Pediatric Department, Faculty of Medicine, Tanta University, Egypt
Clinical Pathology Department, Faculty of Medicine, Tanta University, Egypt
Infect Disord Drug Targets. 2020;20(4):440-447. doi: 10.2174/1871526519666190626141859.
Sepsis is unusual systemic reaction to an ordinary infection, and it probably represents a pattern of response by the immune system to the injury. Vitamin D is a fat-soluble steroid hormone that contributes to the maintenance of normal calcium homeostasis and skeletal mineralization. Vitamin D has an important role in the regulation of both innate and adaptive immune systems.
The current study aimed to evaluate the therapeutic value of vitamin D supplementation as an adjuvant therapy in neonates with sepsis.
This study included 60 neonates with sepsis who were randomly divided into 2 equal groups; group I: 30 neonates with sepsis who received antibiotic only, Group II: 30 neonates with sepsis who received antibiotic therapy and vitamin D. This study also included 30 healthy neonates as a control group. For all patients and controls, serum level of 25 (OH) vitamin D and highly sensitive C reactive protein (hs-CRP) were immunoassayed.
There is no significant difference between groups I, II and controls regarding weight, gestational age, sex and mode of delivery. There were significant differences between groups I and II in sepsis score and hs-CRP after 3, 7, 10 days of treatment (p values for sepsis score were 0.009, 0.006, 0.004 respectively and for hs-CRP were 0.015, 0.001, 0.001 respectively). There was a significant difference in immature /total (I/T) ratio after 7, and 10 days of treatment (p value= 0.045, 0.025, respectively,) while there was no significant difference in immature /total (I/T) ratio after 3 days of treatment (p value = 0.624).Serum 25(OH) vitamin D levels were significantly lower in neonates with sepsis (group I and II) than the controls (p value < 0.05, while there were no significant differences between the three groups considering serum calcium and phosphorus levels (P =1.000, 1.000, respectively). Isolated organisms from blood culture in neonates with sepsis (group I and group II) were most commonly B- hemolytic streptococci, E-coli, hemophilus influenza and staphylococcus aurous. There was a significant negative correlation between hs-CRP and serum 25 (OH) vitamin in group II on entry (r = - 0.832 and P value = 0.001) and after 2 weeks (r = - 0.590 and P value = 0.021). ROC curve of specificity and sensitivity of 25 (OH) vitamin D level in prediction of early-onset neonatal sepsis showed that cutoff value of vitamin D was ≤20 ng/ml, sensitivity was 100%, specificity was 73%, positive predictive value was 73%, negative predictive value was 100% and accuracy was 87.
Serum 25 (OH) vitamin D levels of neonates with the early onset neonatal sepsis were significantly lower than the healthy controls. Vitamin D supplementation improved sepsis score and decrease high levels of hs-CRP; this reflects the role of vitamin D as a target therapy for neonatal sepsis. Further studies are warranted to confirm the therapeutic value of vitamin D in neonatal sepsis.
本研究旨在评估维生素 D 补充作为新生儿败血症辅助治疗的治疗价值。
本研究纳入了 60 例败血症新生儿，随机分为两组；I 组：30 例仅接受抗生素治疗的败血症新生儿，II 组：30 例接受抗生素和维生素 D 治疗的败血症新生儿。本研究还纳入了 30 例健康新生儿作为对照组。对所有患者和对照组进行血清 25(OH)维生素 D 和高敏 C 反应蛋白（hs-CRP）的免疫检测。
I、II 组和对照组在体重、胎龄、性别和分娩方式方面无显著差异。I 组和 II 组在治疗后 3、7、10 天的败血症评分和 hs-CRP 方面有显著差异（败血症评分的 p 值分别为 0.009、0.006、0.004，hs-CRP 的 p 值分别为 0.015、0.001、0.001）。I/T 比值在治疗后 7 天和 10 天有显著差异（p 值分别为 0.045、0.025），而在治疗后 3 天无显著差异（p 值为 0.624）。败血症新生儿（I 组和 II 组）血清 25(OH)维生素 D 水平明显低于对照组（p 值均<0.05），而三组血清钙磷水平无显著差异（p 值分别为 1.000、1.000）。败血症新生儿（I 组和 II 组）血培养分离的病原体最常见的是 B 型溶血性链球菌、大肠杆菌、流感嗜血杆菌和金黄色葡萄球菌。在 II 组中，hs-CRP 与血清 25(OH)维生素 D 在入院时（r=-0.832，p 值=0.001）和 2 周后（r=-0.590，p 值=0.021）呈显著负相关。25(OH)维生素 D 水平预测早发性新生儿败血症的特异性和敏感性的 ROC 曲线显示，维生素 D 的截断值≤20ng/ml 时，敏感性为 100%，特异性为 73%，阳性预测值为 73%，阴性预测值为 100%，准确性为 87%。
早发性新生儿败血症新生儿的血清 25(OH)维生素 D 水平明显低于健康对照组。维生素 D 补充可改善败血症评分，降低 hs-CRP 水平；这反映了维生素 D 作为新生儿败血症靶向治疗的作用。需要进一步研究以证实维生素 D 在新生儿败血症中的治疗价值。
