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العنوان
Assessment of Vitamin D Deficiency in Critically Ill Children /
المؤلف
El-Hefnawy, Passant Marzouk ABD EL-Wahab.
هيئة الاعداد
باحث / Passant Marzouk ABD EL-Wahab El-Hefnawy
مشرف / Farida AL-Baz Mohammed
مشرف / Nadin Nabil Toaima
مناقش / Nesma Ahmed Safwat
تاريخ النشر
2019.
عدد الصفحات
159 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
طب الأطفال ، الفترة المحيطة بالولادة وصحة الطفل
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم طب الاطفال
الفهرس
Only 14 pages are availabe for public view

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from 159

Abstract

Vitamin D plays an important role, not only for bone health, but also in the immune system. Both in vitro and clinical studies have demonstrated that vitamin D is important for the innate and adaptive immune response. In adults, vitamin D insufficiency is common in patients who are hospitalized or have a severe infectious process and is associated with increased mortality.
Vitamin D enhances the antimicrobial response of monocytes of adults suggesting a protective role of vitamin D in infection. Similar links between vitamin D status and the immune system have been shown in pediatric populations. For example, children with cystic fibrosis, who suffer from chronic respiratory infections, have a high prevalence of vitamin D insufficiency that is associated with increased risk of pulmonary exacerbations.
Many children are admitted to a pediatric intensive care unit (PICU) with serious infections or with a high chance of acquiring nosocomial infection once admitted. Severe blood stream infections alone account for significant morbidity and mortality. Adequate nutritional support has been a mainstay in PICU management with research showing improved outcomes and fewer hospital stay days.
This cross-sectional - case control study was conducted on 94 children with age ranging from 2 months-12 years .Sixty of them were admitted to the Pediatric Intensive Care Unit (PICU) of Dar- El Salam Hospital , Cairo, during period between April, 2017 to February, 2018.And thirty-four healthy children were selected from the Outpatient Clinic of Ain-Shams University, children’s Hospital due to minor complaints .
The PICU at Dar El Salam Hospital is a five bedded unit and caters to children with medical/surgical problems, and trauma. However, PICU patients were excluded if they had the following issues: chronic renal disease, gastrointestinal malabsorption conditions, post-operative surgery, or trauma as related to possible abuse.
The present study was designed to assess vitamin D status in children admitted to Pediatric Intensive Care Unit and studied the relationship between vitamin D status at PICU patient and healthy pediatric children (control) and both patient morbidity and mortality.
Vitamin D estimation was performed using Enzyme linked Immune Sorbent Assay (ELISA), Vitamin D deficiency is defined as 25-hydroxy vitamin D [25(OH)D] levels less than 20 ng/ml , insufficiency 20–30 ng/ml, and sufficiency >30 ng/ml.
There is highly significant difference between different levels of Vitamin D between control group and cases group as VDD at control group was 14.7%, compared to 66.7% at cases group. And Vitamin D sufficiency at control group was 47.1% compared to 23.3% at cases group.
A total 60 patients were admitted to PICU department (36 males and 24 females) with age ranging from (2months-12years), using Z-score for weight for age with median (IQR) -1.9(-3.15-0.03).
41% of our patients were admitted due to respiratory causes as sever pneumonia or status asthmaticus, 20% were admitted due to neurological causes as status epileptics or Spinal Muscle Atrophy and 26.7% were admitted due to multiorgan dysfunction syndrome and 38.3% of our patients had chronic disease such as cardiac, chest or neurological disease.
In our study, our patients had median (IQR) PRISM III score 12 (6.5-17) and 66.7% had (1) score on CV-SOFA score, 25% had (3) score and 8.3% had (4) score on the score.
Our study demonstrated that the prevalence of VDD among the studied critically ill children was 66.7% , 10% had insufficient vitamin D and 23.3% had sufficient vitamin D level.
In our study, the multivariate logistic regression shows that there was highly statistically significant association found between mortality and 2nd CRP value on 3rd day of admission to PICU.
However, in our study there is highly significant difference between duration of PICU stay and different levels of vitamin D (P- value = 0.000). As median (IQR) duration of PICU stay in vitamin D deficient group was 11 (11-12) while median (IQR) duration of PICU stay in sufficient group was 5 (3-7).
in view of our study we found a high rate of vitamin D deficiency in critically ill children and there was inverse relationship between PICU stay and vitamin D level, but our findings on association of vitamin D level with severity scores or mortality were inconclusive.