Application of individualized vitamin D supplementation in very preterm infants

doi:10.11852/zgetbjzz2022-1397<br/><br/>

Abstract

Abstract: Objective To investigate the efficacy of individualized vitamin D supplementation in very preterm infants, in order to provide reference for optimizing the vitamin D supplementation strategy for very preterm infants. Methods A total of 106 very preterm infants hospitalized in NICU from July 2021 to July 2022 were selected into this study, and were randomly divided into observation group (n=47) and control group (n=59). Infants in both groups took vitamin D supplementation from the 7th day after birth. In the observation group, infants received daily vitamin D supplementatation,and the dose was based on their serum 25-hydroxy vitamin D[25-(OH)D] level:800U was taken orally for the infants with sufficient vitamin D; for infants with vitamin D insufficiency, oral vitamin D supplementation was increased to 1 400U; for infants with vitamin D deficiency, oral vitamin D supplementation was increased to 1 800U; for infants with excessive vitamin D, oral vitamin D dose was reduced to 400U; for infants with vitamin D potential poisoning and poisoning, vitamin D supplementation would be discontinued. In the control group, infants were routinely supplemented with 800U vitamin D. Serum levels of 25-(OH)D, the incidence of vitamin D deficiency/insufficiency, and the occurrence of vitamin D overdose or poisoning were compared between the two groups within 48 hours, 4 weeks and 8 weeks after birth. Results The incidence of vitamin D deficiency and insufficiency in 106 very preterm infants within 48 hours after birth was 81.1% and 9.43%, respectively. There was no significant difference in serum 25-(OH)D level and incidence of vitamin D deficiency/insufficiency between the two groups within 48h after birth (P>0.05). The level of serum 25-(OH) D in the observation group was significantly higher than that in the control group at 4 and 8 weeks after birth (t=3.84, 5.94, P<0.05), and the incidence rate of vitamin D deficiency was significantly lower than that in the control group (χ²=11.02, 18.32, P<0.05). Conclusion Compared with the routine supplementation of 800U vitamin D, individualized vitamin D supplementation can significantly increase serum 25-(OH)D level at 4 and 8 weeks after birth and reduce the incidence of vitamin D deficiency in very preterm infants.

Key words: individualized, vitamin D supplementation, 25-hydroxyvitamin D, very preterm infants

摘要： 目的探讨个体化维生素D补充方案在极早产儿中应用的有效性,为优化极早产儿维生素D补充方案提供临床依据。方法选取2021年7月—2022年7月在济宁医学院附属医院NICU住院的极早产儿106例,随机分为观察组(n=47)和对照组(n=59),两组患儿均于生后第7天开始补充维生素D,观察组根据血清25-羟维生素D[25-(OH)D]水平决定每日维生素D的补充剂量:维生素D充足的患儿口服维生素D 800U;不足的患儿口服维生素D 增加至1 400U;缺乏的患儿口服维生素D增加至1 800U;过量的患儿口服维生素D减量至400U;维生素D潜在中毒及中毒的患儿停用维生素D。对照组常规补充维生素D 800U,比较两组患儿生后48h内、生后4周、生后8周血清25-(OH)D水平、维生素D缺乏/不足发生率及是否存在维生素D过量或中毒的发生。结果 106例极早产儿生后48h内维生素D缺乏的发生率为81.1%,维生素D不足的发生率为9.43%。两组患儿生后48h内血清25-(OH)D水平及维生素D 缺乏/不足发生率比较,差异无统计学意义(P>0.05)。生后4周、生后8周观察组血清25-(OH)D水平显著高于对照组(t=3.84、5.94,P<0.05),维生素D缺乏发生率明显低于对照组(χ²=11.02、18.32,P<0.05)。结论与常规补充800U维生素D比较,个体化维生素D补充方案能显著提升极早产儿生后4周、生后8周血清25-(OH)D水平,降低维生素D缺乏发生率。

关键词: 个体化, 维生素D补充, 25-羟维生素D, 极早产儿

CLC Number:

R722.6

YOU Fang. Application of individualized vitamin D supplementation in very preterm infants[J]. Chinese Journal of Child Health Care, 2023, 31(10): 1127-1131.

游芳, 倪佰亭, 赵静, 强光峰, 任雪云. 个体化维生素D补充方案在极早产儿中的应用研究[J]. 中国儿童保健杂志, 2023, 31(10): 1127-1131.

References

[1] Bitew ZW,Worku T,Alemu A. Effects of vitamin D on neonatal sepsis:A systematic review and Meta-analysis[J].Food Sci Nutr, 2021, 9(1):375-388.
[2] Zisi D, Challa A, Makis A.The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood[J].Hormones (Athens), 2019, 18:353-363.
[3] Yepes-Nuñez JJ,Broz·ek JL,Fiocchi A,et al. Vitamin D supplementation in primary allergy prevention:Systematic review of randomized and non-randomized studies[J]. Allergy,2018,73(1):37-49.
[4] Yang Y, Zhao L, Guo Y, et al. Effect of different dose of vitamin D supplementation on preterm infants - an updated meta-analysis[J]. J Matern Fetal Neonatal Med, 2018, 31(22):3065-3074.
[5] 薛静,杨亚俊,程小宁.产妇及其新生儿血25羟维生素D水平变化及临床意义研究[J].中国妇幼健康研究, 2017,28(1):23-25.
Xue J, Yang YJ, Cheng XN, Changes and clinical significance of maternal and neonatal serum levels of 25·hydroxy vitamin D[J]. Chinese Journal of Women and Child Health Research, 2017,28(1):23-25.(in Chinese)
[6] Matejek T, Navratilova M, Zaloudkova L, et al. Vitamin D status of very low birth weight infants at birth and the effects of generally recommended supplementation on their vitamin D levels at discharge[J]. J Matern Fetal Neonatal Med, 2020,33(22):3784-3790.
[7] Taha G, Abd-Allah M, Mostafa H, et al. Neonatal and maternal 25-OH vitamin D serum levels in neonates with early-onset sepsis[J]. Children (Basel, Switzerland), 2017,4(37):1-9.
[8] 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]. J Perinatol, 2017,37:673-678.
[9] Park SH.Association of vitamin D status at birth and respiratory outcomes in preterm infants[J]. Korean J Pediatr, 2019,62(5):162-163.
[10] Çetinkaya M, Çekmez F, Erener-Ercan T, et al. Maternal/neonatal vitamin D deficiency:A risk factor for bronchopulmonary dysplasia in preterms[J]. J Perinatol,2015,35:813-817.
[11] Abrams SA. Vitamin D in preterm and full-term infants[J]. Ann Nutr Metab,2020,76(2):6-14.
[12] Kołodziejczyk A, Borszewska-Kornacka MK, Seliga-Siwecka J. Monitored supplementation of vitamin D in preterm infants (MOSVID trial):Study protocol for a randomised controlled trial[J]. Trials, 2017, 18(1):424.
[13] Abrams SA. Calcium and vitamin D requirements of enterally fed preterm infants[J]. Pediatrics, 2013, 131(5):1676-1683.
[14] 中华预防医学会儿童保健分会. 中国儿童维生素A,维生素D临床应用专家共识[J]. 中国儿童保健杂志, 2021, 29(1):110-116.
Child Care Branch of Chinese Preventive Medicine Association.Expert consensus on clinical application of vitamin A and vitamin D in Chinese children[J]. Chin J Child Health Care,2021, 29(1):110-116.(in Chinese)
[15] 中华预防医学会儿童保健分会. 婴幼儿喂养与营养指南[J].中国妇幼健康研究, 2019,30(4):392-417.
Child Care Branch of Chinese Preventive Medicine Association. Guidelines for infant feeding and nutrition[J]. Chinese Journal of Women and Child Health Research, 2019,30(4):392-417.(in Chinese)
[16] Bozkurt O, Uras N, Sari FN, et al. Multi-dose vitamin D supplementation in stable very preterm infants:Prospective randomized trial response to three different vitamin D supplementation doses[J]. Early Human Development, 2017, 112(1):54-59.
[17] Sotunde OF, Laliberte A, Weiler HA. Maternal risk factors and newborn infant vitamin D status:A scoping literature review[J]. Nutr Res,2019,63:1-20.
[18] Agostoni C, Buonocore G, Carnielli V. Enteral nutrient supply for preterm infants:Commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition[J]. J Pediatr Gastroenterol Nutr,2010,50(1):85-91.
[19] 刘亿荣, 曾春英, 张文静,等. 不同剂量维生素D补充在早产儿中的应用研究[J]. 中国儿童保健杂志, 2021,29(10):1142-1144.
Liu YR, Zeng CY, Zhang WJ, et al.Application of different doses of vitamin D supplementation in premature infants[J]. Chin J Child Health Care,2021,29(10):1142-1144.(in Chinese)
[20] Kołodziejczyk-Nowotarska A, Bokiniec R, Seliga-Siwecka J. Monitored supplementation of vitamin D in preterm infants:A randomized controlled trial[J]. Nutrients,2021, 13(10):3442.