25-Hydroxyvitamin D Levels in Preterm Infants ≤32 Weeks Gestational Age and Respiratory Distress Syndrome

Abstract

Objective: The aim of this study was to evaluate neonatal vitamin D status and effect of vitamin D levels on the development of respiratory distress syndrome (RDS) in preterm infants with a gestational age of ≤ 32 weeks. The association between RDS and severity of vitamin D deficiency was secondary outcome of this study. Method: Newborns having a gestational age of ≤32 weeks with RDS consisted the study group, while newborns hospitalized in the neonatal intensive care unit having ≤32 weeks of gestational age with no signs of RDS were the control group. Results: During the study period, 122 preterm infants having a gestational age of ≤ 32 weeks were included. From these, 56 (46%) had RDS (study group), while 66 (54%) newborns (control group) did not have RDS. There was no significant difference between the groups in terms of maternal age, multiple pregnancy, use of antenatal steroid, sex, mode of delivery, maternal age, antenatal steroid use, accompanying maternal diseases and birth season. Median 25-OHD levels of study group and control group were similar (12.3 ng/ml vs 15.6 ng/ml; p=0.38). The rates of preterm infants having low vitamin D levels (25-OHD level<15 ng/ml) did not differ between the groups (38/56, 68% vs 35/66, 53%; p=0.09). Conclusions: There is no established optimal 25-OHD level for both term and premature infants. Besides, taking into account possible unfavorable both maternal and neonatal effects of vitamin D deficiency, adequate vitamin D supplementation should be provided in countries where vitamin D deficiency is common.

Keywords

• 25-hydroxyvitamin D
• preterm infant
• respiratory distress syndrome

Gebelik Yaşı ≤32 Hafta Olan Preterm Bebeklerde 25-Hidroksivitamin D Düzeyleri ve Respiratuvar Distres Sendromu Arasındaki İlişki

Öz

Amaç: Bu çalışmanın amacı, gebelik yaşı ≤ 32 hafta olan prematüre bebeklerde D vitamini durumunu ve D vitamini düzeylerinin respiratuvar distres sendromu (RDS) gelişimine etkisini değerlendirmektir. RDS ile D vitamini eksikliğinin şiddeti arasındaki ilişki bu çalışmanın ikincil sonucunu oluşturmaktadır. Yöntem: RDS'li gebelik yaşı ≤32 hafta olan yenidoğanlar çalışma grubunu oluştururken, yenidoğan yoğun bakım ünitesinde yatan ve RDS bulgusu olmayan ≤32 hafta olan yenidoğanlar kontrol grubunu oluşturmakta idi. Bulgular: Çalışma süresi boyunca gebelik yaşı ≤ 32 hafta olan 122 erken doğmuş bebek dahil edildi. Bunlardan 56'sında (%46) RDS (çalışma grubu) varken, 66 yenidoğanda (%54) (kontrol grubu) RDS saptanmadı. Gruplar arasında anne yaşı, çoğul gebelik, antenatal steroid kullanımı, cinsiyet, doğum şekli, anne yaşı, antenatal steroid kullanımı, eşlik eden anne hastalıkları ve doğum mevsimi açısından anlamlı fark yoktu. Çalışma grubu ve kontrol grubunun medyan 25-OHD seviyeleri benzerdi (12.3 ng/ml'ye karşı 15.6 ng/ml; p=0.38). Gruplar arasında D vitamini düzeyi düşük olan (25-OHD düzeyi <15 ng/ml) erken doğmuş bebeklerin oranları açısından farklılık saptanmadı (38/56, %68'e karşı 35/66, %53; p=0,09). Sonuç: Hem zamanında doğan hem de prematüre bebekler için belirlenmiş bir optimal 25-OHD seviyesi yoktur. Buna karşın, D vitamini eksikliğinin hem maternal hem de neonatal olası olumsuz etkileri göz önünde bulundurularak, D vitamini eksikliğinin yaygın olduğu ülkelerde yeterli D vitamini desteği sağlanmalıdır.

Anahtar Kelimeler

• 25-hidroksivitamin D
• preterm bebek
• respiratuvar distres sendromu

Kaynakça

1. Referans 1. Di Rosa M, Malaguarnera M, Nicoletti F, Malaguarnera L. Vitamin D3: a helpful immuno-modulator. Immunology. 2011 Oct; 134(2): 123–139.doi: 10.1111/j.1365-2567.2011.03482.x
2. Referans 2. Fandiño J, Toba L, González-Matías LC, Diz-Chaves Y, Mallo F. Perinatal Undernutrition, Metabolic Hormones, and Lung Development. Nutrients 2019, 11, 2870; doi:10.3390/nu11122870
3. Referans 3. Rodriguez RJ. Management of respiratory distress syndrome: an update. Respir Care 2003. 48(3): p. 279-86
4. Referans 4. Kim I, Kim SS, Song JI, Yoon SH, Park GY, Lee YW. Association between vitamin D level at birth and respiratory morbidities in very-low-birth-weight infants. Korean J Pediatr 2019;62(5):166-172 https://doi.org/10.3345/kjp.2018.06632.
5. Referans 5. Dogan P, Ozkan H, Koksal N, Bagci O, Varal IG. Vitamin D deficiency and its effect on respiratory distress syndrome in premature infants: results from a prospective study in a tertiary care centreAfrican Health Sciences Vol 20 Issue 1, March, 2020.
6. Referans 6. Fettah ND, Zenciroğlu A, Dilli D, Beken S, Okumus N. Is Higher 25-Hydroxyvitamin D Level Preventive for Respiratory Distress Syndrome in Preterm Infants?. American Journal of Perinatology Vol. 32 No. 3/2015.
7. Referans 7. Say B, Uras N, Sahin S, Degirmencioglu H, Oguz SS, Canpolat FE. Effects of cord blood vitamin D levels on the risk of neonatal sepsis in premature infants. Korean J Pediatr 2017;60:248-253 https://doi.org/10.3345/kjp.2017.60.8.248
8. Referans 8. Fettah ND, Zenciroglu A, Dilli D, Beken S, Okumus N. Is higher 25-hydroxyvitamin D level preventive for respiratory distress syndrome in preterm infants? Amer J Perinatol. 2015;32:247–250. doi:10.1055/s-0034-1383849.

9. Referans 9. Frank L, Sosenko IR. Development of lung antioxidant enzyme system in late gestation: possible implications for the prematurely born infant. J Pediatr. 1987;110(1):9.
10. Referans 10. Hallman M, Kulovich M, Kirkpatrick E, Sugarman RG, Gluck L. Phosphatidylinositol and phosphatidylglycerol in amniotic fluid: indices of lung maturity. Am J Obstet Gynecol. 1976;125(5):613
11. Referans 11. Carlton DP, Albertine KH, Cho SC, Lont M, Bland RD. Role of neutrophils in lung vascular injury and edema after premature birth in lambs J Appl Physiol . 1997;83(4):1307.)
12. Referans 12. Bouillon R, Marcocci C, Carmeliet G, Bikle D, White JH, Dawson-Hughes B, et al. Skeletal and extraskeletal actions of Vitamin D: Current evidence and outstanding questions. Endocr. Rev. 2018;40:1109–1151. doi: 10.1210/er.2018-00126.
13. Referans 13. Foong RE, Bosco A, Jones AC, Gout A, Gorman S, Hart PH, et al. The effects of in utero vitamin D deficiency on airway smooth muscle mass and lung function. Am. J. Respir. Cell Mol. Biol. 2015, 53, 664–675.
14. Referans 14. Saadoon A, Ambalavanan N, Zink K, Ashraf AP, MacEwen M, Nicola T, Fanucchi MV, Harris WT. Effect of Prenatal versus Postnatal Vitamin D Deficiency on Pulmonary Structure and Function in Mice. Am. J. Respir. Cell Mol. Biol. 2017, 56, 383–392.
15. Referans 15. Yarci E, Canpolat FE. 2021. Evalaution of morbidities and complications of neonatal intensive care unit patients with respiratory disorders at different gestational ages. Am J Perinatol. 2021 Jan 31. doi: 10.1055/s-0041-1722942. Online ahead of print.
16. Referans 16. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network.Pediatrics. 2010;126(3):443. Epub 2010 Aug 23.
17. Referans 17. Marshall I, Mehta R, Petrova A. Vitamin D in the maternal-fetal-neonatal interface: clinical implications and requirements for supplementation. J Matern Fetal Neonatal Med 2013; 26: 633–638.
18. Referans 18. 18. Turkiye Cumhuriyeti Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Gebelere D Vitamini Destek Programı, Güncelleme tarihi: 25/04/2011. https://www.saglik.gov.tr/TR,11161/gebelere-d-vitamini-destek-programi-rehberi.html.
19. Referans 19. Tochie JN, Choukem SP, Langmia RN, Barla E, Koki-Ndombo P. Neonatal respiratory distress in a reference neonatal unit in Cameroon: an analysis of prevalence, predictors, etiologies and outcomes. Pan Afr Med J 2016. 24: p. 152.
20. Referans 20. Yu RQ, Chen DZ, Hao XQ, Jiang SH, Fang GD, Zhou Q. Relationship between serum 25(OH)D levels at birth and respiratory distress syndrome in preterm infants. Zhongguo Dang Dai Er Ke Za Zhi 2017. 19(11): p. 1134-1137.
21. Referans 21. Kazzi SNJ, Karnati S, Puthuraya S, Thomas R. Vitamin D deficiency and respiratory morbidity among African American very low birth weight infants. Early Hum Dev 2018. 119: p. 19-24.
22. Referans 22. Association of vitamin D status at birth with pulmonary disease morbidity in very preterm infantsPingyang Chen
23. Referans 23. Cetinkaya M, Çekmez F, Erener-Ercan T, Buyukkale G, Demirhan A, Aydemir G, et al. Maternal/neonatal vitamin D deficiency: a risk factor for bronchopulmonary dysplasia in preterms? J Perinatol 2015. 35(10): p. 813-7.