Nihal AYDIN, Mustafa ÖZÇETİN, Ali AYDIN, Nedim SAMANCI, Yakup ÇAĞ

Alt Solunum Yolu Enfeksiyonu Geçiren 1-24 Ay Arası Çocuklarda Serum 25(OH)D Vitamini Düzeyleri

Amaç: Bu çalışmada; 1-24 ay arası çocuklarda serum D vitamini düzeylerinin alt solunum yolu enfeksiyonu (ASYE) ile ilişkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Eylül 2010 ile Eylül 2013 tarihleri arasında, hastanemizin çocuk polikliniklerine başvuran 1-24 ay arası ASYE tanısı alan 31 hasta çocuk ile aynı yaş grubunda kronik hastalığı olmayan ve ASYE geçirmeyen 33 çocuk olmak üzere toplam 64 çocuk alındı. Hastaların ve kontrol grubundaki olguların serum 25(OH)D vitamini düzeyleri ELISA yöntemiyle ölçüldü. Bulgular: Çalışmamızda; alt solunum yolu enfeksiyonu geçiren çocukların serum 25(OH)D vitamini düzeyleri kontrol grubuna göre daha düşük bulundu (p<0,001). Gebelik boyunca annenin ve sonrasında bebeklerin düzenli D vitamini kullanımı ile ASYE arasında anlamlı bir ilişki saptandı. Annenin giyim şekli, çocuğun anne sütü alımı, dışarıda zaman geçirme süresi, cinsiyeti ve ASYE geçirme sayısı ile serum 25(OH)D vitamini arasında anlamlı bir ilişki saptanmadı. Tartışma: ASYE geçiren 1-24 ay arası çocukların serum 25(OH)D vitamini düzeyleri sağlıklı çocuklara göre anlamlı olarak düşük bulunmuştur. Sonuç: Enfeksiyonlara karşı savunmada önemli rolü olan D vitamininin hangi düzeyin altında savunma sistemini zayıflattığını belirleyebilmek için vaka sayısının daha fazla olduğu klinik-etkinlik araştırmalarına ihtiyaç vardır

Anahtar Kelimeler:

Alt solunum yolu enfeksiyonu, D vitamini, süt çocuğu

Serum 25(OH) Vitamin D Levels in Children Between 1 to 24 Months of Age with Previous Lower Respiratory Tract Infection

Objective: The aim of this study was to investigate the relationship between lower respiratory tract infection (LRTI) and the level of serum vitamin D in infants aged 1-24 months. Material and Method: The sample in this study included a total of 64 infants consisting of 31 infants aged 1 to 24 months and diagnosed with LRTI at the pediatric policlinics of our hospital and 33 infants of the same age range and diagnosed with neither a chronic disease nor LRTI. The levels of serum 25(OH) vitamin D in patients and cases in control group were measured with ELISA. Results: In the study, it was found that levels of serum 25(OH) vitamin D in patients with LRTI were lower than control group (p<0.001). A significant relationship was found between LRTI and regular use of vitamin D by the mother during pregnancy and by the baby postnatally. A significant relationship was not found between serum 25(OH) vitamin D and the clothing style of mother, breastfeeding, time spent outdoors, sex, or number of instances of LRTI. Discussion: The levels of serum 25(OH) vitamin D in infants aged 1-24 months with LRTI was found to be significantly low compared to healthy infants. Conclusion: There is a need for clinical effectiveness studies with a higher number of cases in order to determine under which level of the vitamin D, which plays a critical role in defense against infections, weakens the defense system.

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1. Pletz MW, Rohde GG, Welte T, Kolditz M, Ott S. Advances in the prevention, management, and treatment of communityacquired pneumonia. F1000Res 2016;8(5):300.
2. Forster J, Ihorst G, Rieger CH, Stephan V, Frank HD, Gurth H, et al. Prospective population-based study of viral lower respiratory tract infections in children under 3 years of age (the PRI.DE study). Eur J Pediatr 2004;163:709-16.
3. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) 2008. Rockville, MD: Agency for Healthcare Research and Quality; 2008.
4. Barger-Lux MJ, Heaney RP. Effects of above average summer sun exposure on serum 25OH vitamin D and calcium absorption. J Clin Endocrinol Metab 2002;87(11):4952-6.
5. Özkan B. Nutritional rickets. J Clin Res Pediatr Endocrinol 2010;2(4):137-43.
6. Oren Y, Shapira Y, Agmon-Levin N, Kivity S, Zafrir Y, Altman A, et al. Vitamin D insufficiency in a sunny environment: A demographic and seasonal analysis. Isr Med Assoc J 2010;12(12):751-6.
7. Holick MF. Vitamin D: Extraskeletal health. Endocrinol Metab Clin North Am 2010;39(2):381-400.
8. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequnces. Am J Clin Nutr 2008;87(4):1080-6.
9. S. Currie, Findlay EG, Mchugh BJ, Mackellar A, Man T, Macmillan D, et al. The human cathelicidin LL-37 has antiviral activity against respiratory syncytial virus. PLoS One 2013;8:e73659.
10. Dabrowska-Leonik N, Bernatowska E, Pac M, Filipiuk W, Mulawka J, Pietrucha B, et al. Vitamin D deficiency in children with recurrent respiratory infections, with or without immunoglobulin deficiency. Adv Med Sci 2018;63(1):173-8.
11. Adams JS, Hollis BW. VitaminD: Synthesis, metabolism and clinical measurement. In: Coe FL, Favus MJ, editors; Disorders of bone and mineral metabolism, 2th edition, Philadelphia, Lippincott Williams & Wilkins, 2002;157-74.
12. Brance ML, Miljevic JN, Tizziani R, Taberna ME, Grossi P, Toni P, et al. Serum 25-hydroxyvitamin D levels in hospitalized adults with communityacquired pneumonia. Clin Respir J 2018;12(7):2220-7.
13. Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 2009;19:73-8.
14. Li W, Cheng X, Guo L, Li H, Sun C, Cui X, et al. Association between serum 25-hydroxyvitamin D concentration and pulmonary infection in children. Medicine Baltimore 2018;97(1):e9060.
15. Wang TT, Nestel FP, Bourdeau V, Nagai Y, Wang Q, Liao J, et al. Cutting Edge: 1,25-Dihydroxyvitamin D3 is a directinducer of antimicrobial peptide gene expression. J Immunol 2004;173:2909-12.
16. Karatekin G, Kaya A, Salihoğlu O, Balci H, Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 2009;63:473-7.
17. Yildiz I, Unuvar E, Zeybek U, Toptas B, Cacina C, Toprak S, et al. The role of vitamin D in children with recurrent tonsillopharyngitis. Ital J Pediatr 2012;38(1):25.
18. Ginde AA, Mansbach JM, Camargo CA. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med 2010;169(4):384-90.
19. Camargo CA, Ingham T, Wickens K, Thadhani RI, Silvers KM, Epton MJ, et al. The New Zealand Asthma and Allergy Cohort Study Group. Br J Nutr 2010;104:1051-7.
20. Güven A, Ecevit A, Tarcan A, Tarcan A, Özbek N. Yenidogan bebeklerde kordon kanı vitamin D düzeyleri. Çocuk Saglıgı ve Hastalıkları Dergisi 2011;54:55-61.
21. Lai SH, Liao SL, Tsai MH, Hua MC, Chiu CY, Yeh KW, et al. Low cord-serum 25-hydroxyvitamin D levels are associated with poor lung function performance and increased respiratory infection in infancy. PLoS One 2017;12(3):e0173268.
22. Wagner CL, Greer FR. American Academy of Pediatrics Section on Breast feeding; American Academy of Pediatrics Committee on Nutrition Pediatrics. Prevention of rickets and vitamin D deficiencyin infants, children, and adolescents. Pediatrics 2008;122:1142-52.