Çocuk Servisinde Yatırılarak Tedavi Edilen Alt Solunum Yolu Enfeksiyonu Tanılı 0 – 36 Ay Arası Çocukların Vitamin A Ve Vitamin D Düzeylerinin Aynı Yaş Grubu Sağlıklı Çocuklar Ile Karşılaştırılması

Abstract

Amaç: Alt solunum yolu enfeksiyonları özellikle küçük çocuklarda sık görülmekte olup aynı zamanda hastaneye yatırılarak tedaviyi gerektirmektedir. Çalışmamızda 0-36 ay grubu alt solunum yolu enfeksiyonu tanısıyla takip edilen çocuklarda serum vitamin A ve serum vitamin D düzeylerinin saptanarak, aynı yaş grubundaki sağlıklı çocuklarla karşılaştırılması ve bu vitamin eksikliklerinin alt solunum yolu enfeksiyonu gelişiminde bir risk faktörü olup olmadığının saptanması amaçlanmıştır. Materyal ve metod: Çalışmamızda 01 Şubat 2020-30 Haziran 2020 tarihleri arasında Bağcılar EAH Çocuk Sağlığı ve Hastalıkları Polikliniğine başvuran 0-36 ay arası alt solunum yolu enfeksiyonu tanısı ile izlenen ve serum A ve D vitamini saptanması için kan alınan 82 çocuk çalışmaya dahil edildi. Polikliniğe rutin kontrol için başvuran ve serum A ve D vitamin düzeyleri bakılan 58 sağlıklı çocuk kontrol grubu olarak alındı. Çocukların yaş, cinsiyet, boy ve kilo değerleri kaydedildi. Bulgular: Çalışmamıza katılan hasta grubunun vitamin D ortalaması 15,96±7,49ng/ml, kontrol grubunun vitamin D ortalaması 32,19±14,27 ng/ml olup istatistiksel olarak hasta grubunun vitamin D düzeyi anlamlı derecede düşük bulunmuştur (p=0,0001). Çalışmamıza katılan hasta grubunun vitamin A ortalaması 170,42±60,42 ng/ml, kontrol grubunun vitamin A ortalaması 284,42±71,2 ng/ml olup istatistiksel olarak hasta grubunun vitamin A düzeyi anlamlı derecede düşük bulunmuştur (p=0,0001). Çalışmamızda vitamin D değişkeni ile vitamin A değişkeni arasında pozitif yönde istatistiksel olarak anlamlı korelasyon gözlenmiştir (r=0,432 p=0,0001). Sonuç: ASYE geçiren çocuklarda vitamin A ve vitamin D düzeyleri sağlıklı çocuklara göre daha düşük görülmekte olup bu çocukların vitamin değerlerinin kontrol edilmesi ve gereğinde uygun tedavi verilmesinin ASYE’ye bağlı gelişen morbidite ve mortaliteyi azaltacağını öngörmekteyiz.

Keywords

• Alt Solunum Yolu Enfeksiyonları
• vitamin D
• vitamin A

Supporting Institution

SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, BAĞCILAR EĞİTİM VE ARAŞTIRMA HASTANESİ

Comparison of Vitamin A and Vitamin D Levels of 0-36 Months Old Children, Who were Admitted to Pediatric Inpatient Clinic with Lower Respiratory Tract Infection and Healthy Children within the Same Age Group

Abstract

Background Lower respiratory system infections are highly common in young children and may require inpatient treatment. Studies have shown that patients treated and followed up for lower respiratory system infections have low levels of vitamin A and Vitamin D. In our study, we aimed to determine whether the deficiencies of these vitamins are risk factors for the development of lower respiratory system infections by comparing the serum vitamin A and vitamin D levels of patients 0-36months with lower respiratory tract infection and healthy children. Materials and Method The study included 82 children who applied to pediatric outpatient clinic between February 1st 2020 and June 30th 2020 with lower respiratory tract infection between the age 0-36 months, who gave blood sample for determination of serum vitamin A and vitamin D levels. 58 healthy children who applied to the outpatient clinic for routine check-up were determined as the control group. Age, sex, height and weight of all children were recorded. Results The average vitamin D level of those in the lower respiratory tract infection group was found to be 15.96±7.49ng/ml and those in the healthy group had average vitamin D levels of 32.19±14.27 ng/ml, showing that the sick group had statistically significantly lower levels of vitamin D (p=0.0001). The average vitamin A level of those in the sick group was found to be 170.42±60.42 ng/ml, whereas those in the control group had average vitamin A levels of 284.42±71.2 ng/ml, which showed that those in the sick group had statistically significantly low levels of vitamin A (p=0.0001). Our study showed that there is a positive statistically meaningful correlation between the vitamin D variable and the vitamin A variable (r=0.432, p=0.0001). Conclusions Our study is the only study in the literature comparing both the vitamin A and vitamin D levels of patients with lower respiratory tract infection. Vitamin A and vitamin D levels of patients with lower respiratory tract infections are found to be lower compared to healthy children, therefore we predict that controlling the vitamin levels of such patient and giving the appropriate treatment when needed, will lower the morbidity and mortality caused by lower respiratory tract infections.

Keywords

• Lower Respiratory System Infection
• Vitamin D
• Vitamin A

References

1. 1. Campbell H and Black RE. Global burden of childhood pneu-monia and diarrhoea. Lancet 2013; 381: 1405–1416.
2. 2. Zar HJ, Madhi SA. Childhood pneumonia--progress and chal-lenges. S Afr Med J. 2006 Sep;96(9 Pt 2):890-900.
3. 3. Kocabaş E, Ersöz DD, Karakoç F, Tanır G, Cengiz AB, Gür D ve ark. Türk toraks derneği çocuklarda toplumda gelişen pnömoni tanı ve tedavi uzlaşı raporu.Toraks Dergisi 2009; 10(3): 4-7.
4. 4. Holick MF. The D-lightful vitamin D for child health. JPEN J Parenter Enteral Nutr. 2012 Jan;36(1 Suppl):9S-19S. doi: 10.1177/0148607111430189. Epub 2011 Dec 16.
5. 5. Hewison M. Vitamin D and the immune system: new per-spectives on an old theme. Endocrinol Metab Clin North Am 2010;39(2): 365-79.
6. 6. Das RR, Singh M, Naik SS. Vitamin D as an adjunct to antibi-otics for the treatment of acute childhood pneumonia. Cochrane Database Syst Rev. 2018; 19;7(7):CD011597.
7. 7. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and me-ta-analysis of individual participant data. BMJ. 2017 Feb 15;356:i6583. doi: 10.1136/bmj.i6583. PMID: 28202713; PMCID: PMC5310969.
8. 8. Reyes H, Villalpando S, Pérez-Cuevas R, Rodríguez L, Pérez-Cuevas M, Montalvo I, et al. Frequency and determinants of vitamin A deficiency in children under 5 years of age with pneumonia. Arch Med Res. 2002 Mar-Apr;33(2):180-5. doi: 10.1016/s0188-4409(01)00361-7. PMID: 11886719.

9. 9. Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD008524. doi: 10.1002/14651858.CD008524.pub2. Update in: Cochrane Da-tabase Syst Rev. 2017 Mar 11;3:CD008524. PMID: 21154399.
10. 10. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016 Feb;101(2):394-415. Epub 2016 Jan 8.
11. 11. de Pee S, Dary O. Biochemical indicators of vitamin A defi-ciency: serum retinol and serum retinol binding protein. J Nutr. 2002 Sep;132(9 Suppl):2895S-2901S. doi: 10.1093/jn/132.9.2895S. PMID: 12221267.
12. 12. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with im-plications for the Sustainable Development Goals. Lan-cet 2016; 388: 3027-3035.
13. 13. Kocabaş E, Ersöz DD, Karakoç F, Tanır G, Cengiz AB, Gür D ve ark. Türk toraks derneği çocuklarda toplumda gelişen pnömoni tanı ve tedavi uzlaşı raporu.Toraks Dergisi 2009; 10(3): 3-24.
14. 14. Jat KR. Vitamin D deficiency and lower respiratory tract infections in children: a systematic review and meta-analysis of observational studies. Trop Doct. 2017 Jan;47(1):77-84. doi: 10.1177/0049475516644141. Epub 2016 May 13. PMID: 27178217.
15. 15. McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, Rosenberg AM. Vitamin D deficiency in young children with severe acute lower respiratory infection. PediatrPulmo-nol. 2009 Oct;44(10):981-8. doi: 10.1002/ppul.21089. PMID: 19746437.
16. 16. Moreno-Solís G, Fernández-Gutiérrez F, Torres-Borrego J, Torcello-Gáspar R, Gómez-Chaparro Moreno JL, Pérez-Navero JL. Low serum 25-hydroxy vitamin D levels and bronc- hiolitis severity in Spanish infants. Eur J Pedi-atr2015;174:365-72.
17. 17. Şişmanlar T, Aslan AT, Gülbahar Ö, Özkan S. The effect of vitamin D on lower respiratory tract infections in children. Turk Pediatri Ars. 2016 Jun 1;51(2):94-9. doi: 10.5152/TurkPediatriArs.2016.3383. PMID: 27489466; PMCID: PMC4959747.
18. 18. Agerberth B, Charo J, Werr J, Olsson B, Idali F, Lindbom L, et al. The human anti microbial and chemotactic peptides LL-37 andalpha-defensinsare expressed by specific lymphocyte and monocyte populations. Blood 2000; 96(9):3086-93.
19. 19. Liu MC, Xiao H-Q, Brown AJ, Ritter CS, Schroeder J. Associa-tion of vitamin D and anti microbial peptide production dur-ing late-phase allergic responses in the lung. Clin Exp Allergy 2012;42(3):383-91.
20. 20. Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006;311(5768):1770-3.
21. 21. Matheu V, Bäck O, Mondoc E, Issazadeh Navikas S. Dual effects of vitamin D-induced alteration of TH1/TH2 cytokine expression: enhancing IgE production and decreasing airway eosinophilia in murine allergic airway disease. J Allergy Clin Immunol 2003;112(3):585-92.
22. 22. Lubani MM, al-Shab TS, al-Saleh QA, et al. Vitamin- D-deficiency rickets in Kuwait: the prevalence of a pre- venta-ble disease. Ann Trop Paediatr 1989; 9: 134–139.
23. 23. Lawson DE, Cole TJ, Salem SI, et al. Etiology of rickets in Egyptian children. Hum Nutr Clin Nutr 1987; 41: 199–208.
24. 24. Najada AS, Habashneh MS and Khader M. The fre- quency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr 2004; 50: 364–368.
25. 25. Roth DE, Shah R, Black RE, Baqui AE. Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh. Acta Pædiatr 2010; 99: 389-93.
26. 26. Sutcu Z, Sutcu M, Duru SN, Civilibal M, Elevli M. The role of serum vitamin D level on lower respiratory tract ınfections in children. J Pediatr Inf 2016;10:54-9.
27. 27. Haq R, Haiti M, Chytil F. Retinoic acid affects the expression of nuclear retinoicacid receptors in tissues of retinol-deficient rats. Proceedings of the National Academy of Sci-ences of the United States of America 1991;88(18):8272–6.
28. 28. Tateya I, Tateya T, Surles RL, Tanumihardjo S, Bless DM. Prenatal vitamin A deficiency causes laryngeal malformation in rats. Annals of Otology, Rhinology, andLaryngology2007; 16(10):785–92.
29. 29. Bjersing JL, Telemo E, Dahlgren U, Hanson LA. Loss of ileal IgA+ plasma cells and of CD4+ lymphocytes in ileal Peyer’s patches of vitamin A deficient rats. Clinical & Experimental Immunology 2002;130(3):404–8.
30. 30. Zhang J, Ding E, Li H, Zhao W, Jing H, Yan Y. Low serum levels of vitamins A, D, and E are associated with recurrent respiratory tract infections in children living in Northern Chi-na: A case control study. PlosOne. 2016;11:e0167689.
31. 31. Si NV, Grytter C, Vy NN, Hue NB, Pedersen FK. High dose vitamin A supplementation in the course of pneumonia in Vietnamese children. Acta Paediatr. 1997;86:1052-5.
32. 32. HU N, LI QB, Zou SY. Effect of vitamin A as an adjuvant therapy for pneumonia in children: a Meta analysis J. CJCP. 2018;20:146-53.
33. 33. Sempertegui F, Estrella B, Camaniero V, Betancourt V, Izurieta R, Ortiz W, et al. The beneficial effects of weekly low-dose vitamin A supplementation on acute lower respira-tory infections and diarrhea in Ecuadorian children. Pediat-rics 1999;104(1):e1.
34. 34. Dibley MJ, Sadjimin T, Kjolhede CL, Moulton LH. Vitamin A supplementation fails to reduce incidence of acute respirato-ry illness and diarrhea in preschool-age Indonesian children. Journal of Nutrition 1996;126(2):
35. 35. Mora Jr, iWaTa M, von andrian uh. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol 2008; 8: 685-698.
36. 36. Iang YL and Peng DH. Serum level of vitamin A in children with pneumonia aged less than 3 years. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18: 980-983.
37. 37. Zhang J, Ding E, Li H, Zhao W, Jing H, Yan Y. Low serum levels of vitamins A, D, and E are associated with recurrent respiratory tract infections in children living in Northern Chi-na: A case control study. PlosOne. 2016;11:e0167689.
38. 38. Sun M, Yan Z, Sun R, Tian W, Yi W, Zhang J. Dynamic moni-toring and a clinical correlation analysis of the serum vita-min A, D, and E levels in children with recurrent respiratory tract infections. Am J Transl Res. 2022 May 15;14(5):3533-3538. PMID: 35702083; PMCID: PMC9185048.
39. 39. Bergman P, Lindh au, BJörKheM-BergMan L, Lindh Jd. Vita-min D and respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2013; 8: e65835