Investigation of association between maternal 25-OH vitamin D serum levels and neonatal early onset sepsis in newborns by evaluating key factors

Lower Vitamin D Level as a Risk Factor for Late Onset Neonatal Sepsis: An Observational Case-Control Study

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..

The Role of Low 25-Hydroxyvitamin D Levels in Preterm Infants with Late-Onset Sepsis

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.

Effects of vitamin D on neonatal sepsis: A systematic review and meta-analysis

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.

Association between DNA Damage and Serum Levels of Copper, Zinc, and Selenium in Full-Term Neonates with Late-Onset Sepsis

Objective The alteration in certain trace elements is usually associated with impaired immune function and higher oxidative stress. Therefore, these elements are suggested to play an important role in the pathogenesis of neonatal sepsis. We aimed to evaluate copper (Cu), zinc (Zn), and selenium (Se) serum levels in full-term neonates with late-onset sepsis (LOS) and correlate these levels with DNA damage and other risk factors of sepsis.

Methods The study included a group of 100 neonates diagnosed with sepsis serving as the case group and another one of 60 neonates serving as the control group. DNA damage was assessed using the comet assay method and trace elements were measured using inductively coupled plasma mass spectrometry.

Results Compared with controls, the percentage of DNA damage was significantly elevated in patients with sepsis, while serum levels of Cu, Zn, and Se were markedly decreased (p = 0.001). A strong negative correlation was revealed between Se and DNA damage (r = −0.6, p = 0.001). However, no correlations were found between Cu or Zn and DNA damage. Univariate logistic regression analysis revealed that DNA damage as well as Cu, Zn, and Se serum levels can be considered as relevant risk factors for neonatal sepsis (p = 0.008, 0.004, 0.004, and 0.003, respectively). Receiver-operating characteristic curve analysis showed that the strongest indicator for neonatal sepsis was Se (area under the curve [AUC] = 0.94, confidence interval [CI] = 0.9–0.98, p = 0.001), followed by Cu (AUC = 0.9, CI = 0.85–0.96, p = 0.001), and then Zn (AUC = 0.87, CI = 0.8–0.93, p = 0.001).

Conclusion The percentage of DNA damage may help in the assessment of neonatal sepsis severity. Altered levels of Cu, Zn, and Se may play significant role in the pathogenesis of neonatal sepsis. Se serum level is strongly correlated with percentage of DNA damage. Therefore, Se can predict the severity of LOS.