Maternal and perinatal factors affecting vitamin D status of very low birth weight infants hospitalized in neonatal intensive care unit

https://doi.org/10.22146/ijcn.91172

Tunjung Wibowo(1*), Alifah Anggraini(2), Elysa Nur Safrida(3), Setya Wandita(4), Ekawaty Lutfia Haksari(5)

(1) Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(2) Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(3) Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(4) Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(5) Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


Background: Vitamin D deficiency is a global problem in premature infants. Vitamin D deficiency is associated with skeletal and non-skeletal disease. In premature infants, vitamin D deficiency is primarily associated with metabolic bone disease. 

Objective: The study aims to investigate the prevalence and risk factors of vitamin D deficiency in very low birth weight (VLBW) infants who were hospitalized in the neonatal intensive care unit (NICU) of a tertiary hospital in a developing country. 

Methods: A retrospective cohort was conducted at the NICU of Dr. Sardjito General Hospital, Yogyakarta. VLBW infants (inborn and outborn), hospitalized between January 1, 2018, and December 31, 2020, were enrolled in this study. Data on maternal (age (years), parity, education level, and socio-economic status) and neonatal (birth weight, birth length, and head circumference), gestational age, age of serum 25 hydroxy-vitamin D (25-OHD), sex, type of feeding, postnatal steroid) was taken from the medical records. Serum 25-OHD measurement was conducted at the age of around 4 weeks. Throughout the first 24 hours following birth, all infants at Dr. Sardjito General Hospital weighing <1,500g would receive total parenteral nutrition (TPN). For infants who were referred to Sardjito General Hospital, nutritional and feeding history including TPN was assessed through anamnesis from the nurses or midwives who transport the patient and from referral records. 

Results: A total of 165 very low birth weight infants consisting of 88 male and 77 female newborns were included in this study. The mean ± SD of the vitamin D level was 11.5 ± 7.6 ng/ml (range 2.9 - 45.5 ng/ml). The prevalence of Vitamin D insufficiency, deficiency, and severe deficiency were 12.1; 55.2; and 23%; respectively. Receiving TPN was positively and independently associated with vitamin D levels (p=0.006). 

Conclusions: There is a positive relationship between the administration of TPN and serum 25-OHD level in VLBW infants hospitalized in the NICU.


Keywords


maternal factor; perinatal factor; total parenteral nutrition; very low birth weight infant; vitamin D deficiency

Full Text:

PDF


References

  1. Marshall I, Mehta R, Ayers C, Dhumal S, Petrova A. Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome. BMC Pediatr. 2016;16(1):208. doi: 10.1186/s12887-016-0741-4
  2. Bhimji KM, Naburi H, Aboud S, Manji K. Vitamin D status and associated factors in neonates in a resource constrained setting. Int J Pediatr. 2018;2018:9614975. doi: 10.1155/2018/9614975
  3. Tergestina M, Jose A, Sridhar S, Job V, Rebekah G, Kuruvilla KA, et al. Vitamin D status and adequacy of standard supplementation in preterm neonates from South India. J Pediatr Gastroenterol Nutr. 2014;58(5):661–5. doi: 10.1097/mpg.0000000000000296
  4. Oktaria V, Graham SM, Triasih R, Soenarto Y, Bines JE, Ponsonby A, et al. The prevalence and determinants of vitamin D deficiency in Indonesian infants at birth and six months of age. PLoS One. 2020;15(10):e0239603. doi: 10.1371/journal.pone.0239603
  5. Wacker M, Holiack MF. Vitamin D-effects on skeletal and extraskeletal health and the need for supplementation. Nutrients. 2013;5(1):111–48. doi: 10.3390/nu5010111
  6. Abrams SA. Vitamin D in preterm and full-term infants. Ann Nutr Metab. 2020;76(suppl 2):6–14. doi: 10.1159/000508421
  7. Mitchell SM, Rogers SP, Hicks PD, Hawthorne KM, Parker BR, Abrams SA. High frequencies of elevated alkaline phosphatase activity and rickets exist in extremely low birth weight infants despite current nutritional support. BMC Pediatr. 2009;9:1–7. doi: 10.1186/1471-2431-9-47
  8. Oyatsi DP, Musoke RN, Wasunna AO. Incidence of rickets of prematurity at Kenyatta National Hospital, Nairobi. East Afr Med J. 1999;76(2):63–66.
  9. Motlagh AJ, Davoodvandi A, Saeieh SE. Association between vitamin D level in mother’s serum and the level of vitamin D in the serum of pre-term infants. BMC Pediatr. 2023;23:97. doi: 10.1186/s12887-023-03854-0
  10. Adnan M, Wu SY, Khilfeh M, Davis V. Vitamin D status in very low birth weight infants and response to vitamin D intake during their NICU stays: a prospective cohort study. J Perinatol. 2022;42(2):209–16. doi: 10.1038/s41372-021-01238-9
  11. Fort P, Salas AA, Nicola T, Craig CM, Carlo WA, Ambalavanan N. A comparison of 3 vitamin D dosing regimens in extremely preterm infants: a randomized controlled trial. J Pediatr. 2016;174:132-138.e1. doi: 10.1016/j.jpeds.2016.03.028
  12. Fink C, Peters RL, Koplin JJ, Brown J, Allen KJ. Factors affecting vitamin D status in infants. Children. 2019;6(1):7. doi: 10.3390/children6010007
  13. Chou JH, Roumiantsev S, Singh R. PediTools electronic growth chart calculators: applications in clinical care, research, and quality improvement. J Med Internet Res. 2020;22(1):e16204. doi: 10.2196/16204
  14. Roche Diagnostics. Elecsys® vitamin D total II. [series online] 2017 [cited 2012 January 30]. Available from: URL: https://diagnostics.roche.com/be/en/products/params/elecsys-vitamin-d-total-ii.html
  15. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398–417. doi: 10.1542/peds.2007-1894
  16. Leaf A, Landsdowne Z. Vitamin-conventional uses and new insights. World Rev Nutr Diet. 2014;110:152-66. doi: 10.1159/000358464
  17. Bronsky J, Campoy C, Braegger C, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: vitamins. Clin Nutr. 2018;37(6):2366–78. doi: 10.1016/j.clnu.2018.06.951
  18. Bowyer L, Catling-Paull C, Diamond T, Homer C, Davis G, Craig ME. Vitamin D, PTH and calcium levels in pregnant women and their neonates. Clin Endocrinol (Oxf). 2009;70(3):372–7. doi: 10.1111/j.1365-2265.2008.03316.x
  19. Octavius GS, Daleni VA, Angeline G, Virliani C. A systematic review and meta-analysis of prevalence of vitamin D deficiency among Indonesian pregnant women: a public health emergency. AJOG Glob Rep. 2023;3(2):100189. doi: 10.1016/j.xagr.2023.100189
  20. Nimitphong H, Holick MF. Vitamin D status and sun exposure in Southeast Asia. Dermatoendocrinol. 2013;5(1):34–7. doi: 10.4161/derm.24054



DOI: https://doi.org/10.22146/ijcn.91172

Article Metrics

Abstract views : 2346 | views : 2636

Refbacks

  • There are currently no refbacks.


Bookmark and Share


Copyright (c) 2024 Jurnal Gizi Klinik Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Jurnal Gizi Klinik Indonesia (JGKI) Indexed by:
 
  

  free web stats View My Stats