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Vitamin D insufficiency in neonatal hypoxic-ischemic encephalopathy
Danielle W Lowe1, Bruce W Hollis1, Carol L Wagner1
1Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Pediatric Research
|January 19, 2017
Summary
Most newborns with hypoxic-ischemic encephalopathy (HIE) have low vitamin D levels, which correlate with lower anti-inflammatory IL-17E. Hypothermia treatment did not improve vitamin D status in these infants.
Area of Science:
- Neonatal Medicine
- Immunology
- Endocrinology
Background:
- Vitamin D possesses neuroprotective and immunomodulatory functions, with deficiency linked to poorer stroke outcomes.
- The impact of hypoxia-ischemia and hypothermia on vitamin D status in neonates with hypoxic-ischemic encephalopathy (HIE) remains unclear.
- This study investigated potential dysregulation of vitamin D metabolism and its influence on Th17-related cytokines in neonatal HIE, exploring hypothermia's mitigating effects.
Purpose of the Study:
- To examine the relationship between vitamin D levels (25(OH) and 1,25(OH)₂), vitamin D binding protein, and Th17-related cytokines in neonates with HIE.
- To assess the short-term effects of therapeutic hypothermia on vitamin D status and cytokine profiles in HIE infants.
- To determine if hypothermia influences the association between vitamin D and specific cytokines in neonatal HIE.
Main Methods:
- Serum samples from 50 infants with moderate to severe HIE were analyzed.
- Participants were part of a multicenter randomized controlled trial comparing hypothermia (33°C for 48h) to normothermia.
- Measurements included 25(OH) vitamin D, 1,25(OH)₂ vitamin D, vitamin D binding protein, and Th17-related cytokines (IL-17E, IL-27).
Main Results:
- Vitamin D (25(OH)) insufficiency was prevalent in 70% of HIE infants at birth, with levels declining further within 72 hours, irrespective of treatment.
- Lower 25(OH) vitamin D levels positively correlated with the anti-inflammatory cytokine IL-17E in all HIE infants.
- Therapeutic hypothermia significantly increased the Th17 cytokine suppressor IL-27, disrupting its correlation with vitamin D observed in normothermic infants.
Conclusions:
- The majority of term neonates with HIE exhibit 25(OH) vitamin D insufficiency, associated with reduced circulating IL-17E.
- Therapeutic hypothermia does not ameliorate vitamin D deficiency in infants with HIE.
- The findings suggest a complex interplay between vitamin D, cytokines, and hypothermia in neonatal HIE, warranting further investigation.
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