Study on the correlation between vitamin D deficiency and hypoxic ischemic encephalopathy in premature infants

doi:10.11852/zgetbjzz2020-2062

Abstract

Abstract: Objective To investigate the correlation between vitamin D level at birth and hypoxic ischemic encephalopathy (HIE) in premature infants, so as to provide reference for its prevention. Methods From June 2018 to June 2020, 25 premature infants diagnosed with HIE (HIE group) and 138 children without HIE (non-HIE group) were selected as study objects from Pediatrics of Boluo County Maternal and Child Health Care Family Planning Service Center. 25-(OH)D level of umbilical artery blood at birth and maternal 25-(OH)D level were compared between the two groups. The risk factors for HIE were analyzed by Logistic regression. Results Compared with the non-HIE group, HIE group had a higher incidence of intrauterine distress(χ²=46.875), a lower Apgar score at 1min(t=10.854) and a longer mechanical ventilation time(t=7.166), and the differences were statistically significant(P＜0.01). The level of 25-(OH)D of cord blood at birth and maternal 25-(OH)D level in the HIE group were significantly lower than those in the non-HIE group(t=2.346, 2.092, P＜0.05). And the proportion of vitamin D deficiency or insufficiency at birth was significantly higher than that in the non-HIE group (64% vs. 39.9%, χ²=5.019,P＜0.05). Maternal 25-(OH)D level in the two groups was positively correlated with the 25-(OH)D level of premature infants at birth (HIE group r=0.825, non-HIE group r=0.682, P＜0.05). Logistic regression analysis showed that the risk factors for HIE included intrauterine distress (OR=1.137, 95%CI:1.105-1.209), 1min Apgar score＜5(OR=1.170, 95%CI:1.085-1.443), long mechanical ventilation time(OR=1.431, 95%CI: 1.275-1.610) and low 25-(OH)D level(Mother OR=1.234,95%CI:1.010-1.511;Preterm OR=1.505,95%CI:1.191-1.899). Conclusions The proportion of premature infants with deficiency or insufficient vitamin D at birth is 50.9% (83/163). Low vitamin D level at birth and low maternal vitamin D level are high risk factors for premature infants with HIE, and vitamin D supplementation during pregnancy and after birth should be paid attention to.

Key words: vitamin D deficiency, hypoxic ischemic encephalopathy, premature infants

摘要： 目的分析出生时维生素D水平与早产儿缺氧缺血性脑病(HIE)的相关性,为预防早产儿HIE提供依据。方法选择博罗县妇幼保健计划生育服务中心2018年6月—2020年6月诊断为HIE的早产儿25例(HIE组)和未发生HIE的早产儿138例(非HIE组),比较两组母亲和早产儿出生时血清25-(OH)D的水平,并对HIE的危险因素进行Logistic回归分析。结果与非HIE组比较,HIE组早产儿宫内窘迫发生率较高、1 min Apgar评分较低、机械通气时间较长,差异均有统计学意义(χ²=46.875,t=10.854、7.166,P＜0.01);HIE组母亲和早产儿出生时血清25-(OH)D水平明显低于非HIE组,差异有统计学意义(t=2.346、2.092,P＜0.05),HIE组早产儿出生时维生素D缺乏或不足的比例(64%)明显高于非HIE组(39.9%),差异有统计学意义(χ²=5.019,P＜0.05);两组母亲血清25-(OH)D水平与早产儿出生时25-(OH)D水平呈正相关(HIE组r=0.825,非HIE组r=0.682,P＜0.05)。Logistic 回归分析结果显示HIE的危险因素包括宫内窘迫(OR=1.137,95%CI:1.105～1.209)、1 min低Apgar评分(OR=1.170,95%CI:1.085～1.443)、机械通气时间(OR=1.431,95%CI:1.275～1.610)和低25-(OH)D水平(母亲OR=1.234,95%CI:1.010～1.511;早产儿OR=1.505,95%CI:1.191～1.899)。结论早产儿出生时维生素D缺乏或不足的比例达50.9%(83/163),母亲及早产儿出生时低维生素D水平是早产儿HIE发生的高危因素,应注重孕期和早产儿出生后的维生素D补充。

关键词: 维生素D, 缺乏, 缺氧缺血性脑病, 早产儿

CLC Number:

R722.6

LIU Yi-rong, ZENG Chun-ying, ZHANG Wen-jing, LIU Dong, CAI Yue-ju. Study on the correlation between vitamin D deficiency and hypoxic ischemic encephalopathy in premature infants[J]. Chinese Journal of Child Health Care, 2021, 29(12): 1355-1358.

刘亿荣, 曾春英, 张文静, 刘东, 蔡岳鞠. 维生素D缺乏与早产儿缺氧缺血性脑病的相关性研究[J]. 中国儿童保健杂志, 2021, 29(12): 1355-1358.

References

[1] 刘雪婷,贺斯麟, 姜善雨,等. 早产儿维生素 D 营养状况影响因素分析[J]. 中国妇幼健康研究,2017,28(11):1337-1340.
[2] Panda M, McIntosh J, Chaudhari T, et al. Do maternal vitamin D levels influence vitamin D levels in preterm neonates?[J].Int J Pediatr, 2019:8613414.
[3] Fettah ND, Zenciroğlu A, Dilli D, et al. Is higher 25-hydroxyvitamin D level preventive for respiratory distress syndrome in preterm infants?[J].Am J Perinatol,2015, 32(3):247-250.
[4] Lykkedegn S, Sorensen GL, Beck-Nielsen SS, et al. The impact of vitamin D on fetal and neonatal lung maturation. A systematic review[J]. Am J Physiol Lung Cell Mol Physiol, 2015,308(7):587-602.
[5] 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]. Journal of Perinatology,2017, 37(6),673-678.
[6] 中华医学会儿科学分会新生儿学组.新生儿缺氧缺血性脑病诊断标准[J]. 中华儿科杂志,2005,43(8):584.
[7] Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine scociety clinical pratice guideline[J]. J Clin Endocrinol Metab, 2011,96(7):1911-1930.
[8] Sotunde OF,Laliberte A,Weiler HA,et al. Maternal risk factors and newborn infant vitamin D status: a scoping literature review[J].Nutr Res,2019,63(3):1-20.
[9] 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.
[10] 崔昌萌,郭鑫, 宋思新,等. 维生素D在创伤性脑损伤中神经保护作用的研究进展[J].中华神经创伤外科电子杂志, 2017,3(3):175-178.
[11] 关佳欣,高强,洪铭,等. 维生素 D和脑白质疏松症的研究进[J]. 中华老年多器官疾病杂志, 2017, 16(9):708-711.
[12] 韩碧波,曲书强. 维生素D在新生儿缺氧缺血性脑损伤中的作用[J].中国医师进修杂志,2019,42(3): 269-272.
[13] Stessman LE, Peeples ES .Vitamin D and its role in neonatal hypoxic-ischemic brain injury[J]. Neonatology,2018, 113(4):305-312.
[14] Multu M, Sariaydin M, Aslan Y, et al.Status of vitamin D, antioxidant enzymes, and antioxidant substances in neonates with neonatal hypoxic-ischemic encephalopathy[J]. J Matern Fetal Neonatal Med,2016,29(14):2259-2263.
[15] Balden R, Selvamani A, Sohrabji F. Vitamin D deficiency exacerbates experimental stroke injury and dysregulates ischemia-induced inflammation in adult rats[J]. Endocrinology,2012,153(5):2420-2435.
[16] Eyles D, Brown J, Mackay-Sim A, et al. Vitamin D3 and brain development[J]. Neuroscience, 2003,118(3):641-653.