[Relationship between vitamin D deficiency and necrotizing enterocolitis in preterm infants]

Correlation between tear levels of vascular endothelial growth factor and vitamin D at retinopathy of prematurity stages in preterm infants

Deregulation of vascular endothelial growth factor (VEGF) levels leads to retinopathy of prematurity (ROP). Vitamin D (VIT-D) is known to regulate VEGF in an oxygen dependent manner. The purpose of this study was to correlate tear levels of VEGF and VIT-D with different ROP stages in preterm infants. In this prospective cross-sectional study, we enrolled 104 pre-term infants. They were grouped into: Group-1 (Classical ROP) and Group-2 (Aggressive ROP), which were further subdivided into Group-1A (progressing), Group-1B (regressing), Group-2A (pre-treatment), and Group-2B (post-treatment). Tear VEGF and VIT-D levels and their association with different ROP stages were assessed. Stage 1 and stage 2 had higher whereas stage 3 had lower VEGF levels in Group-1B compared to Group-1A. Stage 1 and stage 3 showed higher levels of VIT-D with no difference in stage 2 in Group-1B compared to Group-1A., Group-2B showed higher VEGF and lower VIT-D levels compared to Group-2A. Presence of a positive correlation at an early stage (stage 1) of ROP and a negative correlation at a more advanced stage (stage 3) of ROP with VIT-D and VEGF implies stage-specific distinct signaling crosstalk. These findings suggest that VIT-D supplementation may have the potential to modify the course and outcome of ROP.

Risk factors for necrotizing enterocolitis in preterm infants: a Meta analysis

OBJECTIVES

To systematically evaluate the risk factors for necrotizing enterocolitis (NEC) in preterm infants.

METHODS

PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched for case-control studies and cohort studies on the risk factors for NEC in preterm infants published up to December 2021. RevMan 5.3 software was used to perform the Meta analysis.

RESULTS

A total of 38 studies were included (28 case-control studies and 10 cohort studies). The Meta analysis showed that maternal gestational diabetes (OR=2.96, P<0.001), intrahepatic cholestasis during pregnancy (OR=2.53, P<0.001), preeclampsia (OR=1.73, P=0.020), history of neonatal asphyxia (OR=2.13, P<0.001), low gestational age (OR=1.23, P=0.010), sepsis (OR=5.32, P<0.001), patent ductus arteriosus (OR=1.57, P=0.001), congenital heart disease (OR=3.78, P<0.001), mechanical ventilation (OR=2.23, P=0.020), history of antibiotic use (OR=1.07, P<0.001), use of vasopressors (OR=2.34, P=0.040), and fasting (OR=1.08, P<0.001) were risk factors for NEC in preterm infants, while cesarean section (OR=0.73, P=0.004), use of pulmonary surfactant (OR=0.43, P=0.008), and breastfeeding (OR=0.24, P=0.020) were protective factors against NEC.

CONCLUSIONS

Maternal gestational diabetes, intrahepatic cholestasis during pregnancy, preeclampsia, low gestational age, fasting, sepsis, patent ductus arteriosus, congenital heart disease, and histories of asphyxia, mechanical ventilation, antibiotic use, and use of vasopressors may increase the risk of NEC in preterm infants, while cesarean section, use of pulmonary surfactant, and breastfeeding may decrease the risk of NEC in preterm infants.

Relationship between maternal risk factors and occurrence of necrotizing enterocolitis in premature infants before and during the first trimester

BACKGROUND

Necrotizing enterocolitis (NEC) is a common inflammatory bowel disease. If not treated timely, NEC may increase the risk of serious infection and death. Epidemiological studies have shown that damage to the gastrointestinal mucosa, premature delivery, and intestinal bacterial action are the basic conditions for the occurrence of this disease. In addition, weakened intestinal barrier function, hypertonic milk formula feeding, hypoxic-ischemic injury, probiotic use, and premature rupture of membranes are also related to the onset of NEC.

AIM

To analyze the correlation between maternal risk factors and NEC in premature infants before and during the first trimester.

METHODS

The clinical data of 54 preterm infants with NEC treated at our hospital from September 2017 to June 2020 were collected as an NEC group, and 106 non-NEC preterm infants during the same period were selected as a non-NEC group. The clinical symptoms of NEC in preterm infants were analyzed, and the maternal risk factors affecting the occurrence of NEC in preterm infants were analyzed by univariate and multivariate logistic regression analyses.

RESULTS

The clinical symptoms of 54 children with NEC were mainly abdominal distension, weakened bowel sounds, and hematochezia, accounting for 77.78%, 74.07%, and 64.81% of cases, respectively. The unconditional multiple logistic regression analysis confirmed that history of smoking before pregnancy, respiratory infection in early pregnancy, intrahepatic cholestasis, neutrophil/lymphocyte ratio (NLR) ≥h3, and gestational diabetes may be risk factors for NEC (odds ratio [OR] > 1, P < 0.05), while taking vitamin D in the first trimester may be a protective factor (OR < 1, P < 0.05).

CONCLUSION

The occurrence of NEC in premature infants may be related to poor living habits before pregnancy, respiratory infections, intrahepatic cholestasis, NLR, etc; these risk factors should be avoided before and during pregnancy.