Vitamin D deficiency and morbidity among preterm infants in a developing country
DOI:
https://doi.org/10.18203/2349-3291.ijcp20170697Keywords:
Morbidity, Preterm Infants, Vitamin D levelsAbstract
Background: The association of serum vitamin D levels to clinical outcome in VLBW infants has not been studied. Our objective was to measure the cord blood levels, and the dose response for two doses of vitamin D in preterm infants and correlate the relationship of vitamin D levels to the clinical outcome.
Methods: We prospectively obtained cord blood levels in 80 preterm infants under 34 weeks gestation (mean gestation age 29±2 weeks and BW: 1210±350 gms). Infants were supplemented with 400 IU or 800-1000 IU vitamin D daily. Serun vitamin D levels were obtained at 2 - 3 weeks after supplementation and levels were correlated to clinical outcome.
Results: The mean cord blood vitamin D level was 12±8.5 ng/ml. Babies who developed sepsis and compared to those who did not develop these morbidities, ROP had vitamin D levels: 13.5±6 (ng/ml) versus 30.5±10 (ng/ml) (p < 0.01) and 15.7±11 (ng/ml) versus 34±18 (ng/ml) (p <0.03) respectively. Supplementation with 400 IU vitamin D resulted in levels of 17±8.6 (ng/ml) and infants given 800-1000 IU vitamin D had levels 46±17(ng/ml) (p <0.001).
Conclusions: These data suggest that cord blood vitamin D levels are low in preterm infants and 800-1000 IU vitamin D supplementation is advisable to achieve levels >30 ng/ml. Infants with low levels of vitamin D have higher incidence of sepsis, and ROP.
References
Hollick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-81.
Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81:353-73.
Ferrari HA, Giovannucci E, Willet WC, Dietrich T, Hughes DB. Estimation of optimal serum concentration of 25-hydroxy vitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84:18-28.
Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet. 1998;351:805-6.
Thomas KK, Jones DM, Thadhani RI. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777-83.
Chapuy MC, Preziosi P, Maamer M. Prevalence of vitamin D in adult normal population. Osteoporosis Int. 1997;7:439-43.
Holick MF, Siris ES, Binkley N. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005;90:3215-24.
Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr. 2005;81:1060-4.
Verstuyf A, Carmeliet G, Bouillon R. Vitamin D: a pleiotropic hormone. Kidney Int. 2010;78:140-5.
Baeke F, Takiishi T, Korf H. Vitamin D: modulator of the immune system. Curr Opin Pharmacol. 2010;10:482-96.
Overbergh L, Stoffels K, Valckx D. Regulation of 25-hydroxyvitamin d-1 alpha hydroxylase by IFN gamma in human monocytic THP1 cells. J Steroid Biochem Mol Biol. 2004;89:453-5.
Judd SE, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Am J Med Sci. 2009;338:40-4.
Berthold GI, Krone W, Berthold HK. Vitamin D and cardiovascular disease. Curr Vasc Pharmacol. 2009;7:414-22.
Shoshan BM, Amir S, Dang DT. 1alpha,25-dihydroxyvitamin D3 (calcitriol) inhibits hypoxia-inducible factor-1/vascular endothelial growth factorpathway in human cancer cells. Mol Cancer Ther. 2007;6:1433-9.
Albert DM, Scheef EA, Wang S. Calcitriol is a potent inhibitor of retinal neovascularization. Invest Ophthalmol Vis Sci. 2007;48:2327-34.
Kamen DL, Tangpricha V. Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med. 2010;88:441-50.
Veldman CM, Cantorna MT, Deluca HF. Expression of 1,25-dihydroxyvitamin D(3) receptor in the immune system. Arch Biochem Biophys. 2000;374:334-8.
Bartley J. Vitamin D: emerging roles in infection and immunity. Expert Rev Anti Infect Ther. 2010;8:1359-69.
Ginde AA, Mansbach JM, Camargo CA. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the third national health and nutrition examination survey. Arch Intern Med. 2009;169:384-90.
Schwalfenberg GK. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Mol Nutr Food Res. 2011;55:96-108.
Alitalo A. Human anti-infectious defence may be enhanced by vitamin D. Duodecim. 2010;126:1127-34.
Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, et al. Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 2009;7:28.
Bikle DD. Vitamin D and the immune system: role in protection against bacterial infection. Curr Opin Nephrol Hypertens. 2008;17:348-52.
Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91:1255-60.
Feindt E, Stroder J. Studies on the antimicrobial effect of vitamin D. Klin Wochenschr. 1977;55:507-8.
Grant WB. Solar ultraviolet-B irradiance and vitamin D may reduce the risk of septicemia. Dermatoendocrinol. 2009;1:37-42.
Grant WB. Vitamin D supplementation could reduce risk of sepsis in infants. World J Pediatr 2010;6:185.
Grant WB. Vitamin D supplementation of mother and infant could reduce risk of sepsis in premature infants. Early Hum Dev. 2010;86:133.
Calcium and vitamin D requirements of enterally fed preterm infants. Available at https:// pediatrics. aappublications.org/content/pediatrics/early/2013/04/24/peds.2013-0420.full.pdf. Accessed on 14 July 2016.
Agarwal R, Virmani D, Jaipal ML, Gupta S, Gupta N, Sankar MJ. Vitamin D status of low birth weight infants in Delhi: a comparative Study. J Trop Pediatr. 2012;58(6):446-50.
Natarajan CK, Sankar J, Agarwal R. Trial of daily Vitamin D supplementation in preterm infants. Pediatrics. 2014;133;628.
