Relationship between serum 25(OH)D levels at birth and early feeding intolerance in very low birth weight infants

doi:10.3877/cma.j.issn.1673-5250.2023.03.010

Objective

To investigate the relationship between serum 25-hydroxy vitamin D[25(OH)D] levels at birth and feeding intolerance (FI) within 7 d after birth (hereinafter referred to as early postnatal period) in very low birth weight infants (VLBWI).

Methods

A total of 161 VLBWI admitted to the Neonatal Intensive Care Unit (NICU) of the Affiliated Hospital of Xuzhou Medical University from September 2020 to April 2022 were included in this study, retrospective analysis was conducted. According to whether FI occurred in early postnatal period, they were divided into FI group (n=82) and feeding tolerance (FT) group (n=79). Serum 25(OH)D levels of VLBWI at birth were detected in 2 groups, and clinical data of 2 groups were collected. Univariate and multivariate analysis of the influencing factors of FI in early postnatal period in VLBWI in this study were performed by chi-square test and independent sample t test, and multivariate unconditional logistic regression analysis, respectively. This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Approval No. XYFY2022-KL044), and all the guardians of the children with the consent and signed informed consents were obtained.

Results

① Results of univariate analysis showed that: the incidence rates of fetal distress, mild asphyxia at birth, mechanical ventilation treatment duration>96 h, delayed timing of initiation of feeds and delayed meconium excretion in FI group were higher than those in FT group; while the level of serum 25(OH)D at birth was lower than that in FT group, and the differences were all statistically significant (P<0.05). ② Multivariate unconditional logistic regression analysis showed that mechanical ventilation treatment duration>96 h (OR=4.483, 95%CI: 1.449-13.865, P=0.009), delayed timing of initiation of feeds (OR=5.908, 95%CI: 1.599-21.823, P=0.008) and delayed meconium excretion (OR=5.248, 95%CI: 1.539-17.898, P=0.008) were all independent risk factors of FI occurrence in early postnatal period in VLBWI. A higher level of serum 25(OH)D at birth (OR=0.474, 95%CI: 0.367-0.614, P<0.001) was a protective factor of FI occurrence in early postnatal period in VLBWI.

Conclusions

Low serum 25(OH)D level at birth in VLBWI may increase the risk of FI in early postnatal period. Reasonable supplementation of vitamin D in early postnatal period may reduce the incidence of FI in early postnatal period in VLBWI.

Key words: Infant, very low birth weight, Feeding intolerance, Vitamin D, Intensive care units, neonatal, Risk factors, Root cause analysis

表1 VLBWI生后早期发生FI影响因素的单因素分析

组别	例数	男性[例数(%)]	胎龄(周，±s)	BW(g，±s)	剖宫产娩出[例数(%)]	母亲产前使用激素[例数(%)]	胎膜早破>18 h[例数(%)]
FI组	82	48(58.5)	30.4±1.8	1 277±147	61(74.4)	55(67.0)	29(35.3)
FT组	79	52(65.8)	30.3±0.9	1 271±149	54(68.4)	57(72.2)	33(41.8)
]统计量		χ²＝0.91	t＝－0.48	t＝－0.29	χ²＝0.72	χ²＝0.49	χ²＝0.70
P值		0.341	0.632	0.771	0.397	0.484	0.404
组别	例数	母亲合并子痫前期[例数(%)]	胎儿宫内窘迫[例数(%)]	出生季节[例数(%)]
组别	例数	母亲合并子痫前期[例数(%)]	胎儿宫内窘迫[例数(%)]	春季(3~5月)	夏季(6~9月)	秋季(10~11月)	冬季(12月~次年2月)
FI组	82	26(31.7)	24(29.3)	24(29.3)	17(20.7)	21(25.6)	20(24.4)
FT组	79	22(27.8)	12(15.2)	18(22.8)	21(26.6)	16(20.3)	24(30.4)
统计量		χ²＝0.29	χ²＝4.59	χ²＝2.26
P值		0.593	0.032	0.520
组别	例数	出生时轻度窒息[例数(%)]	机械通气治疗时间>96 h[例数(%)]	开奶延迟[例数(%)]	胎粪排出延迟[例数(%)]	出生时血清25(OH)D水平(ng/mL，±s)
FI组	82	52(63.4)	48(58.5)	32(39.0)	34(41.5)	8.2±2.3
FT组	79	31(39.2)	27(34.2)	15(19.0)	13(16.5)	14.1±3.3
统计量		χ²＝9.41	χ²＝9.60	χ²＝7.82	χ²＝12.17	t＝12.96
P值		0.002	0.002	0.005	<0.001	<0.001

表1 VLBWI生后早期发生FI影响因素的单因素分析

组别	例数	男性[例数(%)]	胎龄(周，±s)	BW(g，±s)	剖宫产娩出[例数(%)]	母亲产前使用激素[例数(%)]	胎膜早破>18 h[例数(%)]
FI组	82	48(58.5)	30.4±1.8	1 277±147	61(74.4)	55(67.0)	29(35.3)
FT组	79	52(65.8)	30.3±0.9	1 271±149	54(68.4)	57(72.2)	33(41.8)
]统计量		χ²＝0.91	t＝－0.48	t＝－0.29	χ²＝0.72	χ²＝0.49	χ²＝0.70
P值		0.341	0.632	0.771	0.397	0.484	0.404
组别	例数	母亲合并子痫前期[例数(%)]	胎儿宫内窘迫[例数(%)]	出生季节[例数(%)]
组别	例数	母亲合并子痫前期[例数(%)]	胎儿宫内窘迫[例数(%)]	春季(3~5月)	夏季(6~9月)	秋季(10~11月)	冬季(12月~次年2月)
FI组	82	26(31.7)	24(29.3)	24(29.3)	17(20.7)	21(25.6)	20(24.4)
FT组	79	22(27.8)	12(15.2)	18(22.8)	21(26.6)	16(20.3)	24(30.4)
统计量		χ²＝0.29	χ²＝4.59	χ²＝2.26
P值		0.593	0.032	0.520
组别	例数	出生时轻度窒息[例数(%)]	机械通气治疗时间>96 h[例数(%)]	开奶延迟[例数(%)]	胎粪排出延迟[例数(%)]	出生时血清25(OH)D水平(ng/mL，±s)
FI组	82	52(63.4)	48(58.5)	32(39.0)	34(41.5)	8.2±2.3
FT组	79	31(39.2)	27(34.2)	15(19.0)	13(16.5)	14.1±3.3
统计量		χ²＝9.41	χ²＝9.60	χ²＝7.82	χ²＝12.17	t＝12.96
P值		0.002	0.002	0.005	<0.001	<0.001

表2 VLBWI生后早期发生FI影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
胎儿宫内窘迫(vs未发生胎儿宫内窘迫)	1.110	0.733	2.295	0.130	3.034	0.722~12.751
出生时轻度窒息(vs未发生轻度窒息)	0.325	0.548	0.352	0.553	1.384	0.473~4.049
机械通气治疗时间>96 h(vs ≤96 h)	1.500	0.576	6.780	0.009	4.483	1.449~13.865
开奶延迟(vs首次开奶时间≤生后3 d)	1.776	0.667	7.098	0.008	5.908	1.599~21.823
胎粪排出延迟(vs首次胎粪排出时间≤48 h)	1.658	0.626	7.016	0.008	5.248	1.539~17.898
出生时血清25(OH)D水平	－0.746	0.131	31.240	<0.001	0.474	0.367~0.614

表2 VLBWI生后早期发生FI影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
胎儿宫内窘迫(vs未发生胎儿宫内窘迫)	1.110	0.733	2.295	0.130	3.034	0.722~12.751
出生时轻度窒息(vs未发生轻度窒息)	0.325	0.548	0.352	0.553	1.384	0.473~4.049
机械通气治疗时间>96 h(vs ≤96 h)	1.500	0.576	6.780	0.009	4.483	1.449~13.865
开奶延迟(vs首次开奶时间≤生后3 d)	1.776	0.667	7.098	0.008	5.908	1.599~21.823
胎粪排出延迟(vs首次胎粪排出时间≤48 h)	1.658	0.626	7.016	0.008	5.248	1.539~17.898
出生时血清25(OH)D水平	－0.746	0.131	31.240	<0.001	0.474	0.367~0.614

[1]	何洋，李文星，唐军，等. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志，2020, 22(10): 1047-1055. DOI: 10.7499/j.issn.1008-8830.2008132.
[2]	路军英，刘丹. 早产儿喂养不耐受的临床特征及影响因素[J]. 实用临床医药杂志，2015, 19(3): 151-152. DOI: 10.7619/jcmp.201503053.
[3]	Barbalho SM, Goulart RA, Araújo AC, et al. Irritable bowel syndrome: a review of the general aspects and the potential role of vitamin D[J]. Expert Rev Gastroenterol Hepatol, 2019, 13(4): 345-359. DOI: 10.1080/17474124.2019.1570137.
[4]	Panarese A, Pesce F, Porcelli P, et al. Chronic functional constipation is strongly linked to vitamin D deficiency[J]. World J Gastroenterol, 2019, 25(14)：1729-1740. DOI: 10.3748/wjg.v25.i14.1729.
[5]	Basu S, Smith S. Macrolides for the prevention and treatment of feeding intolerance in preterm low birth weight infants: a systematic review and Meta-analysis[J]. Eur J Pediatr, 2021, 180(2): 353-378. DOI: 10.1007/s00431-020-03814-1.
[6]	李颖，崔其亮，吴繁. 胎龄<32周早产儿喂养不耐受情况回顾性分析[J]. 中华新生儿科杂志，2020, 35(3): 175-180. DOI: 10.3760/cma.j.issn.2096-2932.2020.03.004.
[7]	中华医学会儿科学分会儿童保健学组，《中华儿科杂志》编辑委员会. 儿童微量营养素缺乏防治建议[J]. 中华儿科杂志，2010, 48(7): 502-509. DOI: 10.3760/cma.j.issn.0578-1310.2010.07.006.
[8]	邵肖梅，叶鸿瑁，丘小汕. 实用新生儿学[M]. 5版. 北京：人民卫生出版社，2018: 83-88, 575-578.
[9]	张李霞，戴怡蘅. 硫胺素水平与极低出生体重儿喂养不耐受的相关性[J]. 中华新生儿科杂志，2021, 36(5): 54-57. DOI: 10.3760/cma.j.issn.2096-2932.2021.05.012.
[10]	杨嘉琛，朱绪亮，郑亚文，等. 早产儿喂养不耐受的高危因素[J]. 广东医学，2009, 30(7): 1083-1085. DOI：10.3969/j.issn.1001-9448.2009.07.026.
[11]	Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients, 2015, 7(1): 423-442. DOI: 10.3390/nu7010423.
[12]	庄思齐. 中国新生儿营养支持临床应用指南(2013年更新版)解读[J]. 临床儿科杂志，2014, 32(9): 801-803. DOI: 10.3969/j.issn.1000-3606.2014.09.001.
[13]	中华预防医学会儿童保健分会. 中国儿童维生素A、维生素D临床应用专家共识[J]. 中国儿童保健杂志，2021, 29(1): 110-116. DOI: 10.11852/zgetbjzz2020-2118.
[14]	Zhu Z, Yuan L, Wang J, et al. Mortality and morbidity of infants born extremely preterm at tertiary medical centers in China from 2010 to 2019[J]．JAMA Netw Open, 2021, 4(5): e219382. DOI: 10.1001/jamanetworkopen.2021.9382.
[15]	余章斌，韩树萍，陈玉林，等. 我国早产儿喂养不耐受危险因素的Meta分析[J]. 中国新生儿科杂志，2010, 25(6): 346-350. DOI: 10.3969/j.issn.1673-6710.2010.06.008.
[16]	杨玲蓉，李桦，张彤，等. 维生素D缺乏与早产儿坏死性小肠结肠炎的相关性[J]. 中国当代儿科杂志，2018, 20(3): 178-183. DOI: 10.7499/j.issn.1008-8830.2018.03.003.
[17]	Cantorna MT, Snyder L, Arora J. Vitamin A and vitamin D regulate the microbial complexity, barrier function, and the mucosal immune responses to ensure intestinal homeostasis[J]. Crit Rev Biochem Mol Biol, 2019, 54(2): 184-192. DOI: 10.1080/10409238.2019.1611734.
[18]	Fakhoury HMA, Kvietys PR, AlKattan W, et al. Vitamin D and intestinal homeostasis: barrier, microbiota, and immune modulation[J]. J Steroid Biochem Mol Biol, 2020, 200: 105663. DOI: 10.1016/j.jsbmb.2020.105663.
[19]	Du J, Chen Y, Shi Y, et al. 1, 25-dihydroxyvitamin D protects intestinal epithelial barrier by regulating the myosin light chain kinase signaling pathway[J]. Inflamm Bowel Dis, 2015, 21(11): 2495-2506. DOI: 10.1097/MIB.0000000000000526.
[20]	Moore TA, Pickler RH. Feeding intolerance, inflammation, and neurobehaviors in preterm infants[J]. J Neonatal Nurs, 2017, 23(3): 134-141. DOI: 10.1016/j.jnn.2016.09.009.
[21]	Goswami S, Flores J, Balasubramanian I, et al. 1, 25-dihydroxyvitamin D3 and dietary vitamin D reduce inflammation in mice lacking intestinal epithelial cell Rab11a[J]. J Cell Physiol, 2021, 236(12): 8148-8159. DOI: 10.1002/jcp.30486.
[22]	Almeida A, Mitchell AL, Boland M, et al. A new genomic blueprint of the human gut microbiota[J]. Nature, 2019, 568(7753): 499-504. DOI: 10.1038/s41586-019-0965-1.
[23]	Wang S, Wang L, Fan X, et al. An insight into diversity and functionalities of gut microbiota in insects[J]. Curr Microbiol, 2020, 77(9): 1976-1986. DOI: 10.1007/s00284-020-02084-2.
[24]	Singh P, Kumar M, Al Khodor S. Vitamin D deficiency in the gulf cooperation council: exploring the triad of genetic predisposition, the gut microbiome and the immune system[J]. Front Immunol, 2019, 10: 1042. DOI: 10.3389/fimmu.2019.01042.
[25]	Bashir M, Prietl B, Tauschmann M, et al. Effects of high doses of vitamin D3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract[J]. Eur J Nutr, 2016, 55(4): 1479-1489. DOI: 10.1007/s00394-015-0966-2.

[1]	Huanyan Liu, Yang Hua, Lingyun Jia, Xinyu Zhao, Beibei Liu. Lumen structure and hemodynamic characteristics of occluded internal carotid artery[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 809-815.
[2]	Yanbo Ma, Yang Hua, Guimei Liu, Xiufeng Meng, Liping Cui. Risk factors for carotid atherosclerotic lesions in middle adults[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 822-826.
[3]	Yingxiong Huang, Zi Ye, Peng Jiang, Hong Zhan, Chen Yao, Ji Cui. Clinical risk factors for transmural intestinal necrosis in acute mesenteric venous thrombosis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 413-421.
[4]	Zaibo Zhang, Bingyu Wang, Zhikai Jiao, Bibo Tan. Risk factors for lower extremity deep venous thrombosis after gastric cancer surgery: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 475-480.
[5]	Xu Tang, Bing Han, Wei Liu, Ruxing Chen. Analysis of risk factors for metachronous liver metastases after radical colorectal cancer surgery and construction of a predictive model[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 16-20.
[6]	Qian Yang, Cuifang Li, Wanqiu Zhang. Analysis of short-term and long-term prognosis and influencing factors of primary liver cancer with spontaneous ruptured hemorrhage after emergency TACE surgery[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 33-36.
[7]	Fangyuan Wu, Xia Sun, Changfeng Lin, Zhensheng Zhang. Risk factors of HBV-associated cirrhosis complicated with acute upper gastrointestinal bleeding[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 45-47.
[8]	Zibo Zhen, Jinhu Liu. To explore the influencing factors of postoperative intestinal dysfunction in patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia based on the nomogram model[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 61-65.
[9]	Yonghuan Mao, Hanwen Tong, Ji Miao, Xingzhou Wang, Xiaofei Shen, Chunzhao Yu. Analysis of risk factors and prediction model of parastomal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 682-687.
[10]	Chao Hou, Meichen Pan, Wenming Wu, Xingguang Huang, Xiang Li, Lingxue Cheng, Yuxuan Zhu, Wenbo Li. Risk factors of esophageal stricture after endoscopic submucosal dissection for early esophageal carcinoma and intraepithelial neoplasia[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 383-387.
[11]	Wen Zhang, Mudan Song, Xueting Deng, Yun Zhang. Enhanced nutritional support assisted with octreotide in the treatment of esophageal and gastric variceal bleeding in patients with liver cirrhosis and risk factors for rebleeding[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 456-460.
[12]	Menggui Lu, Bin Huang, Qiulin Li, Yuanmei He. Risk factors for multiple organ dysfunction syndrome in patients with bee sting injury[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 1010-1015.
[13]	Da Li, Daya Zhang, Runxiang Chen, Xiaodong Zhang, Shimei Huang, Chen Chen, fan Zeng, Shiju Chen, Feihu Bai. Epidemiological characteristics and risk factors of Helicobacter pylori infection in Dongfang city of Hainan province[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 858-864.
[14]	Ke Meng, Yan Li, Jingshuang Yan, Bin Yan. Risk factors for prolonged gastric transit time in capsule endoscopy[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 671-675.
[15]	Yanli Yang, Yu Chen, Ruochen Zhao, Wei Du, Haijuan Ma, Ke Xu, Liyun Zhang. Bloodstream infection in patients with systemic lupus erythematosus: risk factors and bacteriological analysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 694-699.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export