极早产儿维生素D水平动态监测及其对肺部疾病的影响

Dynamic Monitoring of Vitamin D Levels in Extremely Premature Infants and Its Effect on Pulmonary Diseases

摘要: 目的：动态监测极早产儿维生素D水平并探讨其对极早产儿肺部疾病的影响。方法：选取2019年6月~2020年12月期间于青岛大学附属医院NICU住院、并经得家长的知情同意的胎龄 < 32周的极早产儿共126例，极早产儿在喂养耐受后均给予维生素AD (维生素D 500 IU，维生素A 1500 IU)每日1粒，及维生素D3 400 IU。生后24 h及生后1月、2月分别测血清25-(OH)D水平。根据血清25-(OH)D水平，收集极早产儿住院期间临床资料。进行统计学处理。结果：(1) 极早产儿间胎龄、胎龄分组、出生时的体重和体重分组等一般资料比较，组间差异均无统计学的意义(P > 0.05)。(2) 维生素D水平与肺部疾病：出生时各组间的呼吸窘迫综合征(respiratory distress syndrome, RDS)、支气管肺发育不良(bronchopulmonary dysplasia, BPD)发生率比较，结果示差异有统计学意义(P < 0.05)，维生素D严重缺乏组发生率最高。生后2月龄时维生素D严重缺乏组的BPD比例明显增加，组间比较差异有统计学的意义(P < 0.05)。(3) 出生时维生素D水平缺乏率达92.86%，2月龄时缺乏率为53.17%。对126例极早产儿补充900 IU维生素D后，不同月龄间进行统计学分析示：三组间分别在1月龄、2月龄维生素D水平比较，结果示差异有统计学的意义(P < 0.05)。结论：(1) 极早产儿出生时维生素D缺乏增加RDS、BPD的风险，2月龄时维生素D缺乏增加BPD的风险。(2) 极早产儿出生补充维生素D后，在1月龄、2月龄测得维生素D有所提高。针对早产儿不同的维生素D基础水平需要个体化补充。

Abstract: Objective: To dynamically monitor the vitamin D level of very preterm infants and to explore its effect on lung diseases of very preterm infants. Method: A total of 126 very preterm infants with gestational age less than 32 weeks admitted to NICU of Affiliated Hospital of Qingdao University from June 2019 to December 2020 were selected. After feeding tolerance, all the very preterm infants were given vitamin AD (vitamin D 500 IU, vitamin A 1500 IU), 1 capsule per day, and vitamin D3 400 IU. Serum 25-(OH)D levels were measured 24 hours after birth, 1 month and 2 months after birth. According to the level of serum 25-(OH)D, clinical data of very preterm infants during hospitalization were collected. Statistical analysis was performed. Results: (1) There were no significant differences in gestational age, gestational age group, birth weight, weight group and other general data among very preterm infants (P > 0.05). (2) Vitamin D level and lung disease: there were significant differences in the incidence of respiratory distress syndrome and bronchopulmonary dysplasia among the groups at birth (P < 0.05), and the incidence of severe vitamin D deficiency group was the highest. The proportion of BPD in severe vitamin D deficiency group was significantly increased at 2 months after birth, and the difference was statistically significant (P < 0.05). (3) The vitamin D deficiency rate was 92.86% at birth and 53.17% at 2 months old (or discharged). 126 cases of very preterm infants were given 900 IU vitamin D, the results showed that there were significant differences in vitamin D levels among the three groups at 1 month and 2 months (P < 0.05). Conclusion: (1) Vitamin D deficiency at birth increases risk of RDS, BPD, in very premature infants, and vitamin D deficiency at 2 months of age increases BPD’s risk. (2) Very preterm infants were given vitamin D after birth, and vitamin D was increased at 1 month and 2 months old. Different levels of vitamin D in preterm infants need individualized supplement.