Background: Low Vitamin A levels of plasma increase the risk of neonates’ morbidity. However, whether umbilical cord blood (UCB) vitamin A levels have an association with the outcomes of late-preterm infants (LPI) is not well established. This study aimed to determine umbilical cord blood vitamin A levels and their correlation with outcomes of late-preterm infants. Methods: We prospectively studied 208 LPI between January 1, 2014,and June 30, 2015. The specimens of UCB were collected shortly after birth, and vitamin A levels were determined by Enzyme-Linked Immunosorbent Assay. All singleton newborns, with 34+0 weeks to 36+6 weeks’ gestational age, were eligible for study inclusion in the studied time intervals. Exclusion criteria included significant congenital malformations or chromosomal abnormality or congenital metabolic disease, or life-threatening disease. All subjects were implemented to follow up, and jaundice, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, death, etc. were recorded. Results: The prevalence of low UCB vitamin A level <0.7 μmol/L was 37.5% in LPI. UCB vitamin A levels of LPI with cesarean section was lower than that with vaginal delivery (0.734 (0.634-0.796) μmol/L VS 0.904 (0.666-1.100) μmol/L P = 0.001). Additionally, binary logistic regression analysis revealed that the cesarean section was an independent risk factor for UCB vitamin A level < 0.7 μmol/L. However, UCB vitamin A levels did not correlate with gestational age, birth weight, and sex. Neonates with hospitalization or oxygen supplementation or RDS group had significantly lower UCB vitamin A levels than their counterparties ( P < 0.05), other than with hyperbilirubinemia or sepsis ( P > 0.05). However, univariate binary logistics regression analysis suggested that UCB vitamin A level < 0.7 μmol/L was not an independent risk factor for hospitalization, oxygen therapy, hyperbilirubinemia, sepsis and RDS. Conclusions: Low umbilical cord blood vitamin A levels are common among late-preterm infants. Delivery with cesarean section is an independent risk factor for low umbilical cord blood vitamin A level. However, there is no evidence that low vitamin A level is associated with morbidity of late-preterm infants, including hyperbilirubinemia, sepsis and respiratory distress syndrome.
Background Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients.Methods This is a retrospective study enrolled a Chinese cohort of 980 CAPD patients who were routinely followed up in our department. The demographic and clinical data recorded at the time of initial CAPD and during follow-up time are collected. The included cases were separated into nonstroke and stroke groups. The role of parathyroid hormone and vitamin D supplementation for stroke in CAPD patients is evaluated. The primary endpoint is defined as the first-time occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up.Results A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation (SD) 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (IQR, 15.7 - 22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort.Conclusions CAPD patients suffered a high risk of stroke. Lower iPTH levels were significantly associated with an increased risk of stroke. Vitamin D supplementation is an independent predictive factor for stroke among CAPD patients.
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