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Am J Perinatol 2024; 41(02): 143-149
DOI: 10.1055/s-0041-1740074
Original Article

Lower Vitamin D Level as a Risk Factor for Late Onset Neonatal Sepsis: An Observational Case–Control Study

Shaimaa Reda Abdelmaksoud 
1   Department of Pediatrics, Benha Faculty of Medicine, Benha University, Benha, Egypt
,
Mostafa Abdel-Azim Mostafa
1   Department of Pediatrics, Benha Faculty of Medicine, Benha University, Benha, Egypt
,
Rana Atef Khashaba 
2   Department of Clinical Pathology and Chemistry, Benha Faculty of Medicine, Benha University, Benha, Egypt
,
Effat Assar
1   Department of Pediatrics, Benha Faculty of Medicine, Benha University, Benha, Egypt
› Author Affiliations Funding None.
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Abstract

Objective The aim of the study is to investigate the relation of neonatal and maternal vitamin D and late-onset sepsis (LOS).

Study Design One-hundred twenty term neonates along with their mothers were enrolled in this case–control study. Sixty neonates who were admitted in the neonatal intensive care unit by LOS and had not been previously admitted for last 48 hours and did not receive antibiotics or vitamin D were enrolled as cases (sepsis) group. On the other hand, 60 healthy term neonates were referred as control group. Maternal and neonatal serum 25-OH vitamin D levels were assessed in both the cohorts.

Results Maternal and neonatal 25-OH vitamin D levels in cases (17.2 and 16.1 ng/mL, respectively) were significantly lower than in controls (22.7 and 21 ng/mL, respectively) p = 0.001. In the study group, the neonatal 25-OH vitamin D was negatively correlated with C-reactive protein and length of hospital stay (r = −0.616 and −0.596, respectively) p <0.001 for both. With a cut-off value of 12.9 ng/mL, the specificity and positive predictive value of neonatal vitamin D were 83.3 and 74.4%, respectively. The odds ratio was 1.088 (95% CI = 1.034–1.144)) for LOS in vitamin D-deficient neonates.

Conclusion Neonates with higher vitamin D level are at lower risk of LOS than those with vitamin D deficiency. Maternal vitamin D correlates with neonatal vitamin D. These data suggest that maternal vitamin supplementation during pregnancy may lower the risk of LOS.

Key Points

  • Neonatal and maternal vitamin D deficiency increase risk of LOS.

  • Neonatal vitamin D correlates with maternal vitamin D.

  • Neonatal vitamin D is independent predictor for LOS.

Keywords

25-OH vitamin D - late-onset neonatal sepsis - neonatal sepsis


Publication History

Received: 21 April 2021

Accepted: 03 October 2021

Article published online:
28 November 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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  • References

  • 1 Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017; 390 (10104): 1770-1780
    CrossrefPubMedGoogle Scholar
  • 2 Black RE, Cousens S, Johnson HL. et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010; 375 (9730): 1969-1987
    CrossrefPubMedGoogle Scholar
  • 3 Procianoy RS, Silveira RC. The challenges of neonatal sepsis management. J Pediatr (Rio J) 2020; 96 (Suppl. 01) 80-86
    CrossrefPubMedGoogle Scholar
  • 4 Jäpelt RB, Jakobsen J. Vitamin D in plants: a review of occurrence, analysis, and biosynthesis. Front Plant Sci 2013; 4: 136
    CrossrefPubMedGoogle Scholar
  • 5 Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem?. J Steroid Biochem Mol Biol 2014; 144 (Pt A): 138-145
    CrossrefPubMedGoogle Scholar
  • 6 Green RJ, Samy G, Miqdady MS. et al. Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days. S Afr Med J 2015; 105 (07) 603-605
    CrossrefPubMedGoogle Scholar
  • 7 Reid IR. What diseases are causally linked to vitamin D deficiency?. Arch Dis Child 2016; 101 (02) 185-189
    CrossrefPubMedGoogle Scholar
  • 8 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 (09) 685-698
    CrossrefPubMedGoogle Scholar
  • 9 Upala S, Sanguankeo A, Permpalung N. Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis. BMC Anesthesiol 2015; 15: 84
    CrossrefPubMedGoogle Scholar
  • 10 Amrein K, Zajic P, Schnedl C. et al. Vitamin D status and its association with season, hospital and sepsis mortality in critical illness. Crit Care 2014; 18 (02) R47
    CrossrefPubMedGoogle Scholar
  • 11 Alves FS, Freitas FG, Bafi AT, Azevedo LC, Machado FR. Serum concentrations of vitamin D and organ dysfunction in patients with severe sepsis and septic shock. Rev Bras Ter Intensiva 2015; 27 (04) 376-382
    CrossrefPubMedGoogle Scholar
  • 12 Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 2004; 58 (04) 563-567
    CrossrefPubMedGoogle Scholar
  • 13 Walker VP, Modlin RL. The vitamin D connection to pediatric infections and immune function. Pediatr Res 2009; 65 (5 Pt 2): 106R-113R
    CrossrefPubMedGoogle Scholar
  • 14 Çetinkaya M, Cekmez F, Buyukkale G. et al. Lower vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants. J Perinatol 2015; 35 (01) 39-45
    CrossrefPubMedGoogle Scholar
  • 15 Cizmeci MN, Kanburoglu MK, Akelma AZ. et al. Cord-blood 25-hydroxyvitamin D levels and risk of early-onset neonatal sepsis: a case-control study from a tertiary care center in Turkey. Eur J Pediatr 2015; 174 (06) 809-815
    CrossrefPubMedGoogle Scholar
  • 16 Yang LR, Li H, Yang TY, Zhang T, Zhao RC. Relationship between vitamin D deficiency and early-onset neonatal sepsis. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18 (09) 791-795
    PubMedGoogle Scholar
  • 17 Karras SN, Fakhoury H, Muscogiuri G. et al. Maternal vitamin D levels during pregnancy and neonatal health: evidence to date and clinical implications. Ther Adv Musculoskelet Dis 2016; 8 (04) 124-135
    CrossrefPubMedGoogle Scholar
  • 18 Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr 1988; 112 (05) 761-767
    CrossrefPubMedGoogle Scholar
  • 19 Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979; 95 (01) 89-98
    CrossrefPubMedGoogle Scholar
  • 20 Sankar MJ, Agarwal R, Deorari AK, Paul VK. Sepsis in the newborn. Indian J Pediatr 2008; 75 (03) 261-266
    CrossrefPubMedGoogle Scholar
  • 21 Jatsho J, Nishizawa Y, Pelzom D, Sharma R. Clinical and bacteriological profile of neonatal sepsis: a prospective hospital-based study. Int J Pediatr 2020; 2020: 1835945
    CrossrefPubMedGoogle Scholar
  • 22 Zorc JJ, Levine DA, Platt SL. et al; Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics 2005; 116 (03) 644-648
    CrossrefPubMedGoogle Scholar
  • 23 Holick MF, Binkley NC, Bischoff-Ferrari HA. et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (07) 1911-1930
    CrossrefPubMedGoogle Scholar
  • 24 Bikle DD. Vitamin D and immune function: understanding common pathways. Curr Osteoporos Rep 2009; 7 (02) 58-63
    CrossrefPubMedGoogle Scholar
  • 25 Liu PT, Stenger S, Li H. et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006; 311 (5768): 1770-1773
    CrossrefPubMedGoogle Scholar
  • 26 Turner J, Cho Y, Dinh NN, Waring AJ, Lehrer RI. Activities of LL-37, a cathelin-associated antimicrobial peptide of human neutrophils. Antimicrob Agents Chemother 1998; 42 (09) 2206-2214
    CrossrefPubMedGoogle Scholar
  • 27 Dhandai R, Jajoo M, Singh A, Mandal A, Jain R. Association of vitamin D deficiency with an increased risk of late-onset neonatal sepsis. Paediatr Int Child Health 2018; 38 (03) 193-197
    PubMedGoogle Scholar
  • 28 Agrawal A, Gupta A, Shrivastava J. Role of vitamin-D deficiency in term neonates with late-onset sepsis: a case-control study. J Trop Pediatr 2019; 65 (06) 609-616
    CrossrefPubMedGoogle Scholar
  • 29 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 (05) 1060-1064
    CrossrefPubMedGoogle Scholar
  • 30 Behera CK, Sahoo JP, Patra SD, Jena PK. Is lower vitamin D level associated with increased risk of neonatal sepsis? A prospective cohort study. Indian J Pediatr 2020; 87 (06) 427-432
    CrossrefPubMedGoogle Scholar
  • 31 Liefaard MC, Ligthart S, Vitezova A. et al. Vitamin D and C-reactive protein: a mendelian randomization study. PLoS One 2015; 10 (07) e0131740
    CrossrefPubMedGoogle Scholar
  • 32 Singh P, Chaudhari V. Association of early-onset sepsis and vitamin D deficiency in term neonates. Indian Pediatr 2020; 57 (03) 232-234
    CrossrefPubMedGoogle Scholar
  • 33 Saboute M, Yavar R, Kashaki M, Khaledi FK, Khalesi N, Rohani F. Investigation of association between maternal 25-OH vitamin D serum levels and neonatal early onset sepsis in newborns by evaluating key factors. Lipids Health Dis 2019; 18 (01) 153
    CrossrefPubMedGoogle Scholar