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]	Hongchu Huang, Meirong Huang, Lihong Wen. Risk factor analysis and risk prediction model of granulocytopenia infection after chemotherapy in patients with hematological malignancies[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(05): 285-292.
[2]	Wenbin Luo, Wei Han. Analysis of risk factors related to moderate to severe myelosuppression in patients with pancreatic cancer after first chemotherapy and construction of prediction model[J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(05): 357-362.
[3]	Bin He, Jinfeng Ma. Risk factors for splenic hilar lymph node metastasis in gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 694-699.
[4]	Jing Han, Shaolong Hao, Hua Kang. Retrospective analysis of clinical features of single-center thyroid carcinoma patients in Beijing[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 490-493.
[5]	Kai Lin, Yong Pan, Gaoping Zhao, Chun Yang. Analysis of risk factors and prevention strategy of incisional hernia after stoma reduction surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 634-638.
[6]	Chuang Yang, Xue Ma. Analysis of risk factors for postoperative infection of abdominal wall hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 693-696.
[7]	Yan Zhou, Ying Li, Xiaobing Zhou, Fahui Cheng, Hengzheng He. Efficacy of different types of mesh combined with Nissen fundoplication for repairing hiatal hernia and potential risk factors for recurrence[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 528-533.
[8]	Weiwei Zhang, Qi Chen, Heyu Weng, Liang Huang. Preliminary study on prediction of lymph node metastasis of T1 colorectal cancer by random forest model[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(05): 389-393.
[9]	Sihan Liu, Jing Zhang. Relationship of 25-hydroxyvitamin D3 and the ratio of serum iron to C-reactive protein with renal function impairment in the elderly[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(05): 268-272.
[10]	Guibin Fang, Jin Xiao, Guangtao Fu, Qiujian Zheng. Factors affecting walking ability in elderly patients with hip fractures one year after surgery[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(05): 273-280.
[11]	Nan Si, Hongtao Sun. Research progress on risk factors of renal dysfunction after traumatic brain injury[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(05): 300-305.
[12]	Junling Han, Gang Wang, Liying Ma, Ying Lian, Hui Xu. Study on the therapeutic effect of vitamin D combined with povidone bromide tablets on diarrhea type patients with irritable bowel syndrome and its impact on intestinal barrier function indicators[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 560-564.
[13]	Huiying Chen, Minshan Qiu, Hanquan Shao. Construction and application effect of risk factor model for intestinal mucosal barrier function damage induced by sepsis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 448-452.
[14]	Shirui Yan, Hui Xiong. Identification of risk factors for acute kidney injury in patients with infective endocarditis and prediction of death risk in such patients with acute kidney injury[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 618-624.
[15]	Wenzhe Li, Yi Wang, Jian Cui, Qihang Zheng, Jingyan Wang, Xiangyou Yu. Critically ill patients with acute renal dysfunction in Xinjiang Uygur Autonomous Region：A crosssection study[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2024, 10(05): 269-276.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export