Relationship between serum vitamin D level and nosocomial infection in preterm infants

doi:10.3877/cma.j.issn.1673-5250.2018.06.017

Objective

To investigate the relationship between serum vitamin D level at birth and nosocomial infection in preterm infants.

Methods

A total of 246 preterm infants with gestational age less than 32 weeks at birth who were hospitalized in the Neonatal Intensive Care Unit (NICU) of The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University from January 1, 2011 to December 31, 2015 were enrolled as research subjects. These preterm infants were divided into nosocomial infection group (n=63) and control group (n=183) according to whether they had nosocomial infection or not. These preterm infants in nosocomial infection group were further divided into sepsis subgroup (n=27) and other infections subgroup (n=36) according to their infection types. Serum 25-hydroxyvitamin D [25(OH)VitD] levels at birth of all preterm infants were detected by chemiluminescence immunoassay. The level of serum 25(OH)VitD and the incidence of vitamin D deficiency at birth were compared between nosocomial infection group and control group, different subgroups and control group by Wilcoxon rank sum test and chi-square test, respectively. This study was reviewed by the Ethics Committee of The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University (Approval Number: 2013-01-1015-01).

Results

①There were no significantly differences between nosocomial infection group and control group among gestational age, birth weight, gender, birth season of preterm infants, constituent ratio of delivery mode, maternal age, body mass index (BMI) in the first trimester of pregnancy, and incidences of gestational diabetes mellitus, pregnancy hypertension, chorionic amniocentesis of pregnant mother (P>0.05). ②The incidence of vitamin D deficiency at birth and nosocomial infection of preterm infants were 45.5% (112/246) and 25.6% (63/246), respectively. There were no significantly differences between nosocomial infection group and control group in serum 25(OH)VitD level and incidence of vitamin D deficiency at birth (P>0.05). ③The level of serum 25(OH)VitD at birth in sepsis subgroup was 28.1 nmol/L (23.5-34.1 nmol/L), which was significantly lower than that 32.7 nmol/L (25.3-45.4 nmol/L) in control group, and the difference was statistically significant (Z=-2.011, P=0.044). The incidence of vitamin D deficiency at birth was 70.4% (19/27) in sepsis subgroup, which was significantly higher than that 43.2% (79/183) in control group, and the difference also was statistically significant (χ²=6.995, P=0.008). There were no significant differences in serum 25(OH)VitD level and incidence of vitamin D deficiency at birth between other infections subgroup and control group (P>0.05).

Conclusions

There may be no association between serum 25(OH)VitD level at birth and incidence of nosocomial infection in preterm infants. Vitamin D deficiency may increase the incidence of nosocomial infection sepsis. The relationship between serum 25(OH)VitD level at birth and nosocomial infection need to be further confirmed by large sample, multicenter, randomized and controlled studies.

Key words: Intensive care, neonatal, Vitamin D, Calcifediol, Vitamin D deficiency, Cross infection, Sepsis, Infant, premature

表1 院内感染组与对照组早产儿及其母亲一般临床资料比较

组别	例数	早产儿一般临床资料
		出生胎龄(周，±s)	出生体重(g，±s)	性别[例数(%)]		出生季节[例数(%)]
		出生胎龄(周，±s)	出生体重(g，±s)	男	女	春季	夏季	秋季	冬季
院内感染组	63	29.7±1.5	1 532±490	37(58.7)	26(41.3)	13(20.6)	13(20.6)	18(28.6)	19(30.2)
对照组	183	29.3±1.6	1 415±350	114(62.3)	69(37.7)	50(27.3)	33(18.0)	56(30.6)	44(24.1)
检验值	?	t＝1.020	t＝1.390	χ²＝0.251		χ²＝1.737
P值	?	0.309	0.166	0.616		0.629
组别	例数	母亲一般临床资料
		分娩方式[例数(%)]		年龄(岁，±s)	早孕期BMI(kg/m²，±s)	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	绒毛膜羊膜炎[例数(%)]
		经阴道分娩	剖宫产术分娩	年龄(岁，±s)	早孕期BMI(kg/m²，±s)	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	绒毛膜羊膜炎[例数(%)]
院内感染组	63	46(73.0)	17(27.0)	29.2±4.9	28.6±3.7	4(6.3)	2(3.2)	10(15.9)
对照组	183	113(61.7)	70(38.3)	28.1±4.6	27.3±3.9	28(15.3)	21(11.5)	22(12.0)
检验值	?	χ²＝2.603		t＝1.654	t＝1.443	χ²＝3.318	χ²＝3.810	χ²＝2.414
P值	?	0.107		0.100	0.151	0.069	0.051	0.299

表1 院内感染组与对照组早产儿及其母亲一般临床资料比较

组别	例数	早产儿一般临床资料
		出生胎龄(周，±s)	出生体重(g，±s)	性别[例数(%)]		出生季节[例数(%)]
		出生胎龄(周，±s)	出生体重(g，±s)	男	女	春季	夏季	秋季	冬季
院内感染组	63	29.7±1.5	1 532±490	37(58.7)	26(41.3)	13(20.6)	13(20.6)	18(28.6)	19(30.2)
对照组	183	29.3±1.6	1 415±350	114(62.3)	69(37.7)	50(27.3)	33(18.0)	56(30.6)	44(24.1)
检验值	?	t＝1.020	t＝1.390	χ²＝0.251		χ²＝1.737
P值	?	0.309	0.166	0.616		0.629
组别	例数	母亲一般临床资料
		分娩方式[例数(%)]		年龄(岁，±s)	早孕期BMI(kg/m²，±s)	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	绒毛膜羊膜炎[例数(%)]
		经阴道分娩	剖宫产术分娩	年龄(岁，±s)	早孕期BMI(kg/m²，±s)	妊娠期糖尿病[例数(%)]	妊娠期高血压疾病[例数(%)]	绒毛膜羊膜炎[例数(%)]
院内感染组	63	46(73.0)	17(27.0)	29.2±4.9	28.6±3.7	4(6.3)	2(3.2)	10(15.9)
对照组	183	113(61.7)	70(38.3)	28.1±4.6	27.3±3.9	28(15.3)	21(11.5)	22(12.0)
检验值	?	χ²＝2.603		t＝1.654	t＝1.443	χ²＝3.318	χ²＝3.810	χ²＝2.414
P值	?	0.107		0.100	0.151	0.069	0.051	0.299

表2 院内感染组与对照组早产儿出生时血清25(OH)VitD浓度与维生素D缺乏发生率比较

组别	例数	血清25(OH)VitD浓度[nmol/L，M(P₂₅～P₇₅)]	维生素D缺乏[例数(%)]
院内感染组	63	31.8(24.8～50.9)	33(52.4)
对照组	183	32.7(25.3～45.4)	79(43.2)
检验值	?	Z＝－0.315	χ²＝1.604
P值	?	0.893	0.205

表2 院内感染组与对照组早产儿出生时血清25(OH)VitD浓度与维生素D缺乏发生率比较

组别	例数	血清25(OH)VitD浓度[nmol/L，M(P₂₅～P₇₅)]	维生素D缺乏[例数(%)]
院内感染组	63	31.8(24.8～50.9)	33(52.4)
对照组	183	32.7(25.3～45.4)	79(43.2)
检验值	?	Z＝－0.315	χ²＝1.604
P值	?	0.893	0.205

表3 败血症亚组与对照组早产儿出生时血清25(OH)VitD浓度及维生素D缺乏发生率比较

组别	例数	血清25(OH)VitD浓度[nmol/L，M(P₂₅～P₇₅)]	维生素D缺乏[例数(%)]
败血症亚组	27	28.1(23.5～34.1)	19(70.4)
对照组	183	32.7(25.3～45.4)	79(43.2)
检验值	?	Z＝－2.011	χ²＝6.995
P值	?	0.044	0.008

表3 败血症亚组与对照组早产儿出生时血清25(OH)VitD浓度及维生素D缺乏发生率比较

组别	例数	血清25(OH)VitD浓度[nmol/L，M(P₂₅～P₇₅)]	维生素D缺乏[例数(%)]
败血症亚组	27	28.1(23.5～34.1)	19(70.4)
对照组	183	32.7(25.3～45.4)	79(43.2)
检验值	?	Z＝－2.011	χ²＝6.995
P值	?	0.044	0.008

表4 其他感染亚组与对照组早产儿出生时血清25(OH)VitD浓度及维生素D缺乏发生率比较

组别	例数	血清25(OH)VitD浓度[nmol/L，M(P₂₅～P₇₅)]	维生素D缺乏[例数(%)]
其他感染亚组	36	29.9(24.2～42.0)	14(38.9)
对照组	183	32.7(25.3～45.4)	79(43.2)
检验值	?	Z＝－0.771	χ²＝0.226
P值	?	0.441	0.635

表4 其他感染亚组与对照组早产儿出生时血清25(OH)VitD浓度及维生素D缺乏发生率比较

组别	例数	血清25(OH)VitD浓度[nmol/L，M(P₂₅～P₇₅)]	维生素D缺乏[例数(%)]
其他感染亚组	36	29.9(24.2～42.0)	14(38.9)
对照组	183	32.7(25.3～45.4)	79(43.2)
检验值	?	Z＝－0.771	χ²＝0.226
P值	?	0.441	0.635

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