Low Vitamin D Levels at Birth and Early Respiratory Outcome in Infants With Gestational Age Less Than 29 Weeks

Abstract

BackgroundVitamin D (VitD) is involved in lung development but its influence on respiratory distress syndrome of extremely preterm (EPT) infants have been little investigated. In this study, we examined the influence of low vitamin D status at birth on early respiratory outcomes of this vulnerable infant population.MethodsCord blood 25(OH)D levels ≤ 75 nmol/L were considered as Low vitamin D levels. Stepwise logistic regression and classification regression-tree analyses were used and the primary outcome was the combined outcome of death or mechanical ventilation need by the end of the first week (death or MV DoL7) as a marker od RDS severity.ResultsThe mean (SD) GA and birth weight were 26 (1.4) weeks and 801 (212) gr, respectively; 81/109 (74%) infants had low 25(OH)D levels. Infants with low VitD levels had 25% higher initial FiO2 levels (p < 0.05) and were more likely to be mechanically ventilated on DoL7 (36 vs. 7%, p < 0.05). Adjusted for gestational age, they had 10-fold higher odds of death or MV DoL7 (p < 0.01). By regression tree analysis, the rate of death or MV DoL7 increased from 18 to 71% in infants with GA < 26 weeks and with cord blood 25(OH)D levels higher and lower than 74 nmol/L, respectively (p < 0.05).ConclusionLow vitamin D levels at birth are associated with early adverse respiratory outcomes in infants with GA less 29 weeks. Further largest studies are needed to confirm this association.

Is 25OH Vitamin D Excess before 36 Weeks Corrected Age an Independent Risk Factor for Bronchopulmonary Dysplasia or Death?

“…We chose to study 25(OH)D at the first month because the frequency of excessive concentrations at birth in preterm infants is very low [31][32][33]. In France, Courbebaisse et al reported that in the general population of newborns, 93% of cord blood concentrations were below 75 nmol/L [34], and Papalia et al reported that in infants born below 29 weeks gestational age, 74% had a cord blood concentration ≤75 nmol/L [35]. In France, the current recommendation for vitamin D supplementation during pregnancy is to administer 100,000 IU once during the seventh month of pregnancy.…”

Utility of umbilical cord blood 25-hydroxyvitamin D levels for predicting bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight

“…As a result, vitamin D deficiency contributes to several respiratory complications and lung function impairments in premature infants, including airway hyperresponsiveness, increased resistance, and reduced compliance ( 15 , 40 ). However, the association between vitamin D status and the development of BPD remains controversial in clinical research due to the multifactorial etiology of BPD ( 8 , 9 , 12 , 41 ). Moreover, vitamin D deficiency is not the sole risk factor for BPD, and the risk factors and infants included in analysis vary across studies.…”

Association of Maternal Gestational Vitamin D Supplementation with Respiratory Health of Young Children

“…Animal models of maternal gestational vitamin D deficiency have been reported to impair the bronchiolo–alveolar structure, reduce alveolar density and lung volume in the fetus, and affect long-term pulmonary dysfunctions [ 8 , 10 ]. Observational studies have shown a relationship between maternal gestational vitamin D deficiency and respiratory diseases in preterm and term infants, including respiratory distress syndrome, wheezing events, asthma, and hospital admissions for respiratory tract infections during infancy [ 11 , 12 , 13 , 14 , 15 , 16 ]. However, randomized studies have reported inconsistent effects relating to the maternal gestational Vitamin D3 supplementation of the offspring’s respiratory outcomes [ 17 , 18 , 19 , 20 ].…”