Abstract
We aimed to investigate the correlation between vitamin D status in cord blood and fecal calprotectin concentrations in meconium, and also find their association with intestinal distress symptoms during the first two weeks of life. Two hundred and twenty-eight newborns were enrolled in the study who were delivered at Kyungpook National University Children’s Hospital between July 2016 and August 2017. The first passed meconium samples were collected for fecal calprotectin analysis. Intestinal distress involved infants with necrotizing enterocolitis (NEC) and other feeding interruption signs. The median gestational age of the population was 37.0 (34.3–38.4) weeks, and the median birth weight was 2635 (2100–3268) g. The median fecal calprotectin levels in meconium were 134.1 (55.6–403.2) μg/g (range: 11.5–2000 μg/g) and the median 25-hydroxyvitamin D (25-OHD) concentrations in cord blood were 21.0 (15.5–28.8) ng/mL. Sixty infants (26.3%) had intestinal distress, including four patients (1.8%) diagnosed as having NEC. Higher fecal calprotectin concentrations (398.2 (131.8–900.2) μg/g vs. 105.6 (39.4–248.5) μg/g, p < 0.001) and lower 25-OHD levels (17.9 (12.8–22.1) ng/mL vs. 23.2 (17.2–33.0) ng/mL, p < 0.001) were found in infants with intestinal distress compared to infants without intestinal distress. The cut-off value was set at 359.8 μg/g with a sensitivity of 0.53 and a specificity of 0.82 for the development of intestinal distress in the first two weeks of life. Serum 25-OHD levels in cord blood were inversely correlated with fecal calprotectin concentrations in meconium.
Highlights
Vitamin D is a major regulator of immune function and inflammation and has modulatory effects on the cells of the adaptive and innate immune system
Under the hypothesis that fecal calprotectin in meconium may reflect the inflammatory status in fetal intestines, the present study aimed to investigate the correlation between vitamin D levels in cord blood and fecal calprotectin concentrations in meconium and explore its association and intestinal distress symptoms during the first two weeks of life
Considering previous reports found that fecal calprotectin tends to vary widely in the first month, the present study only investigated the correlation with intestinal distress in the early neonatal period
Summary
Vitamin D is a major regulator of immune function and inflammation and has modulatory effects on the cells of the adaptive and innate immune system. Vitamin D modulates innate immunity by regulating antimicrobial peptides, which have functions including microbiocidal activity and chemotaxis of inflammatory immune cells [4,5]. Vitamin D deficiency can result in a pro-inflammatory state and increase susceptibility to intestinal infections [6]. Vitamin D deficiency in the gastrointestinal tract has been presumed to decrease colonic bacterial clearance and lead to expressions of tight junctions in the intestinal epithelium and elevated Th1-mediated inflammation [7,8,9]. Vitamin D levels have been reported to be associated with severity and the activity of inflammatory bowel disease in adolescents and adults [10]. Maternal 25-hydroxyvitamin D (25-OHD) levels have been associated with necrotizing enterocolitis (NEC) development [11]
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