早产儿出生后早期维生素D营养状况及其影响因素分析

Nutritional status of vitamin D and its influencing factors in preterm infants at the early stage after birth

目的了解早产儿出生后早期维生素D营养状况，并进一步探讨其可能影响因素，进而指导临床维生素D治疗及发现维生素D缺乏高危早产儿。方法回顾性分析2014年4月21日至2016年2月5日入住温州医科大学附属第一医院新生儿科并于出生后2周检测血清25-羟维生素D[25（OH）D]水平的早产儿，同时收集早产儿性别、出生季节、开奶时间等相关数据，根据25（OH）D水平≤37.5 nmol/L、37.5 nmol/L〈25（OH）D≤50.0 nmol/L及25（OH）D〉50.0 nmol/L，分为维生素D缺乏、不足及充足组，采用统计学方法筛选出早产儿出生后2周维生素D的影响因素。结果本研究纳入的172例早产儿25（OH）D平均值为（43.1±16.7）nmol/L，其中维生素D缺乏组、不足组及充足组分别为68例（40%）、50例（29%）及54例（31%），3组维生素D平均值分别为（27.8±16.7）nmol/L、（42.4±3.4）nmol/L及（63.0±11.7）nmol/L。3组间各因素分布比较显示，仅出生季节差异有统计学意义（P＝0.013），冬季出生患儿中有44.2%维生素D缺乏，高于春季（41.7%）、夏季（33.3%）及秋季（38.1%）；且冬季出生患儿中有44.2%维生素D不足，高于春季（30.6%）、夏季（25.1%）及秋季（19.0%）；另冬季出生患儿中仅11.6%维生素D充足，远低于春季（27.8%）、夏季（41.2%）及秋季（42.9%）；差异均有统计学意义（OR＝4.655，95% CI＝1.716～12.627，P＝0.003）。结论早产儿出生后2周普遍存在维生素D水平不足，且冬季出生是早产儿出生早期维生素D不足及缺乏的危险因素。

ObjectiveTo investigate the nutritional status of vitamin D in preterm infants after birth and further explore its possible influencing factors, so as to guide clinical vitamin D therapy and to screen the preterm infants who are at high risk of vitamin D deficiency.MethodsRetrospective analysis was conducted in the neonatal department of our hospital from April 21st, 2014 to February 5th, 2016. The serum 25（OH）D level in preterm infants were measured 2 weeks after birth. Data including gender, season of birth, time to initiation of breastfeeding were collected. According to the 25（OH）D levels[25（OH）D≤37.5 nmol/L, 37.5 nmol/L≤50.0 nmol/L, and 25（OH）D〉50.0 nmol/L], all the preterm infants were divided into three groups： vitamin D deficiency, insufficiency, and sufficiency groups. The influencing factors of vitamin D in preterm infants were screened by using statistical method.ResultsThe mean 25（OH）D level of 172 preterm infants was （43.1±16.7）nmol/L. In vitamin D deficient, insufficient, and sufficient groups, there were 68 （40%）, 50 （29%） and 54（31%） cases of preterm babies, respectively. The mean values of 25（OH）D in these three groups were （27.8±16.7）nmol/L, （42.4±3.4）nmol/L, and （63.0±11.7）nmol/L, respectively. Only the season of birth had significant difference among three groups （P=0.013）： 44.2% of the preterm infants born in winter had vitamin D deficiency, which was higher than those in spring （41.7%）, summer（33.3%）, and autumn （38.1%）; 44.2% of the preterm infants born in winter had vitamin D insufficiency, which was much higher than those in spring （30.6%）, summer （25.1%）, and autumn （19.0%）; furthermore, only 11.6% of the preterm infants born in the winter had vitamin D sufficiency, which was much lower than those in spring （27.8%）, summer （41.2%）, and autumn （42.9%） （OR=4.655, 95% CI=1.716-12.627, P=0.003）.ConclusionVitamin D deficiency in preterm infants 2 weeks after birth is prevalent, and winter birth is a risk factor of vitamin D deficiency and insufficiency in preterm infants.