Vitamin D and IL-10 Deficiency in Preterm Neonates With Bronchopulmonary Dysplasia

Abstract

Introduction: Vitamin D deficiency and inflammation are involved with bronchopulmonary dysplasia (BPD) in preterm neonates; however, the clinical evidence still remains scarce. We hypothesized that vitamin D and inflammatory cytokines may be risk factors for BPD in infants.Methods: Preterm infants born between 28 and 31 weeks' gestation were recruited between January 2016 and 2017. Blood samples were all collected at corresponding time points. Vitamin D was measured using an automatic biochemical analyzer, and inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-10) were measured using ELISA.Results: The baseline characteristics for preterm infants without BPD (non-BPD control, n = 20) or with BPD (n = 19) were similar. In the blood samples collected 24-h post birth, vitamin D was significantly reduced in the BPD neonates (non-BPD vs. BPD, 28.96 ± 3.404 vs. 17.99 ± 2.233 nmol/l, p = 0.0134). Inflammatory cytokines TNF-α, IL-1β, and IL-6 were comparable in both groups. The anti-inflammatory cytokine IL-10, however, was significantly decreased in 24-h blood samples from BPD preterm infants (non-BPD vs. BPD, 44.61 ± 10.48 vs. 11.64 ± 2.351 pg/ml, p = 0.0054). In the BPD infants with mild or moderate disease, vitamin D deficiency was quite similar. IL-10 deficiency, however, was more aggravated in the BPD infants with moderate disease. No changes in Vitamin D or cytokines (TNF-α, IL-1β, IL-6, and IL-10) were observed for blood samples collected 2 or 4 weeks after birth.Conclusion: In our pilot study, Vitamin D and IL-10 levels at 24-h of life were risk factors for the development of BPD in very preterm infants.

Association between vitamin D level and bronchopulmonary dysplasia: A systematic review and meta-analysis

“…BPD was defined as an oxygen dependency at either 28 days of age or 36 weeks of postmenstrual age. BPD was diagnosed in each study according to either the National Institutes of Health consensus [35][36][37][38], or other criteria for oxygen dependency, at 36 weeks of postmenstrual age [39], or at 28 days of age [40,41]. Case reports, case series, single-arm cohort studies, and animal studies were excluded from the meta-analysis.…”

“…The study selection process and exclusion criteria are described in Fig 1. Of the 128 studies identified initially, 120 were excluded based on review of the title, abstract or full text. The reasons for excluding 17 studies [33,34,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] after full-text review, are provided in Fig 1. The remaining eight studies met the inclusion criteria and were included in the meta-analysis [35,37,38,40,41,43,61,62].…”

“…Among 909 infants, 251 (27.6%) infants were diagnosed with BPD (Table 1). Two studies [40,41] defined BPD as an oxygen dependency at 28 days of age; the remaining studies [35,37,38,43,61,62] defined BPD as oxygen dependency at 36 weeks of postmenstrual age, based on National Institutes of Health consensus [63]. The incidence of BPD vary from 6.6% to 56.8%, 6.6% in the study of Yang et al [61], and 56.8% in the study of Kazzi et al [38].…”

“…Among eight studies, four [38,40,41,62] presented results on the association of vitamin D deficiency with BPD; the other four studies [35,37,43,61] assessed the association of vitamin D level with BPD. The four studies that evaluated vitamin D deficiency used 25(OH)D cutoff values of 20 ng/mL(50 nmol/L) [40,41], 10 ng/mL [38], or 12 ng/mL(30 nmol/L) [62].…”

“…Health Office of Dietary Supplements recommendations [46]), and one study [62] that used 12 ng/mL (30 nmol/L) (based on the Institute of Medicine report [70]) ( Table 1). Four studies did not provide definitions of deficiency and, instead, reported levels of vitamin D [35,37,43,61]. The etiology of BPD is multifactorial [63,71], thus vitamin D deficiency may not be the only cause of BPD.…”