Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand.
Specialist Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand.
Paediatr Perinat Epidemiol. 2021 Sep;35(5):540-548. doi: 10.1111/ppe.12755. Epub 2021 Apr 1.
Hospital admission for acute respiratory infections (ARIs) during early childhood is a global public health concern. Vitamin D deficiency is prevalent during pregnancy and infancy. Evidence indicates that vitamin D supplementation prevents ARIs.
To determine whether vitamin D deficiency at birth is associated with ARI hospitalisations during infancy.
We performed a nested case-control study in children aged 0-12 months. Cases had ≥1 ARI hospitalisation and 4 controls were individually matched to each case. Newborn 25(OH)D concentration was measured on dried blood spots using two-dimensional liquid chromatography-tandem mass spectrometry. Hospital admissions were measured using health care records. Median serum 25(OH)D concentration in cases and controls was compared, and covariates of ARI hospitalisation during infancy were assessed using conditional logistic regression analysis.
Six per cent of the cohort (n = 384) had an ARI hospitalisation during infancy, and 1536 controls were matched to cases. Median DBS [25(OH)D] was lower among ARI cases than controls (46 nmol/l vs. 61 nmol/L). Median 25(OH)D levels were lower for those hospitalised ≥2 times (47, IQR 36, 58) vs. those hospitalised once (52, IQR 42, 62) vs. the controls and also lower for those who stayed in the hospital for ≥3 days (45, IQR 36, 54) vs 1-2 days (48, IQR 38, 59) compared to the controls. After adjustment for season of birth and covariates describing demographic, antenatal, perinatal, and infant characteristics, DBS 25(OH)D concentration (<50 nmol/L) at birth was associated with increased odds of ARI hospitalisation during infancy (odds ratio 2.20, 95% confidence interval 1.48, 2.91).
Vitamin D deficiency at birth is associated with increased odds of ARI hospitalisations in infants. The findings have implications for a developed country like New Zealand where vitamin D supplementation is not routinely recommended and the burden of ARI hospitalisation in young children is high.
婴幼儿急性呼吸道感染（ARI）住院是全球公共卫生关注的问题。维生素 D 缺乏在妊娠和婴儿期很常见。有证据表明，维生素 D 补充可预防 ARI。
确定新生儿维生素 D 缺乏是否与婴儿期 ARI 住院有关。
我们对 0-12 个月的儿童进行了嵌套病例对照研究。病例组有≥1 次 ARI 住院，4 名对照组与每个病例组匹配。使用二维液相色谱-串联质谱法在干血斑上测量新生儿 25（OH）D 浓度。使用健康记录测量住院治疗情况。比较病例组和对照组的血清 25（OH）D 中位数浓度，并使用条件逻辑回归分析评估婴儿期 ARI 住院的协变量。
该队列中有 6%（n=384）的儿童在婴儿期有 ARI 住院，有 1536 名对照组与病例组匹配。与对照组相比，ARI 病例组的 DBS[25（OH）D]中位数较低（46nmol/L 比 61nmol/L）。住院≥2 次的患者（47，IQR36，58）的中位数 25（OH）D 水平低于住院 1 次的患者（52，IQR42，62）和对照组，住院时间≥3 天的患者（45，IQR36，54）也低于对照组住院 1-2 天的患者（48，IQR38，59）。调整出生季节和描述人口统计学、产前、围产期和婴儿特征的协变量后，出生时 DBS25（OH）D 浓度（<50nmol/L）与婴儿期 ARI 住院的几率增加相关（比值比 2.20，95%置信区间 1.48，2.91）。
新生儿维生素 D 缺乏与婴儿 ARI 住院的几率增加有关。这些发现对新西兰等发达国家有影响，在这些国家，不常规推荐维生素 D 补充，而幼儿 ARI 住院的负担很高。
