Effects of vitamin D on neonatal sepsis: A systematic review and meta-analysis

Zebenay Workneh Bitew, Teshager Worku, Ayinalem Alemu, Zebenay Workneh Bitew, Teshager Worku, Ayinalem Alemu

Abstract

Vitamin D deficiency is a major public health concern of pregnant women and neonates worldwide, affecting more than half of neonates. Studies report inconsistent and inconclusive effects of vitamin D treatment on neonatal sepsis. This study aimed to provide conclusive evidence regarding the effect of maternal and cord blood vitamin D levels on neonatal sepsis. Data were retrieved from the electronic database (Web of Science, Scopus, CINAHL [EBSCOhost], ProQuest, EMBASE [Ovid], PubMed, Emcare, MEDLINE [Ovid], and gray literature sources [World cat, Mednar, Google scholar and Google]). Joanna Briggs Institute quality assessment tool was utilized for quality assessment while analysis was performed using Open Meta-analyst, Comprehensive Meta-analysis version 3.3.070, and Review Manager version 5.3 software. From the 18 studies included in the study, the overall prevalence of vitamin D deficiency among neonates was 61% (95% CI: 44.3, 77.7); 79.4% (95% CI: 71.6, 87.3) of neonates with sepsis were vitamin D deficient as were 43.7% (23.4, 63.9) of sepsis-free neonates. Neonates born from mothers with low vitamin D levels were at greater risk of developing neonatal sepsis with a weighed mean difference of -8.57 ng/ml (95% CI: -13.09, -4.05). Similarly, neonates with low cord vitamin D levels were at risk for neonatal sepsis with a mean difference of -8.78 ng/ml (95% CI:-11.58, -5.99). The incidence of EONS in full-term newborns was significantly associated with low maternal and cord blood vitamin D levels with weighed mean differences of -11.55ng/ml (95% CI: -17.63, -5.46) & -11.59 ng/ml (95% CI:-16.65, -6.53), respectively. Low levels of vitamin D both in the cord blood and maternal blood were significantly associated with neonatal sepsis. Hence, vitamin D supplementation for pregnant women and newborns could decrease neonatal sepsis.

Keywords: 25‐hydroxyvitamin D; neonatal infections; newborn; vitamin D deficiency.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
The PRISMA flowchart showing study selection process
FIGURE 2
FIGURE 2
The pooled prevalence of vitamin D deficiency among neonates, 2019
FIGURE 3
FIGURE 3
Forest plot showing the association between maternal vitamin D levels with neonatal sepsis, 2019
FIGURE 4
FIGURE 4
Forest plot showing the association between maternal vitamin D level and early‐onset neonatal sepsis among term neonates, 2019
FIGURE 5
FIGURE 5
Forest plot showing the association between cord blood Vitamin D levels and neonatal sepsis, 2019
FIGURE 6
FIGURE 6
Forest plot showing the association between cord blood vitamin D level and early‐onset neonatal sepsis among term neonates, 2019
FIGURE 7
FIGURE 7
Funnel plot showing publication bias of the included studies for the analysis of the effect of cord Vitamin D level on the neonatal sepsis, 2019

References

    1. Abbasian, M. , Chaman, R. , Amiri, M. , Ajami, M. E. , Jafari‐Koshki, T. , Rohani, H. , & Raei, M. (2016). Vitamin D Deficiency in Pregnant Women and Their Neonates. Global Journal of Health science, 8(9), 54008 10.5539/gjhs.v8n9p83
    1. Adatara, P. , Afaya, A. , Salia, S. M. , Afaya, R. A. , Konlan, K. D. , Agyabeng‐Fandoh, E. , … & Boahene, I. G. (2019). Risk Factors Associated with Neonatal Sepsis: A Case Study at a Specialist Hospital in Ghana. The Scientific World Journal, 2019 10.1155/2019/9369051
    1. Agrawal, A. , Gupta, A. , & Shrivastava, J. (2019). Role of vitamin‐D deficiency in term neonates with late‐onset sepsis: A case‐control study. Journal of Tropical Pediatrics, 65(6), 609‐616. 10.1093/tropej/fmz021
    1. Ahmed, P. , Babaniyi, I. B. , Yusuf, K. K. , Dodd, C. , Langdon, G. , Steinhoff, M. , & Dawodu, A. (2015). Vitamin D status and hospitalisation for childhood acute lower respiratory tract infections in Nigeria. Paediatrics and International Child Health, 35(2), 151–156. 10.1179/2046905514y.0000000148
    1. Amare, D. , Mela, M. , & Dessie, G. (2019). Unfinished agenda of the neonates in developing countries: Magnitude of neonatal sepsis: Systematic review and meta‐analysis. Heliyon, 5(9), e02519 10.1016/j.heliyon.2019.e02519
    1. Aye, A. , Yu, Y. , Khaing, K. , & Wai, L. (2018). Serum vitamin D levels in term neonates with early onset sepsis. Pediatr Neonat Biol, 3(3), 124.
    1. Behera, C. K. , Sahoo, J. P. , Patra, S. D. , & Jena, P. K. (2020). Is Lower Vitamin D Level Associated with Increased Risk of Neonatal Sepsis? A Prospective Cohort Study. Indian Journal of Pediatrics, 87(6), 427–432. 10.1007/s12098-020-03188-0
    1. Belachew, A. , & Tewabe, T. (2020). Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: Systematic review and meta‐analysis. BMC Pediatrics, 20(1), 55.
    1. Belderbos, M. E. , Houben, M. L. , Wilbrink, B. , Lentjes, E. , Bloemen, E. M. , Kimpen, J. L. , & Bont, L. (2011). Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics, 127(6), e1513–e1520.
    1. Belur, J. , Tompson, L. , Thornton, A. , & Simon, M. (2018). Interrater reliability in systematic review methodology: Exploring variation in coder decision‐making. Sociological Methods & Research, 20(10), 1–29.
    1. Bi, W. G. , Nuyt, A. M. , Weiler, H. , Leduc, L. , Santamaria, C. , & Wei, S. Q. (2018). Association between vitamin D supplementation during pregnancy and offspring growth, morbidity, and mortality: A systematic review and meta‐analysis. JAMA Pediatrics, 172(7), 635–645. 10.1001/jamapediatrics.2018.0302
    1. Binks, M. J. , Smith‐Vaughan, H. C. , Marsh, R. , Chang, A. B. , & Andrews, R. M. (2016). Cord blood vitamin D and the risk of acute lower respiratory infection in Indigenous infants in the Northern Territory. Medical Journal of Australia, 204(6), 238 10.5694/mja15.00798
    1. Black, R. E. , Laxminarayan, R. , Temmerman, M. , & Walker, N. (2016). Reproductive maternal newborn and child health. Disease control priorities (vol 2).
    1. Boskabadi, H. , Maamouri, G. , Hemmatipour, A. , Parvini, Z. , Ramazani, A. , & Bagheri, F. (2019). Comparison of serum vitamin D in the umbilical cord of survived with not survived premature infants. Iran Journal of Pediatrics, 29(3), 10.5812/ijp.84798
    1. Camargo, C. A. Jr , Ingham, T. , Wickens, K. , Thadhani, R. , Silvers, K. M. , Epton, M. J. , & Crane, J. (2011). Cord‐blood 25‐hydroxyvitamin D levels and risk of respiratory infection, wheezing, and asthma. Pediatrics, 127(1), e180–e187. 10.1542/peds.2010-0442
    1. Çekmez, F. , Aydemir, G. , Yildirim, Ş. , Bulut, Ö. , Tunç, T. , Kul, M. , & Çoban, A. (2014). Diagnostic value of 25‐hydroxyvitamin D level and new cytokines in neonatal sepsis. European Journal of Inflammation, 12(2), 297–304. 10.1177/1721727X1401200209
    1. Cetinkaya, M. , Cekmez, F. , Buyukkale, G. , Erener‐Ercan, T. , Demir, F. , Tunc, T. , & Aydemir, G. (2015). Lower vitamin D levels are associated with increased risk of early‐onset neonatal sepsis in term infants. Journal of Perinatology, 35(1), 39–45. 10.1038/jp.2014.146
    1. Chang, S.‐W. , & Lee, H.‐C. (2019). Vitamin D and health‐The missing vitamin in humans. Pediatrics & Neonatology, 60(3), 237–244.
    1. Charan, J. , Goyal, J. P. , Saxena, D. , & Yadav, P. (2012). Vitamin D for prevention of respiratory tract infections: A systematic review and meta‐analysis. Journal of Pharmacology and Pharmacotherapeutics, 3(4), 300–303. 10.4103/0976-500X.103685
    1. Cizmeci, M. N. , Kanburoglu, M. K. , Akelma, A. Z. , Ayyildiz, A. , Kutukoglu, I. , Malli, D. D. , & Tatli, M. M. (2015). Cord‐blood 25‐hydroxyvitamin D levels and risk of early‐onset neonatal sepsis: A case–control study from a tertiary care center in Turkey. European Journal of Pediatrics, 174(6), 809–815.
    1. Clancy, N. , Onwuneme, C. , Carroll, A. , McCarthy, R. , McKenna, M. , Murphy, N. , & Molloy, E. (2013). Vitamin D and neonatal immune function. The Journal of Maternal‐Fetal & Neonatal Medicine, 26(7), 639–646.
    1. Cooper, P. A. (2014). The challenge of reducing neonatal mortality in low‐and middle‐income countries. Pediatrics, 133(1), 4–6.
    1. Das, B. , Patra, S. , Behera, C. , & Suar, M. (2016). Genotyping of vitamin D receptor gene polymorphisms using mismatched amplification mutation assay in neonatal sepsis patients of Odisha, eastern India. Infection, Genetics and Evolution, 45, 40–47. 10.1016/j.meegid.2016.08.013
    1. de Oliveira, C. O. P. , Souza, J. R. S. , Machado, R. C. , Feijão, A. R. , & de Souza, N. L. (2016). Risk factors for neonatal sepsis in neonatal intensive care unit: Evidence study. Cogitare Enferm, 21(2), 1–9.
    1. DerSimonian, R. , & Laird, N. (1986). Meta‐analysis in clinical trials. Controlled Clinical Trials, 7(3), 177–188.
    1. Dhandai, R. , Jajoo, M. , Singh, A. , Mandal, A. , & Jain, R. (2018). Association of vitamin D deficiency with an increased risk of late‐onset neonatal sepsis. Paediatrics and International Child Health, 38(3), 193–197. 10.1080/20469047.2018.1477388
    1. Dinlen, N. , Zenciroglu, A. , Beken, S. , Dursun, A. , Dilli, D. , & Okumus, N. (2016). Association of vitamin D deficiency with acute lower respiratory tract infections in newborns. Expanded Journal of Maternal‐Fetal & Neonatal Medicine, 29(6), 928–932. 10.3109/14767058.2015.1023710
    1. El‐Kader, M. A. A. , El‐Azab, G. A. E. K. , & El‐Rifaey, S. M. (2018). Relation between vitamin D level and some inflammatory cytokines in full‐term newborns with early onset sepsis. International Journal of Pharmaceutical Sciences Review and Research, 49(2), 64–70.
    1. Fleischmann‐Struzek, C. , Goldfarb, D. M. , Schlattmann, P. , Schlapbach, L. J. , Reinhart, K. , & Kissoon, N. (2018). The global burden of paediatric and neonatal sepsis: A systematic review. The Lancet Respiratory Medicine, 6(3), 223–230. 10.1016/s2213-2600(18)30063-8
    1. Gad, G. I. , Abushady, N. M. , Fathi, M. S. , & Elsaadany, W. (2015). Diagnostic value of anti‐microbial peptide, cathelicidin in congenital pneumonia. Journal of Maternal‐Fetal & Neonatal Medicine, 28(18), 2197–2200. 10.3109/14767058.2014.981806
    1. Gamal, T. , Madiha, A.‐A. , Hanan, M. , Abdel‐Azeem, M. , & Marian, G. (2017). Neonatal and maternal 25‐OH vitamin D serum levels in neonates with early‐onset sepsis. Children, 4(5), 37.
    1. Gharehbaghi, M. , Ghergherechi, R. , & Karimi, B. (2018). Vitamin D deficiency and lower respiratory tract infections in Newborn infants. Hong Kong Journal of Paediatrics, 23(1), 20–24.
    1. Grant, W. B. (2010). Vitamin D supplementation of mother and infant could reduce risk of sepsis in premature infants. Early Human Development, 86(2), 133 10.1016/j.earlhumdev.2010.02.003
    1. Hammad, E. , & Zainab, M. (2018). Meta‐analysis on factors influencing early onset neonatal sepsis. Scholar Journal of Applied Sciences and Research, 1(8), 20–22.
    1. Hug, L. , Alexander, M. , You, D. , & Alkema, L. (2019). National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario‐based projections to 2030: A systematic analysis. Lancet Glob Health, 7(6), e710–e720. 10.1016/s2214-109x(19)30163-9
    1. Inamo, Y. , Hasegawa, M. , Saito, K. , Hayashi, R. , Ishikawa, T. , Yoshino, Y. , & Fuchigami, T. (2011). Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children. Pediatrics International, 53(2), 199–201.
    1. Karras, S. N. , Fakhoury, H. , Muscogiuri, G. , Grant, W. B. , van den Ouweland, J. M. , Colao, A. M. , & Kotsa, K. (2016). Maternal vitamin D levels during pregnancy and neonatal health: Evidence to date and clinical implications. Therapeutic Advances in Musculoskeletal Disease, 8(4), 124–135. 10.1177/1759720X16656810
    1. Khakshour, A. , Farhat, A. S. , Mohammadzadeh, A. , Zadeh, F. K. , & Kamali, H. (2015). The association between 25‐dehydroxy vitamin D and lower respiratory infection in children aged less than "5" years in Imam Reza hospital, Bojnurd, Iran. Journal of Pakistan Medical Association, 65(11), 1153–1155.
    1. Khuri‐Bulos, N. , Lang, R. D. , Blevins, M. , Kudyba, K. , Lawrence, L. , Davidson, M. , & Halasa, N. B. (2014). Vitamin D deficiency among newborns in Amman, Jordan. Global Journal of Health Science, 6(1), 162.
    1. Kumar, A. , Narang, G. S. , Singh, G. , & Virk, N. (2019). Association of vitamin D deficiency with early onset sepsis in term neonates. International Journal of Contemporary Pediatrics, 6(2), 440–444. 10.18203/2349-3291.ijcp20190500
    1. Laxminarayan, R. , Matsoso, P. , Pant, S. , Brower, C. , Røttingen, J.‐A. , Klugman, K. , & Davies, S. (2016). Access to effective antimicrobials: A worldwide challenge. The Lancet, 387(10014), 168–175.
    1. Lee, S. Y. , Kim, H. E. , & An, S. H. (2018). The Association between Vitamin D Levels and Neonatal Early‐onset Sepsis : A Systematic Review and Meta‐analysis. Korean Journal of Clinical Pharmacy, 28(1), 10–16. 10.24304/kjcp.2018.28.1.10
    1. Liao, S. L. , Lai, S. H. , Tsai, M. H. , Hua, M. C. , Yeh, K. W. , Su, K. W. , & Huang, J. L. (2016). Maternal Vitamin D Level Is Associated with Viral Toll‐Like Receptor Triggered IL‐10 Response but Not the Risk of Infectious Diseases in Infancy. Mediators of Inflammation, 2016, 8175898 10.1155/2016/8175898
    1. Liu, L. , Oza, S. , Hogan, D. , Perin, J. , Rudan, I. , Lawn, J. E. , & Black, R. E. (2015). Global, regional, and national causes of child mortality in 2000–13, with projections to inform post‐2015 priorities: An updated systematic analysis. The Lancet, 385(9966), 430–440.
    1. Łuczyńska, A. , Logan, C. , Nieters, A. , Elgizouli, M. , Schöttker, B. , Brenner, H. , & Rothenbacher, D. (2014). Cord blood 25(OH)D levels and the subsequent risk of lower respiratory tract infections in early childhood: The Ulm birth cohort. European Journal of Epidemiology, 29(8), 585–594.
    1. Magnus, M. C. , Stene, L. C. , Håberg, S. E. , Nafstad, P. , Stigum, H. , London, S. J. , & Nystad, W. (2013). Prospective Study of Maternal Mid‐pregnancy 25‐hydroxyvitamin D Level and Early Childhood Respiratory Disorders. PPE Paediatric and Perinatal Epidemiology, 27(6), 532–541.
    1. Mansy, W. , Ibrahim, N. H. , Al‐Gawhary, S. , Alsubaie, S. S. , Abouelkheir, M. M. , Fatani, A. , & Zakaria, E. A. (2019). Vitamin D status and vitamin D receptor gene polymorphism in Saudi children with acute lower respiratory tract infection. Molecular Biology Reports, 46(2), 1955–1962. 10.1007/s11033-019-04645-6
    1. McCarthy, R. , McCallion, N. , Harrison, G. , & Molloy, E. (2009). Relationship between vitamin D and alkaline phosphatase in very‐low‐birthweight infants. Archives of Disease in Childhood‐Fetal and Neonatal Edition, 94(1), F77–F78.
    1. McNally, J. D. , Leis, K. , Matheson, L. A. , Karuananyake, C. , Sankaran, K. , & Rosenberg, A. M. (2009). Vitamin D deficiency in young children with severe acute lower respiratory infection. Pediatric Pulmonology, 44(10), 981–988. 10.1002/ppul.21089
    1. Mohamed Hegazy, A. , Mohamed Shinkar, D. , Refaat Mohamed, N. , & Abdalla Gaber, H. (2018). Association between serum 25 (OH) vitamin D level at birth and respiratory morbidities among preterm neonates. The Journal of Maternal‐Fetal & Neonatal Medicine, 31(20), 2649–2655.
    1. Mohamed, W. A. , & Al‐Shehri, M. A. (2013). Cord blood 25‐hydroxyvitamin D levels and the risk of acute lower respiratory tract infection in early childhood. Journal of Tropical Pediatrics, 59(1), 29–35. 10.1093/tropej/fms042
    1. Moher, D. , Liberati, A. , Tetzlaff, J. , & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta‐analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269.
    1. Mokhtar, W. A. , Mohamed, A. F. , Allam, R. M. , Zidan, N. I. , Mokhtar, G. A. , Malek, M. M. , & Hamed, M. S. (2018). Vitamin D deficiency and vitamin D receptor gene polymorphisms as a risk factor for severe early‐onset neonatal sepsis. Alexandria Journal of Pediatrics, 31(2), 82.
    1. Moraga, P. , & Collaborators, G. C. o. D. (2017). Global, regional, and national age‐sex specific mortality for 264 causes of death, 1980–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1151–1210.
    1. Mugadza, G. , Zvinavashe, M. , Gumbo, F. Z. , & Pedersen, B. S. (2017). Early breastfeeding initiation and incidence of neonatal sepsis in Chipinge District Zimbabwe. International Journal of Contemporary Pediatrics, 5(1), 1 10.18203/2349-3291.ijcp20175564
    1. Munn, Z. , Moola, S. , Lisy, K. , Riitano, D. , & Tufanaru, C. (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. International Journal of Evidence‐Based Healthcare, 13, 147–153.
    1. Murthy, S. , Godinho, M. A. , Guddattu, V. , Lewis, L. E. S. , & Nair, N. S. (2019). Risk factors of neonatal sepsis in India: A systematic review and meta‐analysis. PLoS One, 14(4), e0215683 10.1371/journal.pone.0215683
    1. Nageshu, S. , Krishna, K. L. K. , Bhat, B. , Suma, H. , & Reddy, S. (2016). A study of prevalence of Vitamin D deficiency among pregnant women and its impact on feto maternal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5(4), 1174–1180, 10.18203/2320-1770.ijrcog20160880
    1. Ozdemir, A. A. , & Cag, Y. (2019). Neonatal Vitamin D status and the risk of neonatal sepsis. Pakistan Journal of Medical, 35(2), 420–425. 10.12669/pjms.35.2.342
    1. Panda, M. , McIntosh, J. , Chaudhari, T. , & Kent, A. L. (2019). Do Maternal Vitamin D Levels Influence Vitamin D Levels in Preterm Neonates? International Journal of Pediatric, 2019, 8613414 10.1155/2019/8613414
    1. Prasad, R. , Shanataram, B. , Kiran, B. , & Dsa, S. (2018). Vitamin d levels in late pre‐term neonates and its association with sepsis. Indian Journal of Public Health Research and Development, 9(10), 128–132. 10.5958/0976-5506.2018.01327.X
    1. Pulmano, C. B. (2018). Association of breastfeeding practices and selected clinical outcomes of patients aged 3 months to 2 years old diagnosed with pcap c in a tertiary government hospital in manila from January 2013‐ January 2016. Pediatrics & Therapeutics, 8, 10.4172/2161-0665-c2-055
    1. Puthuraya, S. , Karnati, S. , Kazzi, S. N. J. , Qureshi, F. , Jacques, S. M. , & Thomas, R. (2018). Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants? The Journal of Maternal‐Fetal & Neonatal Medicine, 31(14), 1906–1912.
    1. Roth, D. E. , Jones, A. B. , Prosser, C. , Robinson, J. L. , & Vohra, S. (2009). Vitamin D status is not associated with the risk of hospitalization for acute bronchiolitis in early childhood. European Journal of Clinical Nutrition, 63(2), 297–299. 10.1038/sj.ejcn.1602946
    1. Rudd, K. E. , Johnson, S. C. , Agesa, K. M. , Shackelford, K. A. , Tsoi, D. , Kievlan, D. R. , & Naghavi, M. (2020). Global, regional, and national sepsis incidence and mortality, 1990–2017: Analysis for the Global Burden of Disease Study. The Lancet, 395(10219), 200–211. 10.1016/S0140-6736(19)32989-7
    1. Saboute, M. , Yavar, R. , Kashaki, M. , Khaledi, F. K. , Khalesi, N. , & Rohani, F. (2019). Investigation of association between maternal 25‐OH vitamin D serum levels and neonatal early onset sepsis in newborns by evaluating key factors. Lipids in Health and Disease, 18(1), 153 10.1186/s12944-019-1095-3
    1. Sarwade, B. A. (2019). Vitamin D levels in early onset neonatal sepsis without maternal risk factors: A case‐control study. Vitam Miner, 8(2), 1000183.
    1. Say, B. , Uras, N. , Sahin, S. , Degirmencioglu, H. , Oguz, S. S. , & Canpolat, F. E. (2017). Effects of cord blood vitamin D levels on the risk of neonatal sepsis in premature infants. Korean Journal of Pediatrics, 60(8), 248.
    1. Seale, A. C. , Blencowe, H. , Zaidi, A. , Ganatra, H. , Syed, S. , Engmann, C. , & Cousens, S. N. (2013). Neonatal severe bacterial infection impairment estimates in South Asia, sub‐Saharan Africa, and Latin America for 2010. Pediatric Research, 74(S1), 73–85.
    1. Seliem, M. S. , Abdel Haie, O. M. , Mansour, A. I. , & Salama, S. S. M. E. (2016). The relation between vitamin D level and increased risk for early‐onset neonatal sepsis in full‐term infants. Medical Research Journal, 15(1), 16–21.
    1. Sterne, J. A. , & Egger, M. (2001). Funnel plots for detecting bias in meta‐analysis: Guidelines on choice of axis. Journal of Clinical Epidemiology, 54(10), 1046–1055.
    1. Swai, R. O. , Matee, M. I. , Killewo, J. , Lyamuya, E. F. , Kwesigabo, G. , Tulli, T. , & Ndayongeje, J. (2006). Surveillance of HIV and syphilis infections among antenatal clinic attendees in Tanzania‐2003/2004. BMC Public Health, 6(1), 91.
    1. Tayel, S. I. , Soliman, S. E. , & Elsayed, H. M. (2018). Vitamin D deficiency and vitamin D receptor variants in mothers and their neonates are risk factors for neonatal sepsis. Steroids, 134, 37–42. 10.1016/j.steroids.2018.03.003
    1. Tekgunduz, K. S. , Alp, H. , & Akkar, M. K. (2015). Is vitamin D deficiency alone sufficient to increase the incidence of neonatal sepsis? European Journal of Pediatrics, 174(6), 817–818. 10.1007/s00431-014-2486-0
    1. Thorne‐Lyman, A. , & Fawzi, W. W. (2012). Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: A systematic review and meta‐analysis. Paediatric and Perinatal Epidemiology, 26(Suppl 1), 75–90. 10.1111/j.1365-3016.2012.01283.x
    1. Uday, K. , Ashwin, K. , & Srinivas, G. (2016). Association between vitamin D levels and early onset sepsis in infants: A prospective observational study. International Journal of Contemporary Pediatrics, 3(4), 1189–1192.
    1. Wayse, V. , Yousafzai, A. , Mogale, K. , & Filteau, S. (2004). Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. European Journal of Clinical Nutrition, 58(4), 563–567. 10.1038/sj.ejcn.1601845
    1. Xiao, D. , Zhang, X. , Ying, J. , Zhou, Y. , Li, X. , Mu, D. , & Qu, Y. (2020). Association between vitamin D status and sepsis in children: A meta‐analysis of observational studies. Clinical Nutrition, 39(6), 1735–1741. 10.1016/j.clnu.2019.08.010
    1. Yang, L. R. , Li, H. , Yang, T. Y. , Zhang, T. , & Zhao, R. C. (2016). Relationship between vitamin D deficiency and early‐onset neonatal sepsis. Zhongguo Dang Dai Er Ke Za Zhi, 18(9), 791–795.
    1. You, D. , Hug, L. , Ejdemyr, S. , & Beise, J. (2015). Levels and trends in child mortality. Estimates developed by the UN Inter‐agency Group for Child Mortality Estimation (IGME). Report 2015.
    1. Youssef, M. A. M. , Zahran, A. M. , Hussien, A. M. , Elsayh, K. I. , Askar, E. A. , & Farghaly, H. S. (2019). In neonates with vitamin D deficiency, low lymphocyte activation markers are risk factors for infection. Paediatrics and international child health, 39(2), 111–118. 10.1080/20469047.2018.1528755
    1. Zhang, Q. , Chen, H. , Wang, Y. , Zhang, C. , Tang, Z. , Li, H. , Liu, Z. (2019). Severe vitamin D deficiency in the first trimester is associated with placental inflammation in high‐risk singleton pregnancy. Clinical Nutrition, 38(4), 1921–1926.
    1. Zheng, G. , Pan, M. , Li, Z. , Xiang, W. , & Jin, W. (2018). Effects of vitamin D on apoptosis of T‐lymphocyte subsets in neonatal sepsis. Experimental and Therapeutic Medicine, 16(2), 629–634. 10.3892/etm.2018.6215

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