早产儿补充不同剂量维生素D对血清25(OH)D水平的影响
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摘要
目的探讨不同剂量维生素D(VD)对早产儿血清25-羟VitD(25(OH)D)水平的影响,以及早产儿不同VD营养状态下的合理补充剂量。方法回顾性分析入我院新生儿科并于生后2w检测血清25(OH)D的早产儿,同时收集早产儿胎龄、体质量、开奶时间等资料。生后2w开始接受常规剂量VD(400～900IU/d)口服补充治疗。根据生后2w 25(OH)D值,分为VD缺乏、VD不足及VD充足3组,及根据不同VD补充剂量分为低(400IU/d)、中(650IU/d)、高(900IU/d)剂量组。分别于生后4w及6w复测25(OH)D水平并分析其变化。结果 149例早产儿生后2w 25(OH)D值为(43.0±15.4)nmol/L,VD不足和缺乏率达67.8%。3组低剂量组血25(OH)D均呈逐渐降低趋势,但无显著性差异(P>0.05)。VD充足和不足组中,中剂量组、高剂量组生后2、4、6w两两相比,均无显著性差异(P>0.05)。在VD缺乏组中,中剂量组和高剂量组生后2、4、6w血25(OH)D值均呈逐渐升高趋势,其中高剂量组升高幅度更明显,生后4、6w 25(OH)D与生后2w比均显著升高(P<0.01)。结论每天口服VD 400IU的剂量不足以维持早产儿血25(OH)D水平>50nmol/L。对于VD水平充足的早产儿,650IU/d足以维持其血25(OH)D水平>50nmol/L;但对VD水平不足及缺乏的早产儿,900IU/d在提升血25(OH)D方面更有效,但需注意随访血25(OH)D水平。[营养学报,2019,41(2):168-172 ]
Objective To investigate the effect of VD supplementation on the serum 25(OH)D and adequate supplement dosage of VD for premature newborns under different nutritional status. Methods Retrospective analysis was conducted in the neonatal department of our hospital. The serum levels of 25(OH)D in preterm infants were measured at 2 weeks after birth. The data of patients' gestational age, weight, the time of initial feeding and so on were collected. All the preterm infants received routine doses of VD(400-900 IU/D) oral supplement therapy after 2 weeks post-birth. According to the serum 25(OH)VD levels at 2 weeks post-birth, preterm infants were divided into three groups:VD deficiency, insufficient and sufficient groups. They were further divided into low dose group(400 IU/d), moderate dose group(650 IU/d), and high dose group(900 IU/d) according to the different VD supplementation doses. Then, the preterm infants received serum25(OH)D examination at 4 weeks and 6 weeks. Results The mean serum 25(OH)D level at 2 weeks after birth of 149 preterm infants was(43.0±15.4) nmol/L, in which 67.8% of them were VD insufficient and deficient. In the three low dose groups,the serum 25(OH)D levels had a decreasing trend,with no significant difference(P>0.05). For VD sufficient and insufficient preterm infants, there were no significant difference in serum 25(OH)D levels between moderate dose and high dose groups(P> 0.05). For VD deficient preterm infants, serum 25(OH)D levels at weeks 4 or 6 after birth in moderate dose group and in high dose group showed a increasing trend. For serum 25(OH)D levels at weeks 4 and 6 after birth, there was a significant difference compared with that at week 2 after birth(P<0.01). Conclusion Our data found that,supplementation of 400 IU/d VD was not sufficient to maintain serum 25(OH)D level >50 nmol/L in preterm infants, and for VD sufficient preterm infants supplementation of 650 IU/d VD can achieve this goal. However for VD insufficient and deficiency preterm infants,supplementation of 900 IU/d VD is more effective in increasing serum 25(OH)D levels, The follow-up of serum 25(OH) D levels is needed. [ACTA NUTRIMENTA SINICA, 2019, 41(2):168-172]
Objective To investigate the effect of VD supplementation on the serum 25(OH)D and adequate supplement dosage of VD for premature newborns under different nutritional status. Methods Retrospective analysis was conducted in the neonatal department of our hospital. The serum levels of 25(OH)D in preterm infants were measured at 2 weeks after birth. The data of patients' gestational age, weight, the time of initial feeding and so on were collected. All the preterm infants received routine doses of VD(400-900 IU/D) oral supplement therapy after 2 weeks post-birth. According to the serum 25(OH)VD levels at 2 weeks post-birth, preterm infants were divided into three groups:VD deficiency, insufficient and sufficient groups. They were further divided into low dose group(400 IU/d), moderate dose group(650 IU/d), and high dose group(900 IU/d) according to the different VD supplementation doses. Then, the preterm infants received serum25(OH)D examination at 4 weeks and 6 weeks. Results The mean serum 25(OH)D level at 2 weeks after birth of 149 preterm infants was(43.0±15.4) nmol/L, in which 67.8% of them were VD insufficient and deficient. In the three low dose groups,the serum 25(OH)D levels had a decreasing trend,with no significant difference(P>0.05). For VD sufficient and insufficient preterm infants, there were no significant difference in serum 25(OH)D levels between moderate dose and high dose groups(P> 0.05). For VD deficient preterm infants, serum 25(OH)D levels at weeks 4 or 6 after birth in moderate dose group and in high dose group showed a increasing trend. For serum 25(OH)D levels at weeks 4 and 6 after birth, there was a significant difference compared with that at week 2 after birth(P<0.01). Conclusion Our data found that,supplementation of 400 IU/d VD was not sufficient to maintain serum 25(OH)D level >50 nmol/L in preterm infants, and for VD sufficient preterm infants supplementation of 650 IU/d VD can achieve this goal. However for VD insufficient and deficiency preterm infants,supplementation of 900 IU/d VD is more effective in increasing serum 25(OH)D levels, The follow-up of serum 25(OH) D levels is needed. [ACTA NUTRIMENTA SINICA, 2019, 41(2):168-172]
引文
[1]Bendik I,Friedel A,Roos FF,et a1.Vitamin D:a critical and essential micronutrient for human health[J].Front Physiol,2014,5:248.
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[5]Burris HH,Van Marter LJ,McElrath TF,et al.VitD status among preterm and full-term infants at birth[J].Pediatr Res,2014,75:75-80.
[6]Mists M,Pacaud D,Petryk A,et al.Vitamin D deficiency in children and its management:reviw of current knowledge and recommendations[J].Pediatric,2008,122:398-417.
[7]Hathcock JN,Shao A,Vieth R,et al.Risk assessment for vitamin D[J].Am J Clin Nutr,2007,86:6-18.
[8]Misra M,Pacaud D,Petryk A,et al.Vitamin D deficiency in children and its management:review of current knowledge and recommendations[J].Pediatrics,2008,122:398-417.
[9]P?udowski P,Parczmarewicz E,Bayer M,et al.Practical guidelines for the supplementation of VitD and the treatment of deficit in Central Europe-recommended VitDintakes in the general population and groups at risk of VitD deficiency[J].Endokrynol Pol,2013,64:319-327.
[10]Agostoni C,Buonocore G,Carnielli VP,et al.ESPGHANCommittee on Nutrition.Enteral nutrient supply for preterm infants:commentary from the European Society of Paediatric Gastroenterology,Hepatology and Nutrition Committee on Nutrition[J].J Pediatr Gastroenterol Nutr,2010,50:85-91.
[11]Grant CC,Stewart AW,Scragg R,et al.VitD during pregnancy and infancy and infant serum 25-hydroxyvitd concentration[J].Pediatrics,2014,133:143-153.
[12]McCarthy RA,McPenna MJ,Oyefeso O,et al.VitDnutritional status in preterm infants and response to supplementation[J].Br J Nutr,2014,110:156-163.
[13]Monangi N,Slaughter J,Dawodu A,et al.Vitamin D status of early preterm infants and the effects of VitD intake during hospital stay[J].Arch Dis Child Fetal Neonatal Ed,2014,99166-99168.
[14]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,2010,48:502-509.
[15]World Health Organization.Vitamin and mineral requirements in human nutrition,second edition.WHO/FAO,[R/OL],[2010-05-09].http://whqlibdoc.who.Int/publications/2008/9789241596657_eng.pdf.
[16]World Health Organization.Guidelines on Optimal Feeding of Low Birth-Weight Infants in Low-and Middle-Income Countries[M].Geneva,Switzerland:World Health Organization,2011.
[17]Holick MF.Resurrection of VitD deficiency and rickets[J].J Clin Invest,2006,116:2062-2072.
[18]Selye,H.On the stimulation of new bone-formation with parathyroid extract and irradiated ergosterol[J].Endocrinology,1932,16:547-588.
[19]Holick MF,Biancuzzo RM,Chen TC,et al.VitD2 is as effective as VitD3 in maintaining circulating concentrations of 25-hydroxy VitD[J].J Clin Endocrinol Metab,2008,93:677-681.
[20]Yu X,Wang W,Wei Z,et al.VitD status and related factors in newborns in Shanghai,China[J].Nutrients,2014,6:5600-5610.
[21]Park SH,Lee GM,Moon JE,et al.Severe VitD deficiency in preterm infants:maternal and neonatal clinical features[J].Porean J Pediatr,2015,58:427-433.
[22]Natarajan CP,Sankar MJ,Agarwal R,et al.Trial of daily VitD supplementation in preterm infants[J].Pediatrics,2014,133e628-634.
[2]Pludowski P,Holick MF,Pilz S,et al.VitD effects on musculoskeletal health,immunity,autoimmunity,cardiovascular disease,cancer,fertility,pregnancy,dementia and mortality-a review of recent evidence[J].Autoimmun Rev,2013,12:976-989.
[3]Bhatia J,Griffin I,Anderson D,et al.Selected macro/micronutrient needs of the routine preterm infant[J].J Pediatr,2013 162(3 Suppl):S48-S55.
[4]Monangi N,Slaughter JL,Dawodu A,et al.VitD status of early preterm infants and the effects of VitD intake during hospital stay[J].Arch Dis Child Fetal Neonatal Ed,2014,99:F166-F168.
[5]Burris HH,Van Marter LJ,McElrath TF,et al.VitD status among preterm and full-term infants at birth[J].Pediatr Res,2014,75:75-80.
[6]Mists M,Pacaud D,Petryk A,et al.Vitamin D deficiency in children and its management:reviw of current knowledge and recommendations[J].Pediatric,2008,122:398-417.
[7]Hathcock JN,Shao A,Vieth R,et al.Risk assessment for vitamin D[J].Am J Clin Nutr,2007,86:6-18.
[8]Misra M,Pacaud D,Petryk A,et al.Vitamin D deficiency in children and its management:review of current knowledge and recommendations[J].Pediatrics,2008,122:398-417.
[9]P?udowski P,Parczmarewicz E,Bayer M,et al.Practical guidelines for the supplementation of VitD and the treatment of deficit in Central Europe-recommended VitDintakes in the general population and groups at risk of VitD deficiency[J].Endokrynol Pol,2013,64:319-327.
[10]Agostoni C,Buonocore G,Carnielli VP,et al.ESPGHANCommittee on Nutrition.Enteral nutrient supply for preterm infants:commentary from the European Society of Paediatric Gastroenterology,Hepatology and Nutrition Committee on Nutrition[J].J Pediatr Gastroenterol Nutr,2010,50:85-91.
[11]Grant CC,Stewart AW,Scragg R,et al.VitD during pregnancy and infancy and infant serum 25-hydroxyvitd concentration[J].Pediatrics,2014,133:143-153.
[12]McCarthy RA,McPenna MJ,Oyefeso O,et al.VitDnutritional status in preterm infants and response to supplementation[J].Br J Nutr,2014,110:156-163.
[13]Monangi N,Slaughter J,Dawodu A,et al.Vitamin D status of early preterm infants and the effects of VitD intake during hospital stay[J].Arch Dis Child Fetal Neonatal Ed,2014,99166-99168.
[14]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,2010,48:502-509.
[15]World Health Organization.Vitamin and mineral requirements in human nutrition,second edition.WHO/FAO,[R/OL],[2010-05-09].http://whqlibdoc.who.Int/publications/2008/9789241596657_eng.pdf.
[16]World Health Organization.Guidelines on Optimal Feeding of Low Birth-Weight Infants in Low-and Middle-Income Countries[M].Geneva,Switzerland:World Health Organization,2011.
[17]Holick MF.Resurrection of VitD deficiency and rickets[J].J Clin Invest,2006,116:2062-2072.
[18]Selye,H.On the stimulation of new bone-formation with parathyroid extract and irradiated ergosterol[J].Endocrinology,1932,16:547-588.
[19]Holick MF,Biancuzzo RM,Chen TC,et al.VitD2 is as effective as VitD3 in maintaining circulating concentrations of 25-hydroxy VitD[J].J Clin Endocrinol Metab,2008,93:677-681.
[20]Yu X,Wang W,Wei Z,et al.VitD status and related factors in newborns in Shanghai,China[J].Nutrients,2014,6:5600-5610.
[21]Park SH,Lee GM,Moon JE,et al.Severe VitD deficiency in preterm infants:maternal and neonatal clinical features[J].Porean J Pediatr,2015,58:427-433.
[22]Natarajan CP,Sankar MJ,Agarwal R,et al.Trial of daily VitD supplementation in preterm infants[J].Pediatrics,2014,133e628-634.