| Objective(s):In this study,we measured serum 25-(OH)D levels and neutrophil-lymphocyte ratio(NLR)in full-term infants with early-onset sepsis and analyzed the correlation between serum 25-(OH)D levels and neutrophil-lymphocyte ratio(NLR)with the early-onset sepsis in full-term newborns.Methods:From December 2021 to December 2022,229 term infants who were admitted to the neonatal unit of The Second Affiliated Hospital of Kunming Medical University for less than 72 hours after birth were collected as the research objects.Gender,gestational age,gestational frequency,mode of delivery,birth weight,Apgar score(1minute,5 minutes),serum 25(OH)D level,NLR value and infection-related indicators were collected for all study subjects,along with maternal age and complications during pregnancy.The children were divided into sepsis group,infection group and control group according to whether they were diagnosed with neonatal early onset-sepsis during hospitalization,the presence of risk factors for infection and positive blood non-specific test results.Based on the serum 25(OH)D level,the children were divided into vitamin D adequate group(>20 ng/m L),vitamin D insufficient group(12-20 ng/m L)and vitamin D deficient group(<12 ng/m L).The data were statistically analyzed using SPSS25.0 statistical software,and differences were considered statistically significant at P < 0.05.Results:1.A total of 229 full-term infants were included,and the gestational age was a normally distributed measure,expressed as mean±standard deviation,with a mean gestational age of 39.12±1.00 weeks,including 58 cases in the sepsis group with a mean gestational age of 39.45±0.96 weeks,71 cases in the infection group with a mean gestational age of 39.18±1.01 weeks,and 100 cases in the control group with a mean gestational age of 38.89±0.97 weeks;the mean gestational age in the sepsis group was larger than that in the infection group,and the mean gestational age in the infection group was larger than that in the control group.The comparison of the average gestational age among the three groups was P=0.003(P<0.05),and the difference showed statistical significance.Other factors such as sex,birth weight,gestational age,singleton and twin gestation,mode of delivery,season of birth,Apgar score(1 min/5 min after birth)and mother’s age and percentage of complications during pregnancy were found to be statistically insignificant(all P values > 0.05).2.serum 25(OH)D levels in all three groups were non-normally distributed measures,expressed as median P50(P25,P75).The serum 25(OH)D level was10.44(7.91,12.98)ng/m L in the sepsis group,13.64(9.48,17.76)ng/m L in the infection group,and 15.44(12.07,20.56)ng/m L in the control group,and three groups had statistically significant differences(P < 0.05).The serum 25(OH)levels in the sepsis group were significantly lower than those in the infection group and the control group,and the serum 25(OH)levels in the infection group were lower than those in the control group,pairwise comparison among the three groups showed statistical significance(P < 0.05).3.In the sepsis group,there were 36 cases(62.1%)with vitamin D deficiency,20 cases(34.5%)with insufficient vitamin D and 2 cases(3.4%)with sufficient vitamin D;In the infected group,there were 31 cases(43.7%)with vitamin D deficiency,30 cases(42.3%)with insufficient vitamin D and 10 cases(14.1%)with sufficient vitamin D;In the control group,there were 25 cases(25.0%)with vitamin D deficiency,47 cases(47.0%)with insufficient vitamin D and 28 cases(28.0%)with adequate vitamin D deficiency.The differences in the number and proportion of different vitamin D levels among the three groups showed statistical significance(P <0.05).When comparing the neonates with adequate serum vitamin D levels in each group,the proportion of adequate vitamin D levels in the sepsis group was significantly lower than that in the control group;when comparing the neonates with deficient serum vitamin D levels,the proportion of deficient vitamin D levels in the sepsis group was significantly higher than that in the control group,with all differences being statistically significant(P < 0.05).4.The NLR values of all three groups were non-normally distributed measures,expressed as median P50(P25,P75).The NLR values were 5.11(3.63,7.43)in the sepsis group,3.45(2.38,4.61)in the infection group,and 1.96(1.51,2.69)in the control group,which showed statistically significant differences(P < 0.05)when comparing the NLR values of the three groups.The NLR values in the sepsis group were significantly higher than those in the infection and control groups,and the infection group was higher than the control group,and the differences showed statistically significant(P < 0.05)when two comparisons were made among the three groups.5.Comparing NLR before antibiotic treatment and after antibiotic treatment for72 hours in the sepsis and infection groups,the overall median NLR of infants in each group was statistically different before and after treatment(P < 0.05),of which the discrepancies were 1.88(1.12,3.49)and 0.80(0.35,2.49),respectively.After 72 hours of antibiotic treatment,the percentage decrease of NLR was 36.8% in the sepsis group and 23.2% in the infection group.6.The results of plotting the ROC curve to predict EOS in full-term infants showed that the area under the 25(OH)D curve was 0.724(P < 0.05,95% CI 0.204 to0.348),the area under the NLR curve was 0.851(P < 0.05,95% CI 0.798 to 0.904),the area under the PCT curve tested at the same time was 0.917(P < 0.05(P < 0.05,95% CI 0.872-0.963),and the area under the CRP curve was 0.848(P < 0.05,95% CI0.778-0.917),implying that serum 25(OH)D levels,NLR,PCT and CRP have predictive value for EOS in full-term infants.The best cut-off level of serum25(OH)D for predicting EOS in full-term infants was 12.89,with a sensitivity of75.9% and specificity of 62.0%;the best cut-off level of NLR for predicting EOS in full-term infants was 3.89,with a sensitivity of 74.1% and specificity of 80.7%;the best cut-off level of PCT for predicting EOS in full-term infants was 2.32,with a sensitivity of 86.2% and specificity of 84.2%;the best cut-off level of CRP for predicting EOS in full-term infants was 6.89,with a sensitivity of 77.6% and specificity of 84.2%。7.Multifactorial logistic regression analysis showed that low serum 25(OH)D increased the risk of EOS in full-term infants,which was a statistically significant difference(OR=0.930,95% CI 0.895-0.967,P<0.05);higher NLR increased the risk of EOS in full-term infants,which was a statistically significant difference(OR=1.908,95% CI 1.531-2.379,P<0.05);and male newborns increased the risk of EOS in full-term infants compared to females,which was a statistically significant difference(OR=0.382,95% CI 1.531-2.379,P<0.05).95% CI 1.531-2.379,P < 0.05);winter births had a statistically significant increased risk of EOS in full-term infants compared to spring,summer and autumn seasons significant(OR=1.924,95% CI1.154-3.208,P<0.05).Conclusion(s):1.40.2%(n=92)of 229 full-term infants were vitamin D deficient and 42.3%(n=97)were vitamin D deficient.2.62.1%(n=36)of 58 full-term infants who developed EOS were vitamin D deficient and 34.5%(n=20)were vitamin D deficient.3.Vitamin D levels were measured within 3 days after birth for the purpose of early prediction of EOS in full-term infants with some clinical value.4.The variation of NLR can be used as a monitoring indicator of EOS in full-term infants,and it has a sensitivity of 74.1% and specificity of 80.7% at a cut-off level of 3.89 for predicting EOS in full-term infants. |
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