To evaluate the effect of maternal/ neonatal vitamin D levels on culture positive neonatal sepsis.
This prospective cohort study was conducted in the NICU of a tertiary care teaching hospital in Odisha, Eastern India from January 2015 through December 2016. Forty (40) neonates with culture positive sepsis were included in the study group. Forty (40) healthy neonates admitted for evaluation of neonatal jaundice who are similar in gender, gestational age, postnatal age and without any clinical signs of sepsis were recruited as control group after informed consent. Vitamin D level (25 OH D) was assessed in the neonates and their mothers in both the groups.
Neonatal 25 OH vitamin D level in the study group (12.71 ± 2.82 ng/ml) was significantly lower than in the control group (25.46 ± 7.02 ng/ml). The Odds ratio was 273 (95% CI 30.39–2451.6) for culture positive sepsis in neonates with vitamin D deficiency/insufficiency. Mothers of septic neonates had significantly lower 25 OH vitamin D level (20.92 ± 3.92 ng/ml) than the mothers of healthy neonates in control group (27.31 ± 6.83 ng/ml). The Odds ratio was 4.71 (95% CI 1.69–13.1) for culture positive sepsis in babies born to mothers with vitamin D deficiency/insufficiency.
Neonates with vitamin D deficiency/insufficiency are at higher risk for developing sepsis than those with sufficient vitamin D levels. Lower vitamin D levels in mothers is also associated with increased risk of sepsis in the neonates.
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Clancy N, Onwuneme C, Carroll A, et al. Vitamin D and neonatal immune function. J Matern Fetal Neonatal Med. 2013;26:639–46.
Sankar JM, Agarwal R, Deorari AK, Paul VK. Sepsis in the newborn. Indian J Pediatr. 2008;75:261–6.
Polin RA. Management of neonates with suspected or proven early onset bacterial sepsis. Pediatrics. 2012;129:1006–15.
Karras SN, Fakhoury H, Muscogiuri G, et al. Maternal vitamin D levels during pregnancy and neonatal health: evidence to date and clinical implications. Ther Adv Musculoskelet Dis. 2016;8:124–35.
Parekh D, Patel JM, Scott A, et al. Vitamin D deficiency in human and murine sepsis. Crit Care Med. 2017;45:282–9.
Kempker JA, Han JE, Tangpricha V, Ziegler TR, Martin GS. Vitamin D and sepsis- an emerging relationship. Dermatoendocrinol. 2012;4:101–8.
Youssef DA, Miller CW, El-Abbassi AM, Cutchins DG, Cutchins C, Grant WB. Antimicrobial implications of vitamin D. Dermatoendocrinol. 2011;3:220–9.
Grant WB. Vitamin D supplementation of mother and infant could reduce risk of sepsis in premature infants. Early Hum Dev. 2010;86:133.
Grant WB. Vitamin D supplementation could reduce risk of sepsis in infants. World J Pediatr. 2010;6:185.
Seliem M, Abdel-Haie O, Mansour A, Said S, Salama M. The relation between vitamin D level and increased risk for early-onset neonatal sepsis in full term neonate. Med Res J. 2016;15:16–21.
Gamal TS, Madiha A-AS, Hanan MK, MEl-M A-A, Marian GS. Neonatal and maternal 25-OH vitamin D serum levels in neonates with early-onset sepsis. Children. 2017;4:–37.
Cetinkaya M, Cekmez F, Buyukkale G, et al. Lower vitamin D levels are associated with increased risk of early onset neonatal sepsis in term infants. J Perinatol. 2015;35:39–45.
Yu YK, Khaing KW, Wai LT, Aye AM. Serum vitamin D levels in term neonates with early onset sepsis. Pediatr Neonat Biol. 2018;3:000124.
Cizmeci MN, Kanburoglu MK, Akelma AZ, et al. Cord blood 25-hydroxy vitamin d levels and risk of early onset neonatal sepsis: a case control study from a tertiary care center in Turkey. Eur J Pediatr. 2015;174:809–15.
Dhandai R, Jajoo M, Singh A, Mandal A, Jain R. Association of vitamin D deficiency with an increased risk of late-onset neonatal sepsis. Paediatr Int Child Health. 2018;38:193–7.
Tayel SI, Soliman SE, Elsayed HM. Vitamin D deficiency and vitamin D receptor variants in mothers and their neonates are risk factors for neonatal sepsis. Steroids. 2018;134:37–42.
Ozdemir AA, Cag Y. Neonatal vitamin D status and the risk of neonatal sepsis. Pak J Med Sci. 2019;35:420–5.
Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009;63:473–7.
Munns CF, Shaw N, Kiely M, et al. Global consensus recommendation on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;101:394–415.
Di Rossa M, Malaguarnera M, Nicoletti F, Malaguarnera L. Vitamin D3: a helpful immune-modulator. Immunology. 2011;134:123–9.
Watkins RR, Lemonovich TL, Salata RA. An update on the association of vitamin D deficiency with common infectious diseases. Can J Physiol Pharmacol. 2015;93:363–8.
Izban MG, Nowicki BJ, Nowicki S. 1,25-dihydroxy vitamin D3 promotes a sustained LPS induced NF-kβ-dependent expression of CD55 in human monocytic THP 1 cells. PLoS One. 2012;7:e49318.
Liu PT, Stenger S, Li H, et al. Toll like receptors triggering of a 25 OH vitamin D mediated human antimicrobial response. Science. 2006;311:1770–3.
Gombart AF, Borregaard N, Koeffler HP. Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the 25 OH vitamin D receptor and is strongly upregulated in myeloid cells by 1, 25 dihydroxy vitamin D3. FASEB J. 2005;19:1067–77.
Levy R, Malech HL. Effect of 1,25 dihydroxy vitamin D3, lipopolysachharide or lipoteichoic acid on the expression of NADPH oxidase components in cultured human monocytes. J Immunol. 1991;147:3066–71.
Walker VP, Zhang X, Rastegar I, et al. Cord blood vitamin D status impacts innate immune responses. J Clin Endocrinol Metab. 2011;96:1835–43.
Marshall I, Mehta R, Petrova A. Vitamin D in the maternal-fetal-neonatal interface: clinical implications and requirements for supplementation. J Matern Fetal Neonatal Med. 2013;26:633–8.
Mirzaei F, Amiri Moghadam T, Arasteh P. Comparision of serum 25-hydroxy vitamin D levels between mothers with small for gestational age and appropriate for gestational age newborns in Kerman. Iran J Reprod Med. 2015;13:203–8.
Liefaard MC, Ligthat S, Vitezova A, et al. Vitamin D and C reactive protein: a mandelian randomization study. PLoS One. 2015;10:e0131740.
To all staff nurses and residents working in NICU, to all parents who have given their consent for the study.
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Behera, C.K., Sahoo, J.P., Patra, S.D. et al. Is Lower Vitamin D Level Associated with Increased Risk of Neonatal Sepsis? A Prospective Cohort Study. Indian J Pediatr 87, 427–432 (2020). https://doi.org/10.1007/s12098-020-03188-0
- 25 OH vitamin D
- Neonatal sepsis