LETTERS TO EDITOR Year : 2022  |  Volume : 66  |  Issue : 4  |  Page : 531-532  

Correlation of vitamin D levels with low gestational age and low birth weight in babies developing retinopathy of prematurity

Debolina Deb1, Radha Annamalai2, M Muthayya3
1 Clinical Research Scholar, Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
2 Professor and Head of Department, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
3 Senior Consultant, Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Date of Submission04-Aug-2022Date of Decision18-Oct-2022Date of Acceptance28-Oct-2022Date of Web Publication31-Dec-2022

Correspondence Address:
Debolina Deb
Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai - 600 116, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijph.ijph_1044_22

How to cite this article:
Deb D, Annamalai R, Muthayya M. Correlation of vitamin D levels with low gestational age and low birth weight in babies developing retinopathy of prematurity. Indian J Public Health 2022;66:531-2
How to cite this URL:
Deb D, Annamalai R, Muthayya M. Correlation of vitamin D levels with low gestational age and low birth weight in babies developing retinopathy of prematurity. Indian J Public Health [serial online] 2022 [cited 2023 Jan 1];66:531-2. Available from: https://www.ijph.in/text.asp?2022/66/4/531/366561

Dear Editor,

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder seen predominantly in preterm and low birth weight (BW) babies, with an incidence ranging from 24% to 47% in India.[1] India is in the third epidemic of this disease, contributing around 10% of worldwide childhood blindness due to ROP.[2] This is a condition which if not detected and managed early, would lead to permanent blindness. The severe stages of the condition are due to abnormal angiogenesis in the retina of premature babies. This a multifactorial disorder, with low gestational age (GA), low Birth weight (BW), and prolonged oxygen supplementation being the common contributors. Studies have attributed low levels of growth factors including Vitamin D, clinching toward this pathology.[3],[4] Vitamin D deficiency has been estimated in around 96% of infants worldwide.[5] Vitamin D is a fat-soluble vitamin which has an array of functions which includes inhibition of angiogenesis. Babies generally get their source of Vitamin D from placental transfer in the third trimester, thereby contributing to further deficiency in babies born prematurely.

In this pretext, we conducted a nested case–control study on preterm babies with GA <34 weeks and BW <2000 g in a tertiary care center in South India. The aim was to correlate low Vitamin D levels in preterm babies developing ROP, particularly in babies requiring active intervention. The study included 27 preterm babies with ROP and 27 preterm babies without ROP and their serum Vitamin D levels were analyzed at the 4th week of life. All the babies were given multivitamin supplements from 2nd week of life. Babies were screened for ROP followingICROP (International Classification for Retinopathy of Prematurity, Third Edition) guidelines and managed following ETROP (The Early Treatment for Retinopathy of Prematurity Study) guidelines.

In our study, we observed 15 babies (55.6%) developed Severe ROP requiring intervention in the form of laser photocoagulation. We noted babies developing ROP had a significantly lower GA (27 ± 1.7 weeks, P = 0.001), lower BW (819.4 ± 227.1 g, P = 0.363), prolonged oxygen support for more than 28 days (70.4%, P = 0.393) as well as low Vitamin D through 4th week of life (29.2 ± 11.1 ng/ml, P = 0.012), compared to babies not developing any ROP (GA = 28.9 ± 2.2 weeks, BW = 910.4 ± 356.8 g, prolonged oxygen support = 59.3%, and Vitamin D = 42 ± 19.8 ng/ml).

We could conclude from the study that low Vitamin D levels are a contributory factor in the pathogenesis of ROP. Early detection and correct supplementation to address the deficiency could prevent abnormal angiogenesis in the retina in premature babies that arise due to prolonged oxygen support.

Previous studies had suggested significant Vitamin D deficiency in preterm babies developing ROP in the 1st week of life. Our study concludes babies developing ROP have persistent Vitamin D deficiency in the 4th week of life, even after initiating them on multivitamin supplements (including 100 U of Vitamin D). The study stresses on the importance of using serum Vitamin D as a predictive biomarker in babies with low GA and Birth weight BW in semiurban and rural areas, where there is no access to screening for ROP. Furthermore, adopting this policy could also reduce other conditions associated with Vitamin D deficiency such as osteopenia of prematurity and assist in the early correction of any deformity.

Acknowledgment

We would like to thank the Department of Neonatology, SRIHER, for helping with the literature pertaining to our study. We would also like to thank ICMR for supporting this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
1.Murthy KR, Murthy PR, Shah DA, Nandan MR, Niranjan HS, Benakappa N. Comparison of profile of retinopathy of prematurity in semiurban/rural and urban NICUs in Karnataka, India. Br J Ophthalmol 2013;97:687-9.  
    2.Blencowe H, Moxon S, Gilbert C. Update on blindness due to retinopathy of prematurity globally and in India. Indian Pediatr 2016;53 Suppl 2:S89-92.  
    3.Kabataş EU, Dinlen NF, Zenciroğlu A, Dilli D, Beken S, Okumuş N. Relationship between serum 25 – Hydroxy vitamin D levels and retinopathy of prematurity. Scott Med J 2017;62:129-35.  
    4.Boskabadi H, Abrishami M, Shoeibi N, Sanei Z, Moradi A, Zakerihamidi M. Comparison of vitamin D levels in premature infants with and without retinopathy of prematurity. Arch Iran Med 2022;25:209-13.  
    5.Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009;20:1807-20.