Questioning the adequacy of standardized vitamin D supplementation protocol in very low birth weight infants: a prospective cohort study.

OBJECTIVES: Preterm infants are at increased risk for vitamin D deficiency (VDD). We aimed to assess the adequacy of standardized vitamin D supplementation protocol in very low birth weight (VLBW) infants. Additionally, vitamin D status of mother/infant couples and the associations between vitamin D status at birth and morbidities of the infants were investigated. METHODS: In this single-center, prospective cohort study blood samples were collected from 55 mothers just before delivery and from their infants at birth and on the 30th day of life (DOL) for 25 hydroxy vitamin D (25OHD) measurements. Vitamin D was initiated in dose of 160 IU/kg by parenteral nutrition on the first DOL and oral vitamin D supplementation (400 IU/day) was administered when enteral feedings reached 50% of total intake or on the 15th DOL. RESULTS: The median 25OHD levels of the infants were 16.12 (9.14-20.50) in cord blood and 36.32 (31.10-44.44) in venous blood on the 30th DOL (p<0.01). In 98% of the VLBW infants 25OHD reached sufficient levels on the 30th DOL. None of the mothers had sufficient vitamin D levels (25OHD >30 ng/mL). Maternal 25OHD levels were correlated with the 25OHD levels of the infants in cord blood (r=0.665, p<0.001). There was a significant difference in mean cord 25OHD levels between winter (13.65 ± 5.69 ng/mL) and summer seasons (19.58 ± 11.67 ng/mL) (p=0.021). No association was found between neonatal morbidity and vitamin D status. CONCLUSIONS: The results clearly show that by utilizing the current supplementation protocol, the majority of VLBW infants with deficient/insufficient serum 25OHD levels reached sufficient levels on the 30th DOL. Furthermore, vitamin D levels in mother/infant couples were found to be highly correlated.

Body temperature changes of newborns under fluorescent versus LED phototherapy.

OBJECTIVE: To determine changes in body temperature (BT) of hyperbilirubinemic newborns under conventional phototherapy with fluorescent lamps and light emitting diodes (LED) at different irradiances. METHODS: Otherwise healthy newborn infants >34 wk gestational age (GA) hospitalized for indirect hyperbilirubinemia, requiring phototherapy in the first 10 d of life were enrolled. Infants who received conventional phototherapy with fluorescent lamps (10-15 µW/cm(2)/nm irradiance) were defined as group 1, LED phototherapy of 26-60 µW/cm(2)/nm irradiance as group 2, and LED phototherapy of 60-120 µW/cm(2)/nm irradiance as group 3. Primary outcome measure was mean BT which was defined as arithmetical mean of axillary BT measured at 2 h intervals during the first day of phototherapy. RESULTS: Thirty patients were enroled in each group. Mean birth weight and GA of the total cohort was 2800 ± 530 g and 36.6 ± 2 wk, respectively. Baseline demographic variables and serum total bilirubin levels were similar among groups. Mean BT was 36.7 ± 0.1 °C in group 1, 36.6 ± 0.2 °C in group 2, 37.7 ± 0.2 °C in group 3. Mean BT was higher in group 3 compared to group 1 (p < 0.001) and group 2 (p < 0.001). Group 1 and group 2 had similar mean BT measurements (p = 0.09). During phototherapy all the patients in group 3 had at least one BT measurement ≥ 37.5 °C and 77 % had BT ≥ 38 °C. Only one patient in group 2 had BT ≥ 37.5 °C which was also ≥ 38 °C. During phototherapy all BT measurements were <37.5 °C in group 1. CONCLUSIONS: LED phototherapy of ≥ 60 µW/cm(2)/nm intensity significantly increases BT in hyperbilirubinemic newborns.

Effects of phototherapy using different light sources on oxidant and antioxidant status of neonates with jaundice.

BACKGROUND/AIM: Neonates have limited antioxidant protective capacity. It has recently been demonstrated that phototherapy used for treatment of neonatal jaundice produces oxidative stress. Various phototherapy devices using different light sources are available for phototherapy. We aimed to investigate the effects of phototherapy applied with different light sources on the global oxidant/antioxidant status in neonates. METHODS: Term and late-preterm (≥35 weeks) newborn infants hospitalized to receive phototherapy for non-hemolytic jaundice in the 2-9 days of life were enrolled. Infants who received conventional phototherapy with fluorescent lamps were defined as group 1, intensive light emitting diode (LED) phototherapy as group 2, and fiberoptic phototherapy as group 3. The serum total antioxidant capacity (TAC) and total oxidant status (TOS) were measured before and 24 h after phototherapy. Oxidative stress index (OSI) was calculated. RESULTS: Twenty nine patients were included in each group. At the beginning of phototherapy serum TAC, TOS and OSI levels were similar in all groups. After phototherapy serum TAC decreased significantly in all three groups (p < 0.001). Total oxidant status increased significantly in group 1 (p < 0.001) and group 2 (p = 0.001) whereas a statistically insignificant increase was observed in group 3 (p = 0.057). After phototherapy OSI increased significantly in group 1 (p < 0.001), group 2 (p = 0.001), and group 3 (p = 0.038). CONCLUSION: As indicated by increased OSI, oxidant/antioxidant balance is disturbed in favor of oxidants after blue fluorescent light, LED and fiberoptic phototherapy.

The effect of galactagogue herbal tea on oxidant and anti-oxidant status of human milk.

OBJECTIVE: Human milk (HM) has antioxidant constituents which protect newborns against oxidative damage. We aimed to evaluate whether maternal consumption of herbal tea containing fenugreek had any effects on global oxidant and antioxidant capacity of HM. METHODS: Volunteer mothers 18-35 years of age without any antenatal or perinatal risk factors were randomly assigned to receive galactagogue herbal tea (Humana still-tee®, Herford, Deutschland) 3 cups/d or same amount of water as placebo. The total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) of breast milk samples taken in the 1st day and 7-10 d were compared between groups. RESULTS: Herbal tea (n = 40) and placebo (n = 40) groups had similar TAC, TOS and OSI values in the 1st day samples. TAC, TOS and OSI values in the breast milk samples taken on 7-10th day were also similar. OSI increased significantly in 7-10 day samples compared to 1st day in each group, while TAC and TOS levels did not differ. CONCLUSION: Galactagogue herbal tea containing fenugreek has no detectable effect on global oxidant and antioxidant status of HM. OSI increases in course of lactation compared to colostrums irrespective of galactagogue use.