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Correlations of Serum 1,25-Hydroxy Vitamin D3 level with Severity and Prognosis of Neonatal Respiratory Distress Syndrome by Huimin Shao, Xiantian Ren, Pengfei Zhang

Background: This study was done to explore the correlations of serum 1,25-hydroxy vitamin D3 [1,25-(OH)2-VitD3] level with severity and prognosis of neonatal respiratory distress syndrome (NRDS).
Methods: The clinical data of 145 NRDS children admitted between April 2019 and June 2020 were retrospectively analyzed. The subjects were comprised of 76 boys and 69 girls. Based on NRDS severity, they were assigned into mild group (n = 82) and severe group (n = 63), and their general data were compared. The independent factors affecting NRDS severity were evaluated by multivariate logistic regression analysis. The correlations of serum 1,25-(OH)2-VitD3 level in NRDS children with NRDS severity and other related blood test indices were analyzed using Spearman’s and Pearson’s methods. On the basis of multivariate analysis results, a prediction model was established using R3.6.0 software, which was validated by the receiver operating characteristic (ROC) curve and consistency index. The association between serum 1,25-(OH)2-VitD3 level and prognosis was evaluated through Kaplan-Meier curve.
Results: The severe group had higher groups of children with a gestational age < 39 weeks, spontaneous delivery, selective cesarean section, intrauterine distress, intrauterine infection, maternal hypertension, maternal dyslipidemia, and older maternal age than the mild group (p < 0.05). Procalcitonin, C-reactive protein, activin-A, Clara cell protein-16, interleukin-18, and IL-10 were significantly higher in the severe group than those in the mild group (p < 0.05), while serum bicarbonate, 1,25-(OH)2-VitD3, vitamin A, and IL-8 were significantly lower in the severe group than those in the mild group (p < 0.05). Multivariate logistic regression analysis results exhibited that gestational age < 39 weeks, lower 1,25-(OH)2-VitD3 and vitamin A levels, higher activin-A and CC-16 were independent risk factors for severe NRDS (p < 0.05). ROC curve analysis revealed that the area under the ROC curve of the model was 0.785, and the prediction accuracy was 88.08%. Serum 1,25-(OH)2-VitD3 level was significantly negatively correlated with NRDS severity (r = -0.287, p < 0.001), activin-A (r = -0.073, p < 0.001), and CC-16 (r = -0.098, p < 0.001), but positively correlated with vitamin A (r = 0.009, p < 0.001). Kaplan-Meier curve revealed that the survival rate of NRDS children with a high 1,25-(OH)2-VitD3 level was significantly higher than that of children with a low 1,25-(OH)2-VitD3 level (p < 0.001).
Conclusions: 1,25-(OH)2-VitD3 is an independent influencing factor for the severity of NRDS and may affect the prognosis of NRDS children.

DOI: 10.7754/Clin.Lab.2022.220153