Search In this Thesis
   Search In this Thesis  
العنوان
Assessment of Vitamin D status among Septic Children Admitted to PICU and its effect on the Clinical Outcome \
المؤلف
Mostafa, Mohamed Ibrahim Mohamed.
هيئة الاعداد
باحث / محمد ابراهيم محمد مصطفى
مشرف / اسماء الحسينى احمد
مشرف / احمد مصطفى علام
مناقش / اسماء الحسينى احمد
تاريخ النشر
2019.
عدد الصفحات
182 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 - طب الأطفال
الفهرس
Only 14 pages are availabe for public view

from 182

from 182

Abstract

Vitamin D is a hormone important for not only calcium homeostasis but also the proper functioning of multiple organ systems.
Vitamin D deficiency is thought to negatively impact the cardiovascular, respiratory and immune systems directly through cellular vitamin D receptors.
Many studies have showed that vitamin D deficiency and insufficiency are common in the Middle East and North Africa.
Severe sepsis is a life-threatening condition commonly treated in pediatric intensive care units (PICUs) worldwide.
There are no available published studies on the association between vitamin D status and outcome in septic critically ill hospitalized children in Egypt.
The aim of this study was to determine the incidence of vitamin D deficiency among septic critically ill children admitted to pediatric ICU, Children Hospital, Ain Shams University and the influence of vitamin D status on clinical outcome.
This work is a prospective observational study on 52 critically ill children who were diagnosed with sepsis and admitted to pediatric ICU, Children Hospital, Ain Shams University in the time period from July 2017 till January 2019.
The patients aged 1 month - 18 years and we excluded those transferred in from another intensive care unit and children with chronic kidney, liver or GI diseases.
Sepsis diagnosis was defined according to the International Consensus Conference on Pediatric Sepsis.
All children were subjected to detailed clinical history with special consideration to order of birth, nutritional history, daycare center attendance, sun exposure, vitamin D supplementation and its duration.
Full general and systemic clinical examinations were done with special consideration to vital signs and clinical signs of rickets.
Nutritional status was assessed by weight for length/height precentiles using WHO child growth standards.
Serum sample for 25(OH) D measurement was obtained as close as possible to diagnosis of sepsis using ELIZA. Vitamin D deficiency was defined as serum 25(OH) D less than 20 ng/ml (50 nmol/L) and insufficiency as serum 25(OH) D between 20 and 30 ng/ml.
According to serum vitamin D level, the patients were divided into vitamin D deficient, insufficient and sufficient patients.
The patients were compared on admission to PICU regarding vital data, severity scores, number of systems affected and initial labs.
The patients were compared during PICU stay regarding need for mechanical ventilation, use of catecholamines, progression to septic shock, SOFA score, length of PICU stay and mortality.
The following conclusion points were reached:
 There was a high frequency of vitamin D deficiency (67.3%) among septic children admitted to the Pediatric Intensive Care Unit (PICU) of children Hospital of Ain shams University while 11.5% of patients were vitamin D insufficient. The mean of serum vitamin D (25OHD) among patients was (18.6±20.6 ng/ml).
 There was no any significant statistical difference between vitamin D deficient and sufficient patients regarding demographic data such as sex, age, weight and height.
 Malnutrition was more significantly associated with vitamin D deficiency and this indicates that vitamin D deficiency was a part of generalized malnutrition.
 Exclusive breast feeding without vitamin D supplementation and increased order of birth were highly significant associated with vitamin D deficiency.
 There was no significant difference between vitamin D deficient and sufficient patients regarding presence of clinical signs of rickets.
 There was no any significant statistical difference between vitamin D deficient and sufficient patients regarding vital data, PIM-2 score and number of systems affected in 1st day of admission
 Vitamin D deficiency was highly significant associated with low serum calcium level and high serum CRP level.
 There was no significant difference between vitamin D deficient and sufficient patients regarding presence of positive blood culture.
 There was a poor clinical outcome among vitamin D deficient patients but with no significant statistical difference compared to vitamin D sufficient patients.