:
Sepsis is unusual systemic reaction to an ordinary infection, and it probably represents
a pattern of response by the immune system to the injury. Vitamin D is a fat-soluble steroid hormone
that contributes to the maintenance of normal calcium homeostasis and skeletal mineralization.
Vitamin D has an important role in the regulation of both innate and adaptive immune systems.
Aim of the Work:
The current study aimed to evaluate the therapeutic value of vitamin D supplementation
as an adjuvant therapy in neonates with sepsis.
Subjects and Method:
This study included 60 neonates with sepsis who were randomly divided
into 2 equal groups; group I: 30 neonates with sepsis who received antibiotic only, Group II: 30
neonates with sepsis who received antibiotic therapy and vitamin D. This study also included 30
healthy neonates as a control group. For all patients and controls, serum level of 25 (OH) vitamin
D and highly sensitive C reactive protein (hs-CRP) were immunoassayed.
Results:
There is no significant difference between groups I, II and controls regarding weight,
gestational age, sex and mode of delivery. There were significant differences between groups I
and II in sepsis score and hs-CRP after 3, 7, 10 days of treatment (p values for sepsis score were
0.009, 0.006, 0.004 respectively and for hs-CRP were 0.015, 0.001, 0.001 respectively). There
was a significant difference in immature /total (I/T) ratio after 7, and 10 days of treatment (p
value= 0.045, 0.025, respectively,) while there was no significant difference in immature /total
(I/T) ratio after 3 days of treatment (p value = 0.624).Serum 25(OH) vitamin D levels were significantly
lower in neonates with sepsis (group I and II) than the controls (p value < 0.05, while
there were no significant differences between the three groups considering serum calcium and
phosphorus levels (P =1.000, 1.000, respectively). Isolated organisms from blood culture in neonates
with sepsis (group I and group II) were most commonly B- hemolytic streptococci, E-coli,
hemophilus influenza and staphylococcus aurous. There was a significant negative correlation between
hs-CRP and serum 25 (OH) vitamin in group II on entry (r = - 0.832 and P value = 0.001)
and after 2 weeks (r = - 0.590 and P value = 0.021). ROC curve of specificity and sensitivity of 25
(OH) vitamin D level in prediction of early-onset neonatal sepsis showed that cutoff value of vitamin
D was ≤20 ng/ml, sensitivity was 100%, specificity was 73%, positive predictive value was
73%, negative predictive value was 100% and accuracy was 87.
Conclusion and Recommendation:
Serum 25 (OH) vitamin D levels of neonates with the early
onset neonatal sepsis were significantly lower than the healthy controls. Vitamin D supplementation
improved sepsis score and decrease high levels of hs-CRP; this reflects the role of vitamin D
as a target therapy for neonatal sepsis. Further studies are warranted to confirm the therapeutic
value of vitamin D in neonatal sepsis.