CORRELATION OF VITAMIN D (25(OH)D) LEVELS

IN PRETERM INFANT OXYGENATION THERAPY

WITH RESPIRATORY DISTRESS SYNDROME
AT SAIFUL ANWAR MALANG HOSPITAL
Yesi Adisti Pramitasari, Ernita Selviana, Brigitta Ida Resita Vebrianti Corebima, Eko Sulistijono
Neonatology Division Paediatric Department Saiful Anwar General Hospital, Medical Faculty of Brawijaya University, Malang, East Java, 65145, Indonesia

BACKGROUND/OBJECTIVES Figure 1:
Distribution of 25 (OH) D levels in 80 respondents
Respiratory distress syndrome (RDS) is the leading cause of
death in preterm infants caused by insufficient pulmonary
surfactant production. In Indonesia, according to the Basic
Health Research (RISKESDAS) from the Ministry of Health
(Kemenkes) 2017, RDS is the third cause of death in neonates
aged 7-28 days. The fetus does not have endogenous
25(OH)D production and is utterly dependent on the mother's
transfer. Calcitriol or 1,25(OH)2D, the active metabolite of
vitamin D, interacts with a specific receptor called the vitamin
D receptor (VDR). VDR receptors are expressed in fetal ATII
cells, where their activation induces proliferation, synthesis,
and secretion of surfactants from both protein and
phospholipid fractions. Transplacental vitamin D transmission
mainly occurs in the third trimester of pregnancy, putting
preterm infants at high risk of vitamin D deficiency. Oxygen
is one of the therapies in RDS, but prolonged oxygen therapy
can have adverse effects on preterm infant.

Figure 2:
Spearman correlation test results between serum 25(OH)D
METHODOLOGY levels in Preterm infant and incidence of RDS

Cross-sectional research was carried out from March to May

2020 in the neonatology inpatient room of Saiful Anwar
Hospital Malang. The study used consecutive sampling to
collect the subjects who met the inclusion and exclusion
criteria to reach the sample size required for each group. The
diagnosis of Respiratory Distress Syndrome (RDS) was based
on an increase in breathing effort immediately after birth until
3-days-old, indicated by an increase in Downe Scores. If a
Downe score of ≥1 was obtained, a chest X-ray was
performed. Serum vitamin D level was measured by enzyme-
linked immunosorbent assay (ELISA) method using blood
samples from umbilical cord veins taken from all neonatal
subjects within the first 24 hours of life.

Figure 3:
Spearman correlation test results between serum 25(OH)D
RESULTS levels in Preterm infant and time oxygenation

The average serum 25(OH)D level was 16.04 ng/ml and most
of the infants had deficiency status 70% (56/80), 27% (22/80)
had insufficiency status, and 3% (2/80) were normal. Among
preterm infants with gestational age 28-37 weeks, we found
51 subjects (88%) with vitamin D deficiency and 29 samples
(96%) of them suffering from RDS. The Mann Whitney test
produced a value of sig = 0.000 (sig <0.05) indicating that
there were differences in serum 25(OH)D levels in preterm
and term infants. The average 25(OH)D serum level of
preterm infants without RDS was 15.07, while in preterm
infants with RDS of 11.28. Based on the Spearman
correlation test, there was a significant relationship between
serum 25(OH)D levels deficiency and the incidence of RDS
with a significance value (p = 0.001). The correlation
coefficient obtained was -0.430 that has a negative direction.
Based on the Spearmen correlation test, there was a CONCLUSIONS
significant relationship between serum 25(OH)D levels
deficiency and the duration of oxygen therapy with a The 25(OH)D level is lower in preterm infants with
significance value (p = 0.004). RDS, indicating the significantly longer oxygen
therapy duration for preterm infants.

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