摘要
目的探讨新生儿重症监护病房(neonatal intensive care unit,NICU)住院新生儿生后25-羟维生素D(25-hydroxy vitamin D,25-OHD)基础水平及维生素D补充后的提升情况,并观察不同维生素D状态对并发症的影响。方法前瞻性纳入2021年1月至2022年1月生后72 h内收住长江大学附属荆州医院NICU的新生儿,检测生后72 h内25-OHD基础水平后,补充维生素D。补充2、4和6周后检测血清25-OHD水平。依据生后72 h内25-OHD基础水平分为充足、不足、缺乏、严重缺乏4组。采用方差分析、独立样本t检验、配对样本t检验、χ^(2)检验或Fisher精确概率法比较不同临床情况、不同胎龄新生儿25-OHD基础水平及不同25-OHD基础状态组患儿补充维生素D前后25-OHD水平的差异,并分析不同25-OHD基础状态组并发症和病死率的差异。结果研究期间符合纳入标准者626例,排除7例后,最终619例患儿纳入研究,72 h内血清25-OHD水平为(21.8±10.1)ng/ml。充足组134例(21.6%),不足组208例(33.6%),缺乏组186例(30.0%),严重缺乏组91例(14.7%)。(2)不同性别、胎龄、胎数、出生月份、是否小于胎龄儿间比较,25-OHD基础水平差异均无统计学意义(P值均>0.05)。(3)持续补充维生素D 2周者158例,持续补充4周者64例,持续补充6周者13例,均在8周内出院。基础25-OHD充足组、不足组、缺乏组和严重缺乏组患儿补充2周后血清25-OHD水平较补充前差异均无统计学意义[分别为(37.1±9.3)与(36.8±4.9)ng/ml、(24.7±7.2)与(24.7±2.9)ng/ml、(16.0±7.6)与(15.4±2.9)ng/ml、(8.1±5.6)与(7.6±1.4)ng/ml,t值分别为0.18、0.04、0.65和0.48,P值均>0.05],补充4周后患儿血清25-OHD水平较补充前均提高[分别为(40.0±5.2)与(35.8±3.9)ng/ml、(29.7±6.4)与(24.5±2.9)ng/ml、(20.3±7.1)与(15.6±3.0)ng/ml、(14.9±7.3)与(6.5±2.3)ng/ml,t值分别为2.13、2.66、5.08和7.64,P值均<0.05]。(4)基础25-OHD严重缺乏组低钙血症[23.1%(21/91)与9.7%(18/186)]及新生儿呼吸窘迫综合征的发生率均高于缺乏组[15.4%(14/91)与3.2%(6/186)](χ^(2)值分别为9.07和13.49,P值均<0.008);不同25-OHD基础状态组患儿新生儿败血症、新生儿坏死性小肠结肠炎、支气管肺发育不良、早产儿视网膜病变的发生率及病死率差异均无统计学意义(P值均>0.05)。结论NICU新生儿25-OHD呈不足状态,维生素D缺乏率高。不同胎龄新生儿间维生素D状态无明显差异。也许需要较长时间持续补充维生素D才能提高血清25-OHD水平。维生素D严重缺乏患儿低钙血症和新生儿呼吸窘迫综合征的发生率较高。
Objective To investigate the change in 25-hydroxy vitamin D(25-OHD)levels in hospitalized newborns in the neonatal intensive care unit(NICU)between baseline and vitamin D supplementation,and to explore the effect of different levels of vitamin D on the complications.Method A prospective study was conducted on the newborns admitted to NICU at Jingzhou Hospital Affiliated to Yangtze University within 72 h after birth from January 2021 to January 2022.Vitamin D supplementation was initiated after the detection of basal 25-OHD levels within 72 h after birth.Serum 25-OHD levels were measured after 2,4,and 6 weeks of supplementation.Newborns were categorized into four groups according to the basal 25-OHD level:sufficient,insufficient,deficient,and severely deficient groups.The analysis of variants,independent sample t-test,paired sample t-test,Chi-square test,or Fisher's exact probability method were employed to evaluate the differences in basal 25-OHD levels among newborns with different clinical conditions and gestational ages,as well as the variation in 25-OHD levels before and after supplementation among the four groups.Furthermore,differences in the morbidity and mortality among different basal status groups were analyzed.Result(1)During the study period,626 cases met the inclusion criteria,and after excluding seven cases,619 infants were ultimately included in the study with serum 25-OHD level within 72 h being(21.8±10.1)ng/ml.There were 134 cases(21.6%)in the sufficient group,208 cases(33.6%)in the insufficient group,186 cases(30.0%)in the deficient group,and 91 cases(14.7%)in the severe deficient group.(2)No statistically significant differences were observed in the basal 25-OHD levels regardless of the genders,gestational age,birth month,number of fetuses or small for gestational age(all P>0.05).(3)Among all infants,158 cases continued to supplement vitamin D for two weeks,64 cases continued for four weeks,and 13 cases continued for six weeks,with all of them discharged within eight weeks.Compared with the basal 25-OHD levels,there were no statistically significant differences in the serum 25-OHD levels among the sufficient,insufficient,deficient,and severely deficient groups after two weeks of supplementation[(37.1±9.3)vs.(36.8±4.9)ng/ml,(24.7±7.2)vs.(24.7±2.9)ng/ml,(16.0±7.6)vs.(15.4±2.9)ng/ml,(8.1±5.6)vs.(7.6±1.4)ng/ml;t=0.18,0.04,0.65 and 0.48,respectively;all P>0.05].After four weeks of supplementation,however,the serum 25-OHD levels in the four groups were higher than those before supplementation[(40.0±5.2)vs.(35.8±3.9)ng/ml,(29.7±6.4)vs.(24.5±2.9)ng/ml,(20.3±7.1)vs.(15.6±3.0)ng/ml,(14.9±7.3)vs.(6.5±2.3)ng/ml;t=2.13,2.66,5.08 and 7.64,respectively;all P<0.05].(4)The incidence of hypocalcemia[23.1%(21/91)vs.9.7%(18/186)]and neonatal respiratory distress syndrome[15.4%(14/91)vs.3.2%(6/186)]were higher in the severely deficient group than those in the deficient group(χ^(2)=9.07 and 13.49,both P<0.008).No statistically significant differences were observed in the incidence of neonatal sepsis,neonatal necrotizing enterocolitis,bronchopulmonary dysplasia,retinopathy of prematurity,and mortality among the four groups(all P>0.05).Conclusions The insufficiency of 25-OHD levels and vitamin D deficiency were prevalent in NICU neonates.Vitamin D status did not significantly differ among newborns with varying gestational ages.A prolonged period of sustained vitamin D supplementation may be required to elevate the serum 25-OHD level.The incidence of hypocalcemia and neonatal respiratory distress syndrome are higher in newborns with severe vitamin D deficiency.
作者
易晓倩
刘建宏
李玉洁
何昊
朱晓芳
Yi Xiaoqian;Liu Jianhong;Li Yujie;He Hao;Zhu Xiaofang(Department of Neonatology,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou 434020,China)
出处
《中华围产医学杂志》
CSCD
北大核心
2023年第12期969-975,共7页
Chinese Journal of Perinatal Medicine
基金
荆州市2022年度医疗卫生科技计划项目(指导性计划)(2022HC23)。
作者简介
通信作者:朱晓芳,Email:L10090@yangtzeu.edu.cn,电话:0716-8494435。
