الفهرس 
Vitamin DOnly 14 pages are availabe for public view
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Abstract
V
itamin D is a fat-soluble steroid hormone for its classical functions, such as skeletal health and bone metabolism Recently, there has been considerable recognition of the importance of its role in modifying the immune system and regulating cell proliferation and cell differentiation (Arshad et al., 2021).
There are two forms of vitamin D: cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2) (Chang and Lee, 2019). The main source of vitamin D is skin exposure to ultraviolet B (UVB) rays from the sun, there are few dietary sources of vitamin D, including oily fish like sardines, tuna, mackerel, and salmon. It is rarely found in vegetables, cereals, and fruits (Shaheen et al., 2021).
Serum 25-hydroxy vitamin D is the main circulating metabolite of vitamin D with a reported half-life of approximately three weeks (Morgan et al., 2016). It is the best estimator of human body vitamin D stores. During pregnancy it crosses the placenta through passive or facilitated transport according to a concentration gradient, so is the major source of vitamin D to the developing fetus, this does mean that a mother deficient in vitamin D is equal to a fetus deficient in vitamin D. with increased risk of various maternal and fetal adverse effects, including increased risk of gestational diabetes mellitus, preeclampsia, small for gestational age neonates, respiratory distress syndrome (Arshad et al., 2022).
The present study was designed to assess neonatal and maternal plasma 25- hydroxy vitamin D levels and correlate maternal levels to adverse neonatal outcome (respiratory distress syndrome, early onset sepsis, bronchopulmonary dysplasia and intrauterine growth restriction) in Egyptian samples.
This case-control study was carried out on 100 newborn infants and their respective mothers. All subjects were selected from at delivery room and Neonatal Intensive Care Unit of Gynecology and Obstetrics Hospital of Ain Shams University. informed written consents were obtained from parents of the neonates enrolled in this study after explanation of the nature, aims of the study, benefits for their neonates and for all community and expected risks for their participated neonates in the study. The study design was approved by the ethical Committee of faculty of Postgraduate Childhood Studies of Ain Shams University, National Research Center and Neonatal Intensive Care Unit of Gynecology and Obstetrics Hospital of Ain Shams University.
One hundred neonates and their respective mothers enrolled in this study. The included newborn infants were divided into two groups:
1) Patient groups: included 80 neonates and their respective mothers, subdivided into four groups each group included 20 neonates with different diagnoses (RDS, BPD, EONS and IUGR infants).
2) Control groups: included 20 healthy newborn infants of matched age and sex and their respective mothers
A detailed history was obtained from each mothers including age, parity, weight and height for calculation of BMI, diet (especially eggs, dairy products and fish), educational status and vitamin D supplementation.
The neonates included in this study were subjected to:
Assessment of gestational age, anthropometric Measurements, Apgar score, measurement of 25(OH)vitamin D level using Enzyme-linked immunosorbent assay (ELISA), Complete Blood Count (CBC) and C-Reactive protein and chest x ray.
The results of the current study revealed that:
Demonstrated that there was a statistical significant association between low maternal 25(OH) vitamin D levels and increased maternal BMI (P value 0.003), irregular sun exposure (P value 0.001), low maternal fish and dairy products intake (P value 0.040), low educational level (P value 0.038), and younger maternal age (P value 0.027).and there was no a statistical significant relation with parity and maternal 25(OH)vitamin D supplementation (P value 0.410, 0.305) respectively.
It also showed that there was a statistical significant association between control and patient groups of neonates as regards low neonatal 25 (OH) vitamin D levels and neonatal anthropometric measures (P value 0.001). It was found that in patient neonates there was a lower neonatal 25(OH)vitamin D level which had a statistical significance with lower mean birth weight, decreased mean length and small mean head circumference.
In addition, there was a statistical significant relationship found between low neonatal 25(OH) vitamin D (ng/ml) levels and RDS grade (P value 0.047) with 80% of the deficiency group had grade 3 or grade 4.
Mode of oxygen support also was a statistical significant among deficiency group (P value 0.012) with 40% were on CPAP and 60% of them were on invasive mechanical ventilation. There was no a statistical relation as regard duration of oxygen support (P value 0.084).
As regards BPD, it was found to be more prevalent among neonates with low vitamin D and mode of oxygen support (P value 0.047 and 0.012) respectively. There was no statistical significant relation with the duration of oxygen support (P value 0.084).
Showed that there was a statistical significant difference between control and patient neonates as regards neonatal 25(OH)vitamin D and neonatal laboratory parameters for early onset sepsis. it was found that the neonatal 25(OH)vitamin D level was a statistical significant lower in-patient groups (P value 0.001), the patient neonates with sepsis have lower 25(OH) vitamin D level than control group with abnormal laboratory parameters such as (leukopenia <5000 *10/mm3 (50%) or leukocytosis >20000 *10/mm3 (20%), thrombocytopenia <150 *10/mm3 (65%) I:T ratio >0.02 (95%) and CRP >6 (95%).
As for the cut off point of maternal 25 (OH) vitamin D level to differentiate between control and patients group, it was found to be ≤22.6 (ng/ml) with sensitivity of 91.25%, specificity of 90.0% and area under curve of 94.8 % while the cut off point of neonatal 25 (OH) vitamin D level to differentiate between control and patients group was found to be ≤21.5(ng/ml) with sensitivity of 96.25%, specificity of 80% and area under curve of 93.9%.
CONCLUSION
from the current study, it was concluded that:
Low maternal serum vitamin D level had a significant positive correlation with neonatal vitamin D level. Consequently, low maternal vitamin D level increased the risk of several neonatal adverse outcome such as RDS, IUGR, EONS and BPD.
Cut off point of maternal 25 (OH) vitamin D level to diagnose decrease maternal 25(OH) vitamin D level was found to be ≤22.6 (ng/ml) with sensitivity of 91.25%, specificity of 90.0% and area under curve of 94.8 %.
Cut off point of neonatal 25 (OH) vitamin D level to diagnose decrease neonatal 25 (OH) vitamin D level was found to be ≤21.5(ng/ml) with sensitivity of 96.25%, specificity of 80% and area under curve of 93.9%.
Increased maternal BMI, younger maternal age irregular sun exposure and low fish and dairy products intake affected the maternal and neonatal 25(OH)vitamin D (ng/ml) levels, being lower in this group.
Vitamin D levels were found to affect or influence the development of RDS grade, bronchopulmonary dysplasia, intrauterine growth restriction and early onset neonatal sepsis.
RECOMMENDATIONS
Appropriate vitamin D supplementation to the pregnant women according recommended daily allownace is 600 iu/day to prevent neonatal adverse outcome such as respiratory distress syndrome, neonatal bronchopulmonary dysplasia, neonatal early onset sepsis and neonatal intrauterine growth restriction.
Follow the preventive measures and avoid risk factors which lead to low maternal vitamin D such as exposure to sun light which is the main source of vitamin D, exercise and weight loss for obese women and regular vitamin D supplementation.