Study On The Clinical Value Of Vitamin D Levels In Neonatal Indirect Hyperbilirubinemia

Part One:Meta-Analysis of the Correlation between Vitamin D Levels and Neonatal Indirect HyperbilirubinemiaObjectiveNeonatal hyperbilirubinemia(NHB)is one of the most common disorders of the neonatal period,in which severe neonatal indirect hyperbilirubinemia(NIH)can cause irreversible brain damage.Therefore,it is very important to prevent,diagnose and treat NIH in a timely manner.It has been suggested that vitamin D(VD)may affect serum bilirubin levels and influence the development of NIH.In this study,we applied the method of Meta-analysis to investigate the relationship between serum VD levels and NIH to provide help for the diagnosis and treatment of NIH.MethodsSearch China National Knowledge Infrastructure(CNKI),Wanfang Database,Chinese Biomedical Literature Database(CBM),PubMed,Cochrane Library,Embase,Web of Science,and manually searched conference papers randomized controlled clinical studies related to the relationship between vitamin D and NIH.The time limit is from the date of establishment to December 2022.Literature screening and data collection were performed independently by two investigators.The included literatures were assessed for quality by applying the NOS(Newcastle-Ottawa Scale).A meta-analysis was conducted on the included studies using Stata16 software.ResultsSeven case-control studies exploring the relationship between vitamin D and neonatal indirect hyperbilirubinemia were finally included.There were 808 neonates,437 were in the case group.Meta-analysis showed that serum vitamin D levels were 6.67 ng/ml lower in the case group than the control group(95%CI(-9.87,-3.48),Z=4.09,P<0.05).Subgroup analysis was performed according to whether the serum bilirubin was concentrated above 15 mg/dl.Serum vitamin D was 9.55 ng/ml lower in the group with serum bilirubin concentrated above 15 mg/dl than the control group(95%CI(-10.72,-8.38),Z=16.02,P<0.05).Serum vitamin D was 3.79ng/ml lower in the group with serum bilirubin not concentrated above 15mg/dl than the control group(95%CI(-5.24,-2.33),Z=5.11,P<0.05).ConclusionSerum vitamin D levels were lower in neonates with neonatal indirect hyperbilirubinemia than in neonates without hyperbilirubinemia.It also suggests that newborns with lower vitamin D levels are at higher risk for developing hyperbilirubinemia.Part Two:Neonatal Vitamin D Levels and Their Effects on Serum Bilirubin Levels1.Study of Neonatal Vitamin D Levels and Its Influencing FactorsObjectiveSerum 25-hydroxyvitamin D(25(OH)D)levels were collected from neonates to investigate the nutritional status of neonatal vitamin D and its influencing factors,and to provide a reference for clinical prevention and treatment of neonatal vitamin D deficiency and insufficiency.MethodsIn this study,96 singleton neonates admitted to the neonatal unit of the Second Affiiliated Hospital of Dalian Medical University from January 2022 to January 2023 were randomly selected.Serum 25(OH)D measured within 72 hours after birth were collected from the neonates included in the study.General data of the newborns and mothers was also collected to analyze the factors affecting vitamin D.Results1.Vitamin D deficiency or insufficiency was prevalent in newborns after birth,and the proportions of vitamin D deficiency,insufficiency and appropriateness were:28.1%,42.7%and 29.2%,respectively.2.By univariate analysis,the season of birth and the pregnancy-induced hypertension were associated with vitamin D levels,P<0.05.3.By multiple linear regression analysis,pregnancy-induced hypertension was an influencing factor of vitamin D level in newborns.Conclusion1.Vitamin D insufficiency and deficiency were prevalent in newborns,and its rate could be more than half.2.The pregnancy-induced hypertension increases the risk of vitamin D deficiency or insufficiency in newborns.2.Study on the Clinical Value of Vitamin D Levels in Neonatal Indirect HyperbilirubinemiaObjectiveThe relationship between serum vitamin D and NIH was investigated by collecting serum 25(OH)D,serum bilirubin levels and recording the duration of jaundice in neonates.Compare the levels of serum 25(OH)D in neonates with neonatal indirect hyperbilirubinemia and non-jaundice,compare the duration of jaundice between different vitamin D levels in the case group,explore the relationship between serum 25(OH)D and bilirubin levels.MethordIn the study,87 neonates admitted to the neonatal ward of the Second Affiliated Hospital of Dalian Medical University from January 2022 to January 2023 were randomly selected.The neonates were divided into case group(n=52)and control group(n=35)according to whether they met the diagnosis of NIH.The results of 25(OH)D and complete biochemical tests were collected from neonates before admission to the hospital for clinical intervention.SPSS 25.0 was applied for statistical analysis.Results1.Fifty-two neonates in the case group and 35 neonates in the control group were included in this study.The differences between the two groups in terms of mode of delivery,gender and birth weight were not statistically significant(P>0.05).2.The serum 25(OH)D level in the case group was(15.11±6.40)ng/ml,and the serum 25(OH)D level in the control group was(21.85±6.83)ng/ml.The serum 25(OH)D level in the case group was lower than that in the control group,and the difference was statistically significant(t=-4.690,P<0.001).3.A total of 52 neonates were included in the case group,of which 17 cases(32.7%)were vitamin D deficient,26 cases(50%)were vitamin D deficient,and 9 cases(17.3%)were vitamin D appropriate.The case group was divided into vitamin D deficient,vitamin D insufficient and vitamin D appropriate groups according to the different serum vitamin D levels,and the differences in the duration of jaundice between the groups were compared,and it was concluded that the differences in the duration of jaundice among the three groups were statistically significant(H=7.441,P=0.024).Multiple comparisons were performed showing a statistically significant difference in the duration of jaundice between the vitamin D deficient and vitamin D appropriate groups(P=0.021),and no statistically significant difference in the duration of jaundice between the vitamin D deficient and vitamin D insufficient groups and the vitamin D insufficient and vitamin D appropriate groups(P>0.05).4.There was no correlation between serum 25(OH)D level and serum total bilirubin level(r=-0.105,P>0.05),indirect bilirubin level(r=-0.102,P>0.05)and direct bilirubin level(r=0.022,P>0.05)in the case group.Conclusion1.The serum 25(OH)D levels of neonates in the case group were lower than those in the control group,but there was no correlation between serum 25(OH)D levels and serum bilirubin levels in neonates with NIH.2.In different serum 25(OH)D levels,the duration of jaundice was different,and serum vitamin D levels had an effect on the duration of j aundice.