25-hydroxy Vitamin D deficiency – A potential risk factor neonatal sepsis correlation with biochemical markers and neonatal sequential organ failure assessment score

Abstract

Background: Sepsis could be a life-threatening organ dysfunction generated due to the dysregulation of the immunological response to infection. An operational definition of organ dysfunction applicable to neonates that predicts mortality within the infection setting is lacking. The neonatal sequential organ failure assessment (nSOFA) score was developed to predict mortality from late-onset neonatal sepsis in term babies (late-onset sepsis [LOS]). Objectives: This study aimed to focus on Vitamin D role in late-onset neonatal sepsis in term babies and to search out the correlation of Vitamin D levels with inflammatory markers, the severity of the disease, and association with nSOFA score and mortality risk. Patients and Methods: We screened all term newborns admitted to the neonatal intensive care unit (NICU) due to suspected or confirmed LOS during the study period. Our final cohort consisted of 148 patients with valid test results and data. Neonates with suspected LOS (Group 1 n = 52) confirmed LOS (Group 2 [n = 74]) or septic shock (group 3 [n = 24]). Baseline clinical data, nSOFA score within the first 24 h, cardiovascular support, the duration of mechanical ventilation, length of the NICU stay, 7th and 28th-day mortality recorded, plasma levels of 25-hydroxyvitamin D (25[OH] D), C-reactive protein, and pre- and procalcitonin were investigated. Newborns were followed until they discharge from the NICU or death. Results: Term newborns with late-onset neonatal sepsis had lower levels of 25(OH) D. We revealed a negative correlation between the levels of 25(OH) D and biochemical markers/nSOFA score in all patients with late-onset neonatal sepsis. Thirty-seven (25%) patients with LOS died within 28 days of NICU admission (with a median 25(OH) D level of 18.3 nmol (interquartile range: 8.7–23.8). There were 35 patients (23.64%) who received vasopressors (N-SOFA ≥3) during their NICU stay. These patients had significantly lower 25(OH) D levels.(P < 0.0001). Lower 25(OH) D levels among study groups were independently associated with a higher n-SOFA score. Conclusion: Our results showed that Vitamin D deficiency predisposed to the development of late-onset neonatal sepsis negatively correlated with biochemical markers and nSOFA score.