Vitamin D status in preterm neonates and the effects of its supplementation on respiratory distress syndrome

Abstract

AimThe aim of this study was to investigate the status and effects of vitamin D supplement as adjuvant therapy in the management of respiratory distress syndrome (RDS) in preterm infants.Patient and MethodsVitamin D was prospectively studied in 196 preterm neonates, 96 of them developed RDS, which further subdivided into three subgroups (subgroup received just conventional therapy, subgroup received conventional therapy plus vitamin D 400 IU/day, and subgroup received conventional therapy plus vitamin D 800 IU/day). The patient selection for each treatment subgroup was done by computed randomization, and all the patients had the same treatment protocols assigned for each subgroup.ResultsThe preterm group who developed RDS had lower vitamin D concentrations than the preterm group without RDS (*P < .001). Also, the subgroups supplemented with vitamin D had lower Downes Respiratory Distress score and PaCO2 levels, less duration of hospitalization, and complications rates than the subgroup without vitamin D supplementation. The subgroup supplemented with 800 IU/day vitamin D showed also significantly improvement, less hospitalization duration, and less complications than those supplemented with 400 IU/day.Conclusions25‐hydroxyvitamin D concentration was deficient in most preterm babies especially those who developed RDS. Administration of 800 IU/day vitamin D as an adjuvant therapy in cases of RDS was associated with significant decreased in severity, rate of complications, and duration of hospital stay in preterm neonates with RDS.

Editorial for the article entitled, “Vitamin D status in preterm neonates and the effects of its supplementation on respiratory distress syndrome,” Al‐Biltagi, et al

“…This finding suggests that vitamin D deficiency during pregnancy alone is a risk factor for RDS. We and others have demonstrated an association between vitamin D deficiency and preterm birth, 6–12 and Al‐Biltagi et al, 1 provide compelling evidence that among those infants who are preterm of similar gestational ages, those with vitamin D deficiency have a greater risk of RDS, reaffirming the earlier findings of Mohamed Hegazy et al 3 Identifying the problem is important, but to offer a potentially effective therapy that might change the trajectory of the disease or syndrome is paramount.…”

“…Not surprising based on the plethora of studies that have emerged around the globe showing high rates of vitamin D deficiency, even in sunny climates, 2,5 there was a significant deficiency in this cohort of Egyptian mothers and their preterm infants, and especially in those infants who developed RDS. The group of preterm infants with RDS did not differ from those without RDS on the basis of gestational age 1 . This finding suggests that vitamin D deficiency during pregnancy alone is a risk factor for RDS.…”

“…This finding helps to establish a dose‐effect of vitamin D supplementation on respiratory outcome in preterm infants who are at higher risk of vitamin D deficiency in the first place. Those infants who were supplemented with 800 IU vitamin D/day had statistically and clinically significantly lower Downes scores and paCO2 on DOL 6, decreased hospital length of stay, and fewer complications compared with those receiving 0 or 400 IU/day 1 . This was not a randomized clinical trial and the investigator team was not blinded to treatment, potentially biasing Downes scoring; however, the finding of lower paCO2 values in the 800 IU group provides unbiased results supporting the hypothesis.…”

“…What is exciting and extends the work of earlier studies in different regions of the world is that treatment with a vitamin D supplement had a positive effect on severity of RDS and the associated clinical course in this Egyptian cohort of preterm infants: of those 96 infants who met the criteria for the diagnosis of RDS, (and who did not differ on the basis of gestational age, birth weight, birth head circumference, sex, mode of delivery, Apgar scores, or maternal/neonatal 25(OH)D at baseline), the higher dose treatment with 800 IU vitamin D/day was associated with decreased lung morbidity and more rapid recovery based on declining Downes respiratory scores and paCO2 values 1 . This finding helps to establish a dose‐effect of vitamin D supplementation on respiratory outcome in preterm infants who are at higher risk of vitamin D deficiency in the first place.…”

“…As Al‐Biltagi et al 1 mention, there is mounting laboratory and animal data that link vitamin D deficiency with lung maturation and function affecting the alveolar type II cells themselves, surfactant synthesis and alveolarization. A perusal of various topics in the literature reminds us that we are forever “reinventing the wheel.” The association of sunlight exposure—ultraviolet light and its salubrious effect on those with tuberculosis was a breakthrough in its day but its importance waned with the advent of antibiotic therapy 27 .…”