Relationship between vitamin D deficiency and necrotizing enterocolitis in preterm infants
YANG Ling-Rong1, LI Hua1, ZHANG Tong1, ZHAO Ru-Cui2
Department of Pediatrics, Third People's Hospital of Chengdu/Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610031, China
Abstract:Objective To evaluate the relationship of vitamin D level with the development of necrotizing enterocolitis (NEC) in preterm infants. Methods A total of 429 preterm infants with a gestational age of < 36 weeks, who were admitted to the department of neonatology within 2 hours after birth between January and December, 2016, were enrolled in the study. According to whether these infants developed NEC, the 429 subjects were divided into NEC group (n=22) and non-NEC group (n=407). Peripheral venous blood was collected from these preterm infants and their mothers at admission to measure the level of 25-hydroxyvitamin D (25-OHD). The two groups were compared in terms of the serum 25-OHD levels of preterm infants and their mothers. Pearson correlation analysis was used to investigate the correlation between the serum 25-OHD levels of preterm infants and their mothers. The distribution of vitamin D levels in preterm infants was compared between the two groups. The univariate logistic regression analysis was used to determine the risk factors for NEC in preterm infants. Results The serum 25-OHD levels of preterm infants and their mothers in the NEC group were significantly lower than in the non-NEC group (P < 0.001). In both groups, the serum 25-OHD levels of mothers and preterm infants were positively correlated with each other (P < 0.001). The distribution of vitamin D levels (normal vitamin D level, low vitamin D level, vitamin D deficiency, and severe vitamin D deficiency) was significantly different between the NEC and non-NEC groups (P < 0.001). The univariate logistic regression analysis showed that gestational age, birth weight, 25-OHD levels of preterm infants and their mothers, the duration of mechanical ventilation, the duration of oxygen inhalation, and the length of hospital stay were associated with the development of NEC (P < 0.05). Conclusions The serum 25-OHD levels of preterm infants and their mothers may be related to the development of NEC in preterm infants, suggesting that vitamin D supplementation during pregnancy is important for preventing the development of NEC in preterm infants.
YANG Ling-Rong,LI Hua,ZHANG Tong et al. Relationship between vitamin D deficiency and necrotizing enterocolitis in preterm infants[J]. CJCP, 2018, 20(3): 178-183.
Dominguez KM, Moss RL. Necrotizing enterocolitis[J]. Clin Perinatol, 2012, 39(2):387-401.
[4]
Berrington JE, Hearn RI, Bythell M, et al. Deaths in preterm infants:changing pathology over 2 decades[J]. J Pediatr, 2012, 160(1):49-53.e1.
[5]
De Plaen IG, Liu SX, Tian R, et al. Inhibition of nuclear factor-kappaB ameliorates bowel injury and prolongs survival in a neonatal rat model of necrotizing enterocolitis[J]. Pediatr Res, 2007, 61(6):716-721.
[6]
De Plaen IG. Inflammatory signaling in necrotizing enterocolitis[J]. Clin Perinatol, 2013, 40(1):109-124.
[7]
Clancy N, Onwuneme C, Carroll A, et al. Vitamin D and neonatal immune function[J]. J Matern Fetal Neonatal Med, 2013, 26(7):639-646.
[8]
Hatun Ş, Ozkan B, Bereket A. Vitamin D deficiency and prevention:Turkish experience[J]. Acta Paediar, 2011, 100(9):1195-1199.
[9]
De-Regil LM, Palacios C, Ansary A, et al. Vitamin D supplementation for women during pregnancy[J]. Cochrane Database Syst Rev, 2012, (2):CD008873.
Neu J, Walker WA. Necrotizing enterocolitis[J]. N Engl J Med, 2011, 364(3):255-264.
[16]
Sharma R, Hudak ML. A clinical perspective of necrotizing enterocolitis:past, present, and future[J]. Clin Perinatol, 2013, 40(1):27-51.
[17]
Calton EK, Keane KN, Newsholme P, et al. The impact of vitamin D levels on inflammatory status:a systematic review of immune cell studies[J]. PLoS One, 2015, 10(11):e0141770.
[18]
Miliku K, Vinkhuyzen A, Blanken LM, et al. Maternal vitamin D concentrations during pregnancy, fetal growth patterns, and risks of adverse birth outcomes[J]. Am J Clin Nutr, 2016, 103(6):1514-1522.
[19]
Çetinkaya M, Çekmez F, Erener-Ercan T, et al. Maternal/neonatal vitamin D deficiency:a risk factor for bronchopulmonary dysplasia in preterms?[J]. J Perinatol, 2015, 35(10):813-817.
Masri OA, Chalhoub JM, Sharara AI. Role of vitamins in gastrointestinal diseases[J]. World J Gastroenterol, 2015, 21(17):5191-5209.
[22]
Di Rosa M, Malaguarnera G, De Gregorio C, et al. Immuno-modulatory effects of vitamin D3 in human monocyte and macrophages[J]. Cell Immunol, 2012, 280(1):36-43.
[23]
Abraham BP, Prasad P, Malaty HM. Vitamin D deficiency and corticosteroid use are risk factors for low bone mineral density in inflammatory bowel disease patients[J]. Dig Dis Sci, 2014, 59(8):1878-1884.
[24]
Liu Y, Zhu L, Fatheree NY, et al. Changes in intestinal toll-like receptors and cytokines precede histological injury in a rat model of necrotizing enterocolitis[J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297(3):G442-G450.
[25]
Cetinkaya M, Erener-Ercan T, Kalayci-Oral T, et al. Maternal/neonatal vitamin D deficiency:a new risk factor for necrotizing enterocolitis in preterm infants?[J]. J Perinatol, 2017, 37(6):673-678.
[26]
Principi N, Bianchini S, Baggi E, et al. Implications of maternal vitamin D deficiency for the fetus, the neonate and the young infant[J]. Eur J Nutr, 2013, 52(3):859-867.