Umbilikal Kord 25-Hidroksivitamin D Düzeyleri ile Term ve Miada Yakın Yenidoğanlarda Solunum Sıkıntısı Arasındaki İlişki: Prospektif Gözlemsel Bir Çalışma

Abstract

Amaç: Vitamin D yetersizliği, erken başlangıçlı sepsisten solunumsal uyum bozukluklarına uzanan çeşitli yenidoğan sorunlarıyla giderek daha sık ilişkilendirilmektedir. Bu çalışmada, 34. gebelik haftası ve üzerinde doğan bebeklerde kord kanı 25-hidroksivitamin D konsantrasyonlarının solunum sıkıntısının varlığı ve şiddetiyle birlikte değişip değişmediği incelenmiştir. Gereç ve Yöntem: Gebelik yaşı ≥34 hafta olan yenidoğanlarda doğum sırasında kord kanı alındı ve lameller cisimcik sayımı (LCS) için gastrik sıvı aspire edildi. Elde edilen kord 25-OH-D konsantrasyonları ile LCS değerleri, bebeklerin gereksinim duyduğu solunum desteği düzeyiyle karşılaştırıldı. Bulgular: Doksan dokuz yenidoğan çalışmaya alındı; bunlardan 52'si (%52,5) solunum sıkıntısı nedeniyle yoğun bakıma yatırıldı. Bu bebeklerde medyan kord 25-OH-D düzeyi 5,8 (3-51,1) ng/ml iken kontrollerde 13 (2,8-23,2) ng/ml idi (p=0,043); LCS değerleri de benzer biçimde düşüktü (p=0,033). Solunum sıkıntısı grubunda 25-OH-D ile LCS arasında zayıf bir korelasyon saptandı (r=0,306, p=0,035). Buna karşılık çok değişkenli lojistik regresyonda solunum sıkıntısının bağımsız belirleyicisi yalnızca gebelik yaşı oldu (düzeltilmiş OR=0,42, %95 GA 0,23-0,79, p=0,007); vitamin D düzeyi bağımsız bir ilişki göstermedi (düzeltilmiş OR=0,95, %95 GA 0,87-1,05, p=0,32). Sonuç: Solunum sıkıntısı olan yenidoğanlarda kord 25-OH-D düzeyleri daha düşük bulunmakla birlikte, bu fark büyük ölçüde immatüriteye bağlıydı; gebelik yaşı ve doğum ağırlığı hesaba katıldığında vitamin D'nin bağımsız bir katkısı gösterilemedi. Bulgular hipotez üretici niteliktedir ve daha geniş serilerde doğrulanmayı gerektirmektedir.

Keywords

• Yenidoğan
• 25-OH-Vit D
• solunum sıkıntısı
• geçici takipne.

Umbilical Cord 25-Hydroxyvitamin D Concentrations and Respiratory Distress in Term And Near-Term Newborns: A Prospective Observational Study

Abstract

Objective: Vitamin D insufficiency has increasingly been implicated in neonatal conditions ranging from early-onset sepsis to disorders of respiratory adaptation. We examined whether 25-hydroxyvitamin D concentrations measured in cord blood track with the presence and severity of respiratory distress among infants born at or beyond 34 gestational weeks. Materials and Methods: Cord blood was drawn at delivery, and gastric fluid was aspirated for lamellar body counting (LBC), in newborns of ≥34 weeks' gestation. Cord 25-OH-D concentrations and LBC values were then examined against the level of respiratory support each infant required. Results: Ninety-nine newborns were enrolled, of whom 52 (52.5%) required intensive care admission because of respiratory distress. Median cord 25-OH-D reached 5.8 (3-51.1) ng/ml in these infants versus 13 (2.8-23.2) ng/ml among controls (p=0.043), and LBC values were likewise reduced (p=0.033). Within the respiratory distress group, 25-OH-D correlated weakly with LBC (r=0.306, p=0.035). On multivariable logistic regression, however, only gestational age remained an independent predictor of respiratory distress (adjusted OR=0.42, 95% CI 0.23-0.79, p=0.007), whereas vitamin D did not (adjusted OR=0.95, 95% CI 0.87-1.05, p=0.32). Conclusion: Although cord 25-OH-D was lower among newborns with respiratory distress, the difference tracked with immaturity: once gestational age and birth weight were accounted for, vitamin D carried no independent association. The findings are hypothesis-generating and require testing in larger cohorts.

Keywords

• Newborn
• 25-OD-Vit D
• respiratory distress
• transient tachypnoe

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