Therapeutic value of Vitamin D as an adjuvant therapy in neonates with sepsis.
Infect Disord Drug Targets. 2019 Jun 26. doi: 10.2174/1871526519666190626141859.
Hagag AA1, El Frargy MS1, Houdeeb HA2.
1 Pediatric Department, Faculty of Medicine, Tanta University. Egypt.
2 Clinical Pathology Department, Faculty of Medicine, Tanta University. Egypt.
- Alternately, prevent neonate sepsis by mother-to-be having high vitamin D level
- Unfortunately the abstract does not indicate vitamin D dose size
- Sepsis is both prevented and treated by Vitamin D - many studies
- Most Sepsis children also have a chronic disease (both low vitamin D) – Aug 2018
- Sepsis in first year of life is much more likely if preterm (low Vitamin D) – May 2017
- Neonatal Sepsis 4.8 X more likely if poor Vitamin D receptor – June 2018
Sepsis is an unusual systemic reaction to what is sometimes an otherwise ordinary infection, and it probably represents a pattern of response by the immune system to injury. Vitamin D is a fat-soluble steroid hormone that contributes to the maintenance of normal calcium homeostasis and skeletal mineralization. Vitamin D has an important role in the regulation of both innate and adaptive immune systems.
AIM OF THE WORK:
Current study aimed to evaluate the therapeutic value of vitamin D supplementation as an adjuvant therapy in neonates with sepsis.
SUBJECTS AND METHOD:
This study included 60 neonates with sepsis who were divided into 2 equal groups; group I: 30 neonates with sepsis who received antibiotic only, Group II: 30 neonates with sepsis who received antibiotic therapy and vitamin D. This study included also 30 healthy neonates as a control group. Serum level of 25 (OH) vitamin D and highly sensitive C reactive protein (hs-CRP) were immunoassayed.
RESULTS:
There is no significant difference between group I, II and controls as regard weight, gestational age, sex and mode of delivery. There were significant differences between group I and group II in sepsis score and hs-CRP after 3, 7, 10 days of treatment (p values for sepsis score were 0.009, 0.006, 0.004 respectively and for hs-CRP were 0.015,0.001,0.001 respectively).There was significance difference in immature /total (I/T) ratio after 7,10 days of treatment (p value= 0.045, 0.025 respectively) while there was no significance difference in immature /total (I/T) ratio after 3 days of treatment (p value = 0.624).
Serum 25(OH) vitamin D levels was significantly lower in neonates with sepsis (group I and II) than controls (p value < 0.05 while there were no significant differences between the three groups as regard serum calcium and phosphorus levels (P =1.000, 1.000 respectively). Isolated organisms from blood culture in in neonates with sepsis (group I and group II) were most commonly B- hemolytic streptococci, E-coli, Hemophilus Influenza and Staphylococcus aurous. There were significant negative correlation between hs-CRP and serum 25 (OH) vitamin in group II at entry (r = - 0.832 and P value = 0.001) and after 2 weeks (r = - 0.590 and P value = 0.021).
ROC curve of specificity and sensitivity of 25 (OH) vitamin D level in prediction of early-onset neonatal sepsis shows that cutoff value of vitamin D was ≤20 ng/ml, sensitivity 100%, specificity 73%, positive predictive value 73%, negative predictive value 100% and accuracy 87.
CONCLUSION AND RECOMMENDATION:
Serum 25 (OH) vitamin D levels of neonates with early onset neonatal sepsis were significantly lower than healthy controls. Vitamin D supplementation improved sepsis score and decrease high levels of hs-CRP; this reflects the role of vitamin D as a target therapy for neonatal sepsis. Further studies are warranted to confirm the therapeutic value of vitamin D in neonatal sepsis.