vitamin D (800-1000 IU per day) for VLBW infants was unable to improve vitamin D levels above the desired 50 or even 75 nmol/L before discharge.
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Affiliation(s)
- Tomas Matejek
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Martina Navratilova
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Lenka Zaloudkova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jana Malakova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Maly
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Sylva Skalova
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Vladimir Palicka
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Fedakâr A. Vitamin D Deficiency, Prevalence and Treatment in Neonatal Period. Endocr Metab Immune Disord Drug Targets 2019; 19:866-873. [PMID: 30857517 DOI: 10.2174/1871530319666190215152045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Maternal vitamin D deficiency is an important risk factor that causes infantile rickets in the neonatal and infantile period. The aim of this study was to review the prevalence, clinical characteristics, and treatment of vitamin D deficiency and the follow-ups with infants and their mothers by the neonatal intensive care unit of Afiyet Hospital in Turkey. METHODS Calcium (Ca), phosphorus (P) and 25 (OH) vitamin D were studied and prospectively recorded in infants and their mothers detected to have hypocalcemia during routine biochemistry tests performed on the third postnatal day of the patients follow up and treated with different diagnoses. RESULTS A total of 2,460 infants were admitted into the neonatal intensive care unit between August 2014 and January 2018. Of the infants included in the study, 324 (66.1%) were male and 166 (33.8%) were female, and 366 (74.6%) of them had been delivered by cesarean section (C/S), 124 (25.3%) of them had been delivered by Normal Spontaneous Delivery (NSD). Hypocalcemia was detected in 490 (19.9%) of the infants. In a total of 190 (38.7%) infants and 86 mothers (17.5%), the levels of 25 (OH) vitamin D were found to be below the laboratory detection limit of <3 ng/ml. When vitamin D deficiency + insufficiency is assessed by season, 151 of them were found to be in summer (30.99%), 118 in spring (24.18%), 117 in the winter season(23.87%), and 93 in autumn(18.97%), respectively. There was a statistically significant positive correlation of 78.7% between the vitamins D values of the mothers and the infants (p: 0.000, p<0.05). CONCLUSION This study conducted that a positive correlation of between the vitamin D values of the mothers and the infants. In order to prevent maternal vitamin D deficiency, the appropriate dose of prophylaxis providing optimal levels of vitamin D and should be given by according to the levels of 25 (OH) D vitamin during pregnancy.
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Affiliation(s)
- Atiye Fedakâr
- Department of Pediatrics, Afiyet Hospital. Umraniye, Istanbul, Turkey
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Abstract
Objective: To evaluate the maternal and neonatal 25-hydroxyvitamin D [25(OH)D] levels and the effect of 25(OH)D levels on the development of neonatal sepsis. Methods: This prospective study was performed in the neonatal intensive care unit of Medicine Hospital/Biruni University between November 2017 and September 2018. Fifty one term infants with sepsis group and 56 term infants with control group were included in this study. Blood samples for whole blood count, CRP, Ca, P, ALP, 25(OH)D and culture were obtained from all neonates. Results: Mean vitamin D levels for the neonates and their mothers were found to be 12.4±8.5 ng/ml and 13±8.7 ng/ml, respectively. There was a significant correlation between maternal and newborn 25(OH)D levels (r=0.72, p<0.01). The number of the newborns with vitamin D deficiency was significantly higher in the sepsis group (n=31, 60.8%) than in the control group (n=30, 53.6%; p=0.00), corresponding to significantly lower levels of vitamin D in the sepsis group (11±5.5 ng/ml vs. 13.8±10.6 ng/ml; p=0.012). Similarly, maternal vitamin D levels was significantly lower in the sepsis group than in the control group (10.8±5.6 ng/ml vs. 14.9±10 ng/ml; p=0.001). Conclusion: Our findings suggest that there may be an association between vitamin D deficiency and neonatal sepsis
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Affiliation(s)
- Abdurrahman Avar Ozdemir
- Abdurrahman Avar Ozdemir Department of Pediatrics, Medicine Hospital, Biruni University, Istanbul, Turkey
| | - Yakup Cag
- Yakup Cag Department of Pediatrics, Dr. Lutfi Kirdar Training and Research Hospital, Medical Sciences University, Istanbul, Turkey
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Kaufman D, Zanelli S, Sánchez PJ. Neonatal Meningitis. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Omran A, Mousa H, Abdalla MO, Zekry O. Maternal and neonatal vitamin D deficiency and transient tachypnea of the newborn in full term neonates. J Perinat Med 2018; 46:1057-1060. [PMID: 29267176 DOI: 10.1515/jpm-2017-0280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022]
Abstract
AIM To investigate the association between maternal and neonatal serum 25-hydroxyvitamin D (25-OHD) levels and development of transient tachypnea of the newborn (TTN) in full term infants. METHODS This was a prospective case-control study carried out on 30 neonates with TTN and their mothers and 30 control neonates and their mothers. Levels of 25-OHD were measured in maternal and neonatal blood samples that were obtained in the first 12-24 h of postnatal age. RESULTS Both maternal and neonatal 25-OHD levels in the TTN group were significantly lower compared to the control group (P=0.0001). A negative correlation was observed between neonatal 25-OHD level and average hospital stay (P=0.0001). CONCLUSION We observed that lower maternal and neonatal vitamin 25-OHD levels were associated with TTN development in full term infants.
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Affiliation(s)
- Ahmed Omran
- Departments of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Heba Mousa
- Departments of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohamed Osama Abdalla
- Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Osama Zekry
- Departments of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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GÜMÜŞ H, KAZANASMAZ H. Kültür Kanıtlı Geç Neonatal Sepsis Olgularında Sıklık, İzole Edilen Mikroorganizmalar ve Antibiyotik Direncinin Araştırılması. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2018. [DOI: 10.17517/ksutfd.440633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kim I, Kim SS, Song JI, Yoon SH, Park GY, Lee YW. Association between vitamin D level at birth and respiratory morbidities in very-low-birth-weight infants. KOREAN JOURNAL OF PEDIATRICS 2018; 62:166-172. [PMID: 30360037 PMCID: PMC6528057 DOI: 10.3345/kjp.2018.06632] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/15/2018] [Indexed: 12/31/2022]
Abstract
Purpose This study aimed to evaluate vitamin D status at birth in very-low-birth-weight infants (VLBWIs: <1,500 g) and to determine the association between vitamin D level and respiratory morbidity. Methods A retrospective study was conducted at Soonchunhyang University Bucheon Hospital between November 2013 and November 2017. We collected blood samples and data on respiratory morbidity from 230 VLBWIs on the first day of life. Patients who were transferred to other hospitals (n=19), died before 36 weeks of gestational age (n=18), or whose blood samples were not collected immediately after birth (n=5) were excluded. Finally, 188 patients were enrolled. VLBWIs with different vitamin D levels were compared with respect to demographic features, maternal diseases, respiratory morbidities, and other neonatal diseases. Results The mean serum vitamin D level, as measured by 25-hydroxyvitamin D (25(OH)D), was 13.4± 9.3 ng/mL. The incidence of vitamin D deficiency (<20 ng/mL) was 79.8%, and 44.1% of preterm infants had severe vitamin D deficiency (<10 ng/mL). Logistic analysis shows that a low serum 25(OH)D level (<20 ng/mL) was a risk factor for respiratory distress syndrome (odds ratio [OR], 4.32; P=0.010) and bronchopulmonary dysplasia (OR, 4.11; P=0.035). Conclusion The results showed that 79.8% of preterm infants in this study had vitamin D deficiency at birth. Low vitamin D status was associated with respiratory morbidity, but the exact mechanism was unknown. Additional studies on the association between vitamin D level and neonatal morbidity are required.
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Affiliation(s)
- Ian Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jee In Song
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seock Hwa Yoon
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ga Young Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yong-Wha Lee
- Department of Laboratory Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Dhandai R, Jajoo M, Singh A, Mandal A, Jain R. Association of vitamin D deficiency with an increased risk of late-onset neonatal sepsis. Paediatr Int Child Health 2018; 38:193-197. [PMID: 30003852 DOI: 10.1080/20469047.2018.1477388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Vitamin D deficiency in mothers and neonates is being recognised increasingly as a leading cause of many adverse health effects in the newborn infant, including sepsis. METHODS A prospective observational study was conducted at a tertiary care Paediatric teaching hospital in northern India to assess vitamin D deficiency as a possible risk factor for late-onset sepsis (LOS) in term and late preterm neonates and also to examine the correlation between maternal and infant vitamin D levels during the neonatal period. Late-onset sepsis (LOS) was defined as the development of signs and symptoms of severe sepsis after 72 h of life and a positive sepsis screen. All term and late preterm neonates admitted with LOS between September 2015 and February 2016 who had not been previously admitted for >48 h and had not been prescribed antibiotics or vitamin D were included in the study. Matched controls were recruited from otherwise healthy neonates admitted with physiological hyperbilirubinaemia. Serum 25(OH) vitamin D was assessed in neonates in both groups and their mothers. RESULTS A total of 421 neonates were admitted to the neonatal intensive care unit during the study period, 120 of whom satisfied the inclusion criteria, and 60 were recruited as cases. Sixty neonates were recruited as controls who were similar in gender, gestational age, age at admission and anthropometry. The study group had significantly lower mean (SD) vitamin D levels [15.37 ng/ml (10.0)] than the control group [21.37 ng/ml (9.53)] (p = 0.001). The odds ratio was 1.7 (95% CI 0.52-5.51) for LOS in vitamin D-deficient neonates. Mothers of septic neonates also had significantly lower mean (SD) vitamin D levels [17.87 (11.89)] than the mothers of non-septic neonates [23.65 ng/ml (9.55)] (p = 0.004). Maternal vitamin D levels strongly correlated to neonatal vitamin D levels in both groups. CONCLUSION Neonates with vitamin D deficiency are at greater risk of LOS than those with sufficient vitamin D levels.
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Affiliation(s)
- Rajeshwari Dhandai
- a Department of Pediatrics , Chacha Nehru Bal Chikitsalaya , New Delhi , India
| | - Mamta Jajoo
- a Department of Pediatrics , Chacha Nehru Bal Chikitsalaya , New Delhi , India
| | - Amitabh Singh
- a Department of Pediatrics , Chacha Nehru Bal Chikitsalaya , New Delhi , India
| | - Anirban Mandal
- b Sitaram Bhartia Institute of Science and Research , New Delhi , India
| | - Rahul Jain
- a Department of Pediatrics , Chacha Nehru Bal Chikitsalaya , New Delhi , India
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Vitamin D deficiency and clinical outcomes related to septic shock in children with critical illness: a systematic review. Eur J Clin Nutr 2018; 73:1095-1101. [PMID: 30006615 DOI: 10.1038/s41430-018-0249-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/28/2018] [Accepted: 06/08/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Low vitamin D blood levels are related to many clinical outcomes in children with critically illness. However, the relationship of it and septic shock has not been systematically analyzed. The objective of this review was to evaluate the effect of vitamin D on septic shock and predict if vitamin D administration can improve prognosis of it. MATERIALS AND METHODS Online databases were searched up to June 1st, 2017 for studies on the relation of vitamin D deficiency (VDD) and clinical outcomes on septic shock in children with critical illness. The primary end point was the effect of VDD on occurrence of septic shock. The secondary endpoints were the association of VDD and clinical outcomes related to septic shock. We summarized the strength of association between VDD and each factor on septic shock. Individual factors were defined as strong, moderate, weak, or inconclusive according to the numbers of the article supporting the relation between them. RESULTS Eight studies published between 2012 and 2017, for a total of 1367 patients, were included in the final analysis. We extracted eight patient-level factors and among them one showed strong association of VDD and septic shock. Four factors demonstrated moderate or weak strength of evidence for it: nonresolution of shock, catecholamine refractory shock, fluid boluses, vasopressor use. But evidence for the association between VDD and severity of illness, stay of pediatric intensive care unit (PICU), are weak. Most of the articles showed no significant association between VDD and mortality. CONCLUSIONS Among critically ill children, VDD might be associated with the occurrence and resolution of septic shock. A larger multicenter trial could conclusively confirm these findings. Further research is also needed to identify vitamin D administration for better outcomes in pediatric patients.
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Tayel SI, Soliman SE, Elsayed HM. Vitamin D deficiency and vitamin D receptor variants in mothers and their neonates are risk factors for neonatal sepsis. Steroids 2018. [PMID: 29530503 DOI: 10.1016/j.steroids.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Increasing prevalence of neonatal sepsis in recent years catch attention to early prevention and management. Vitamin D receptor (VDR) polymorphism can modulate VDR expression level that greatly influences immunity and susceptibility to microbial infections. We aimed to investigate the association of VDR polymorphism at FokI, rs2228570 T/C, and TaqI, rs731236 C/T gene with serum 25-hydroxyvitamin D level and risk of neonatal sepsis. METHODS This work carried on 160 subjects classified into 80 cases (40 mothers and their 40 septic neonates) and 80 healthy controls (40 volunteer mothers and their 40 healthy neonates). Genotyping of VDR polymorphisms were assayed by real-time PCR and serum 25-hydroxyvitamin D level and hs-CRP were measured by ELISA. RESULTS Vitamin D deficiency was observed in mothers of cases compared with healthy ones (p = <0.001) and in septic neonates versus healthy ones (p = <0.001). Septic neonates had much higher VDR FokI TT genotype (p = 0.014) and T allele (p = 0.003) versus healthy ones. TT genotype and T allele could increase the risk of sepsis with OR 95% CI [4.804 (1.4-16.4)] and [2.786 (1.4-5.7)] respectively while VDR TaqI showed no association with sepsis. There was a strong LD between FokI and TaqI in sepsis cases. In sepsis, T/T genotype at FokI had significantly lower vitamin D (p = <0.001). CONCLUSION Vitamin D deficiency in mothers/neonates is a risk factor for neonatal sepsis. VDR FokI T allele had lower 25-hydroxyvitamin D level that may predispose to sepsis hazards.
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Affiliation(s)
- Safaa I Tayel
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Egypt.
| | - Shimaa E Soliman
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Egypt
| | - Hanan M Elsayed
- Pediatric Department, Faculty of Medicine, Menoufia University, Egypt
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Zheng G, Pan M, Li Z, Xiang W, Jin W. Effects of vitamin D on apoptosis of T-lymphocyte subsets in neonatal sepsis. Exp Ther Med 2018; 16:629-634. [PMID: 30116318 PMCID: PMC6090303 DOI: 10.3892/etm.2018.6215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/10/2018] [Indexed: 01/08/2023] Open
Abstract
Effect of vitamin D on apoptosis of peripheral blood T-lymphocyte subsets in treatment of neonatal sepsis was investigated. A total of 150 neonatal patients with sepsis were randomly divided into vitamin D treatment group (observation group) and treatment control group, while 100 healthy newborns were selected as healthy control group. T-lymphocyte subsets were detected by flow cytometer, the levels of tumor necrosis factor-α, interleukin-1 and calcitonin were determined by double-antibody immunoluminometric assay, and the effect of vitamin D on the above indicators in the treatment of sepsis was observed. Serum 25(OH)D (22.52±5.56 mg/l) in the treatment group was obviously increased compared with that in the treatment group (14.85±6.14 mg/l) (P<0.05), but the levels in the two groups were remarkably lower than that in the normal control group (26.38±6.56 mg/l), and the differences were statistically significant (P<0.05). Cluster of differentiation 4 (CD4+) T-lymphocyte subset in sepsis patients was obviously reduced compared with that in the healthy control group (P<0.01); the difference in comparison of CD8+ T-lymphocyte subset between sepsis patients and healthy people was not statistically significant (P>0.05). After treatment for 72 h, CD4+ T-lymphocytes were increased, and the ratio of CD4+ to CD8+ was close to 1, suggesting that the effect was superior to that in the treatment control group. The inflammatory factor levels in children with sepsis were evidently higher than those in the healthy control group (P<0.01), and high-level states of inflammatory factors were significantly improved after treatment with vitamin D for 72 h, indicating that the effect was superior to that in the treatment group. The results indicated that the prognosis of sepsis patients treated with vitamin D is improved, and the mechanism may be achieved by regulating T-lymphocyte subsets and inflammatory factors.
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Affiliation(s)
- Ge Zheng
- Department of Paediatrics, Ruian People's Hospital, Wenzhou, Zhejiang 325200, P.R. China
| | - Minli Pan
- Department of Paediatrics, Ruian People's Hospital, Wenzhou, Zhejiang 325200, P.R. China
| | - Zhishu Li
- Department of Paediatrics, Ruian People's Hospital, Wenzhou, Zhejiang 325200, P.R. China
| | - Wenna Xiang
- Department of Paediatrics, Ruian People's Hospital, Wenzhou, Zhejiang 325200, P.R. China
| | - Weimin Jin
- Department of Paediatrics, Ruian People's Hospital, Wenzhou, Zhejiang 325200, P.R. China
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Almeida ACF, de Paula FJA, Monteiro JP, Nogueira-de-Almeida CA, Del Ciampo LA, Aragon DC, Ferraz IS. Do all infants need vitamin D supplementation? PLoS One 2018; 13:e0195368. [PMID: 29649273 PMCID: PMC5896946 DOI: 10.1371/journal.pone.0195368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/23/2018] [Indexed: 01/04/2023] Open
Abstract
A high prevalence of vitamin D deficiency (VDD) in children has been observed worldwide, but there are few studies on the nutritional status of vitamin D (VD) in healthy infants. The main cause of deficiency in healthy children is breastfeeding without supplementation and lack or insufficiency of sun exposure. The aims of this study were to determine serum concentrations of 25(OH)D and verify its association with parathyroid hormone (PTH) concentrations and use of VD supplementation in healthy infants aged ≥ 6 to ≤ 24 months attended at two Primary Health Care Units in Ribeirão Preto city, São Paulo, Brazil. A cross-sectional, observational and analytical study was performed in which serum concentrations of 25(OH)D, PTH, alkaline phosphatase (AP), calcium (Ca), phosphorus (P) and albumin were determined in 155 healthy infants. Information on sun exposure, sociodemographic aspects of mothers and clinical and nutritional characteristics of infants were obtained through interviews with responsible infants’s legal representatives. Ten infants (6%) presented deficient 25(OH)D serum concentration (≤20ng/ml) and 46 (30%), insufficient (21 to 29ng/ml). No changes in serum P, Ca and albumin concentrations were detected. Only one infant had an increase in PTH serum concentrations. 35% (55/155) of infants had high AP e 40% (22/55) presented insufficient serum concentrations of 25(OH)D but none presented deficient ones. There was a weak association between serum concentrations of 25(OH)D and PTH and an association between serum concentrations of 25(OH)D and P when adjusted for sex, age and BMI. There were no associations between inadequate serum concentrations of 25(OH)D (deficient ou insufficient), sun exposure and VD supplementation. This study found a low prevalence of deficient 25(OH)D serum concentration and high prevalence of insufficient ones which was not associated with changes in serum PTH, AP, P, Ca and albumin concentrations, VD supplementation and the formula volume intake.
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Affiliation(s)
- Ane Cristina Fayão Almeida
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo—USP, Ribeirão Preto, Brazil
| | | | - Jacqueline Pontes Monteiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo—USP, Ribeirão Preto, Brazil
| | | | - Luiz Antonio Del Ciampo
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo—USP, Ribeirão Preto, Brazil
| | - Davi Casale Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo—USP, Ribeirão Preto, Brazil
| | - Ivan Savioli Ferraz
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo—USP, Ribeirão Preto, Brazil
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Matejek T, Navratilova M, Zaloudkova L, Malakova J, Maly J, Skalova S, Palicka V. Parathyroid hormone – reference values and association with other bone metabolism markers in very low birth weight infants – pilot study. J Matern Fetal Neonatal Med 2018; 32:2860-2867. [DOI: 10.1080/14767058.2018.1450858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Tomas Matejek
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martina Navratilova
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Lenka Zaloudkova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jana Malakova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Maly
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Sylva Skalova
- Department of Paediatrics, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vladimir Palicka
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Elsori DH, Hammoud MS. Vitamin D deficiency in mothers, neonates and children. J Steroid Biochem Mol Biol 2018; 175:195-199. [PMID: 28179126 DOI: 10.1016/j.jsbmb.2017.01.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 01/08/2023]
Abstract
Vitamin D is produced in response to the exposure of skin to sunlight through UV-B synthesis. It can also be obtained from diet and dietary supplements. Vitamin D is essential for strong bones as it helps to absorb calcium from diet. Vitamin D deficiency mainly occurs if strict vegetarian diet is followed as mostly the source of vitamin D is animal based; therefore, exposure to sunlight is restricted or having dark skin color. Low vitamin D levels results in increased possibility of gestational diabetes among pregnant women, low birth weight and pre-eclampsia in infants, and mothers may suffer bone impairment, osteoporosis, hypocalcaemia, and hypertension. Vitamin D deficiency is directly linked with severe complication in mothers and neonates, causing rickets, poor fetal growth and infantile eczema in neonates. Higher prevalence rate of vitamin D deficiency has led professionals to emphasize on development of relevant precautionary measures.
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Affiliation(s)
- Deena H Elsori
- Department of Applied Sciences and Mathematics, College of Arts and Sciences, Abu Dhabi University, United Arab Emirates
| | - Majeda S Hammoud
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait.
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Berridge MJ. Vitamin D deficiency: infertility and neurodevelopmental diseases (attention deficit hyperactivity disorder, autism, and schizophrenia). Am J Physiol Cell Physiol 2017; 314:C135-C151. [PMID: 29070492 DOI: 10.1152/ajpcell.00188.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The process of development depends on a number of signaling systems that regulates the progressive sequence of developmental events. Infertility and neurodevelopmental diseases, such as attention deficit hyperactivity disorder, autism spectrum disorders, and schizophrenia, are caused by specific alterations in these signaling processes. Calcium signaling plays a prominent role throughout development beginning at fertilization and continuing through early development, implantation, and organ differentiation such as heart and brain development. Vitamin D plays a major role in regulating these signaling processes that control development. There is an increase in infertility and an onset of neurodevelopmental diseases when vitamin D is deficient. The way in which vitamin D deficiency acts to alter development is a major feature of this review. One of the primary functions of vitamin D is to maintain the phenotypic stability of both the Ca2+ and redox signaling pathways that play such a key role throughout development.
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Affiliation(s)
- Michael J Berridge
- Laboratory of Molecular Signalling, The Babraham Institute , Cambridge , United Kingdom
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Abstract
Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by setting. Differing estimates of disease burden have been reported from high-income countries compared with reports from low-income and middle-income countries. The clinical manifestations range from subclinical infection to severe manifestations of focal or systemic disease. The source of the pathogen might be attributed to an in-utero infection, acquisition from maternal flora, or postnatal acquisition from the hospital or community. The timing of exposure, inoculum size, immune status of the infant, and virulence of the causative agent influence the clinical expression of neonatal sepsis. Immunological immaturity of the neonate might result in an impaired response to infectious agents. This is especially evident in premature infants whose prolonged stays in hospital and need for invasive procedures place them at increased risk for hospital-acquired infections. Clinically, there is often little difference between sepsis that is caused by an identified pathogen and sepsis that is caused by an unknown pathogen. Culture-independent diagnostics, the use of sepsis prediction scores, judicious antimicrobial use, and the development of preventive measures including maternal vaccines are ongoing efforts designed to reduce the burden of neonatal sepsis.
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Affiliation(s)
- Andi L Shane
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Pablo J Sánchez
- Divisions of Neonatology and Infectious Disease, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Barbara J Stoll
- University of Texas, Health McGovern Medical School, Houston, TX, USA
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Bozkurt O, Uras N, Sari FN, Atay FY, Sahin S, Alkan AD, Canpolat FE, Oguz SS. Multi-dose vitamin d supplementation in stable very preterm infants: Prospective randomized trial response to three different vitamin D supplementation doses. Early Hum Dev 2017; 112:54-59. [PMID: 28779655 DOI: 10.1016/j.earlhumdev.2017.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Preterm newborns are born with lower vitamin D stores. Although vitamin D supplementation is recommended there is no consensus regarding the adequate dose of supplementation for preterm infants. AIMS To assess the effect of three different doses of vitamin D supplementation (400, 800 and 1000IU/d) in preterm infants ≤32weeks gestation on the prevalence of vitamin D deficiency and 25(OH) D levels at 36weeks postmenstrual age (PMA). STUDY DESIGN Prospective randomized trial. SUBJECTS 121 preterm infants with gestational age of 24-32weeks were randomly allocated to receive 400, 800 or 1000IU/d vitamin D. OUTCOME MEASURES Serum concentration of 25(OH) D and the prevalence of vitamin D deficiency at 36weeks PMA. Vitamin D deficiency was defined as serum 25(OH) D concentrations <20ng/ml. RESULTS Of the 121 infants 72% had deficient vitamin D levels before supplementation. The average 25(OH) vitamin D concentrations at 36weeks PMA were significantly higher in 800IU (40±21.4ng/ml) and 1000IU group (43±18.9ng/ml) when compared to 400IU group (29.4±13ng/ml). The prevalence of vitamin D deficiency (2.5 vs 22.5; RR: 0.09; CI:0.01-0.74) and insufficiency (30 vs 57.5; RR:0.32; CI:0.13-0.80) was significantly lower in 1000IU group when compared to 400IU group at 36weeks PMA. CONCLUSION 1000IU/d of vitamin D supplementation in preterm infants ≤32weeks gestation age effectively decreases the prevalence of vitamin D deficiency and leads to higher concentrations of 25(OH) vitamin D at 36weeks PMA TRIAL REGISTRATION: Clinical Trials.gov: NCT02941185.
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Affiliation(s)
- Ozlem Bozkurt
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
| | - Nurdan Uras
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Fatma Nur Sari
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Funda Yavanoglu Atay
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Suzan Sahin
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Ayse Dogan Alkan
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Fuat Emre Canpolat
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Serife Suna Oguz
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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47
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Say B, Uras N, Sahin S, Degirmencioglu H, Oguz SS, Canpolat FE. Effects of cord blood vitamin D levels on the risk of neonatal sepsis in premature infants. KOREAN JOURNAL OF PEDIATRICS 2017; 60:248-253. [PMID: 29042866 PMCID: PMC5638722 DOI: 10.3345/kjp.2017.60.8.248] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/17/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Abstract
Purpose Vitamin D plays a key role in immune function. Vitamin D deficiency may play a role in the pathogenesis of infections, and low levels of circulating vitamin D are strongly associated with infectious diseases. In this study, we aimed to evaluate the effects of low vitamin D levels in cord blood on neonatal sepsis in preterm infants. Methods One hundred seventeen premature infants with gestational age of <37 weeks were enrolled. In the present study, severe vitamin D deficiency (group 1) was defined as a 25-hydroxyvitamin D (25(OH)D) concentration <5 ng/mL; vitamin D insufficiency (group 2), 25(OH)D concentration ≥5 ng/mL and <15 ng/mL; and vitamin D sufficiency (group 3), 25(OH)D concentration ≥15 ng/mL. Results Sixty-three percent of the infants had deficient levels of cord blood vitamin D (group 1), 24% had insufficient levels (group 2), and 13% were found to have sufficient levels (group 3). The rate of neonatal sepsis was higher in group 2 than in groups 1 and 3. Conclusion There was no significant relationship between the cord blood vitamin D levels and the risk of neonatal sepsis in premature infants.
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Affiliation(s)
- Birgul Say
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Nurdan Uras
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Suzan Sahin
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Halil Degirmencioglu
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Serife Suna Oguz
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Fuat Emre Canpolat
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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Mohamed Hegazy A, Mohamed Shinkar D, Refaat Mohamed N, Abdalla Gaber H. Association between serum 25 (OH) vitamin D level at birth and respiratory morbidities among preterm neonates. J Matern Fetal Neonatal Med 2017; 31:2649-2655. [DOI: 10.1080/14767058.2017.1350162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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49
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Puthuraya S, Karnati S, Kazzi SNJ, Qureshi F, Jacques SM, Thomas R. Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants? J Matern Fetal Neonatal Med 2017; 31:1906-1912. [DOI: 10.1080/14767058.2017.1332034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Subhash Puthuraya
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Sreenivas Karnati
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | | | - Faisal Qureshi
- Department of Pathology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Suzanne M. Jacques
- Department of Pathology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Ronald Thomas
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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Gokhale SG, Gokhale S. Effect of two high dose vitamin D by parenteral route in treating vitamin D deficiency a prospective interventional study. J Matern Fetal Neonatal Med 2017; 31:2183-2187. [PMID: 28573886 DOI: 10.1080/14767058.2017.1338257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vitamin D deficiency is recognized as a global public health problem. Despite ample sunshine, vitamin D deficiency is very common in the Middle East (15°-36°N) and African (35°S-37°N) countries; and in South Asian countries. AIM To find a simple, affordable and practical plan to treat vitamin-d deficiency. TYPE OF STUDY This was a prospective interventional study. OUTCOME VARIABLE The primary outcome was typed as vitamin-D level more than 50 nanograms/ml as 'yes' and poor response or 'no' when it was less than 50 ng/ml. PARTICIPANTS 80 Women participated in study. Laboratory tests: Vitamin D [25-OHD]-estimations were performed with LCMSMS-liquid chromatography tandem mass spectrometry. Corrective vitamin-D doses: All participants received TWO doses of Vitamin-D injections one ml at a time [600K IU/ml or 600,000 IU/ml]. All participants received their first dose; after collecting blood samples for Vitamin-D estimations. Second dose was given about a month after the first one [range 30-37 days]. These doses were given to correct the deficiency. RESULTS Even with this high dose treatment 60% woman had unsatisfactory Vitamin-D levels.
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Affiliation(s)
- Sanjay G Gokhale
- a Department of Pediatrics and Neonatology , Rajhans Hospital and Research Center , Saphale , India
| | - Sankalp Gokhale
- b Neuro ICU, BANNER , University Medical Center, UA College of Medicine , Tucson , Arizona , USA
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