Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study

Shereen A Mohamed; Nermin R Kamel; Aya E Fouda; Rabab E Elhawary; Mohamed A Abdelmegeid

doi:10.1186/s13052-024-01665-2

Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study

Ital J Pediatr. 2024 May 18;50(1):101. doi: 10.1186/s13052-024-01665-2.

Authors

Shereen A Mohamed¹, Nermin R Kamel², Aya E Fouda², Rabab E Elhawary³, Mohamed A Abdelmegeid²

Affiliations

¹ Pediatrics Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt. Shereenmohamed@cu.edu.eg.
² Pediatrics Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
³ Clinical Pathology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Background: Sepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country.

Methods: This case-control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture.

Results: Forty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml).

Conclusion: In the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).

Keywords: Mortality; Neonatal Sepsis; Vitamin D deficiency.

MeSH terms

C-Reactive Protein / analysis
C-Reactive Protein / metabolism
Case-Control Studies
Egypt / epidemiology
Female
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Male
Neonatal Sepsis* / blood
Neonatal Sepsis* / diagnosis
Risk Factors
Vitamin D Deficiency* / blood
Vitamin D Deficiency* / complications
Vitamin D Deficiency* / epidemiology
Vitamin D* / analogs & derivatives
Vitamin D* / blood

Substances

25-hydroxyvitamin D