Effects of Vitamin D deficiency and supplementation on 25(OH)D3 levels and neuropsychobehavioral development in premature infants.
Efectos de la deficiencia de vitamina D y la suplementación sobre los niveles de 25(OH)D3 y el desarrollo neuropsicológicoconductual en bebés prematuros.
Resumen
Este estudio exploró sistemáticamente el impacto del desequili- brio metabólico de la vitamina D en los niveles de 25(OH)D3 y en el desarrollo neuropsicológico de bebés prematuros, y propuso una estrategia de suplemen- tación individualizada. Los bebés prematuros se categorizaron en grupos ade- cuados, insuficientes y deficientes según los niveles de 25(OH)D3 en la sangre del cordón umbilical, y luego se asignaron aleatoriamente a un grupo con dosis estándar (800 UI/día) o a otro grupo con suplementación individualizada (400- 1000 UI/día) con vitamina D. Entre los bebés prematuros con deficiencia de vitamina D, el grupo de suplementación individualizada presentó niveles signi- ficativamente más altos de 25(OH)D3 a los 3 y 9 meses de edad gestacional co- rregida, en comparación con el grupo de dosis estándar, lo que indica que una dosis de 1000 UI/día fue más efectiva que 800 UI/día para corregir la deficien- cia de vitamina D (p<0,05). A los 9 y 18 meses de edad gestacional corregida, los bebés prematuros de los grupos con insuficiencia y deficiencia de vitamina D obtuvieron puntuaciones significativamente más bajas en las Escalas de De- sarrollo de Gesell para la habilidad motora gruesa, la habilidad motora fina, la competencia lingüística, la capacidad adaptativa y la habilidad personal-social en comparación con el grupo adecuado (p<0,05). Dentro del grupo deficiente, el grupo de suplementación individualizada obtuvo puntuaciones más altas en las cinco habilidades a los 9 y 18 meses de edad gestacional corregida en com- paración con el grupo de dosis estándar (p<0,05). Existen diferencias signifi- cativas en los niveles de 25(OH)D3 en la sangre del cordón umbilical entre los bebés prematuros, y un protocolo de suplementación de vitamina D específico para cada individuo es más eficaz para corregir la deficiencia de vitamina D.
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De Beritto TV, Chu A. The Evolving Need for Neonatal Care: From the Pre- mature Infant to the Rare Disease. Pediatr Ann. 2023;52(8):e282. https://doi.org/10.3928/19382359-20230613-03.
Flake AW. A supportive physiologic environment for the extreme premature infant: Improving life outside the womb. J Pediatr Surg. 2022;57(2):167-171. https://doi.rg/10.1016/j.jpedsurg.2021.10.025.
Mansur JL, Oliveri B, Giacoia E, Fusaro D, Costanzo PR. Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children. Nutrients. 2022;14(9):1900. https://doi.org/10.3390/nu14091900.
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Abrams SA. Vitamin D and bone minerals in neonates. Early Hum Dev. 2021;162:105461. https://doi.org/10.1016/j.earlhumdev.2021.105461.
Chinnappan A, Sharma A, Agarwal R, Thukral A, Deorari A, Sankar MJ. Fortification of Breast Milk with Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates: A Randomized Noninferiority Trial. JAMA Pediatr. 2021;175(8):790-796. https://doi.org/10.1001/jamapediatrics.2021.0678.
Chacham S, Pasi R, Chegondi M, Ahmad N, Mohanty SB. Metabolic Bone Disease in Premature Neonates: An Unmet Challenge. J Clin Res Pediatr Endocrinol. 2020;12(4):332-339. https://doi.org/10.4274/jcrpe.galenos.2019.2019.0091.
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van den Heuvel EG, Lips P, Schoonmade LJ, Lanham-New SA, van Schoor NM. Comparison of the Effect of Daily Vitamin D2 and Vitamin D3 Supplementation on Serum 25-Hydroxyvitamin D Concentration (Total 25(OH)D, 25(OH)D2, and 25(OH) D3) and Importance of Body Mass Index: A Systematic Review and Meta-Analysis. Adv Nutr. 2024;15(1):100133. https://doi.org/10.1016/j.advnut.2023.09.016.
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Liu CC, Huang JP. Potential benefits of vitamin D supplementation on pregnancy. J Formos Med Assoc. 2023;122(7):557-563. https://doi.org/10.1016/j.jfma.2023.02.004.
Kumar M, Shaikh S, Sinha B, Upadhyay RP, Choudhary TS, Chandola TR, et al. Enteral Vitamin D Supplementation in Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics. 2022;150(Suppl 1):e2022057092K. https://doi.org/10.1542/peds.2022-057092K.
Fisher M, Marro L, Arbuckle TE, Potter BK, Little J, Weiler H, et al. Association between toxic metals, vitamin D and preterm birth in the Maternal-Infant research on environmental chemicals study. Paediatr Perinat Epidemiol. 2023;37(5):447- 457. https://doi.org/10.1111/ppe.12962.
Guo H, Xie J, Yu X, Tian Y, Guan M, Wei J. Effects of vitamin D supplementation on serum 25(OH)D(3) levels and neurobehavioral development in premature infants after birth. Sci Rep. 2024;14(1):23972. https://doi.org/10.1038/s41598-024-75191-w.
Chen GD, Pang TT, Li PS, Zhou ZX, Lin DX, Fan DZ, et al. Early pregnancy vitamin D and the risk of adverse maternal and infant outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):465. https://doi.org/10.1186/s12884-020-03158-6.
Motlagh AJ, Davoodvandi A, Saeieh SE. Association between vitamin D level in mother’s serum and the level of vitamin D in the serum of pre-term infants. BMC Pediatr. 2023;23(1):97. https://doi.org/10.1186/s12887-023-03854-0.
Bollen SE, Bass JJ, Fujita S, Wilkinson D, Hewison M, Atherton PJ. The Vitamin D/Vitamin D receptor (VDR) axis in muscle atrophy and sarcopenia. Cell Signal. 2022;96:110355. https://doi.org/10.1016/j.cellsig.2022.110355.
Aggeletopoulou I, Thomopoulos K, Mouzaki A, Triantos C. Vitamin D-VDR Novel Anti-Inflammatory Molecules-New Insights into Their Effects on Liver Diseases. Int J Mol Sci. 2022;23(15):8465. https://doi.org/10.3390/ijms23158465.
Voutsadakis IA. Vitamin D receptor (VDR) and metabolizing enzymes CYP27B1 and CYP24A1 in breast cancer. Mol Biol Rep. 2020;47(12):9821-9830. https://doi.org/10.1007/s11033-020-05780-1.
Usategui-Martín R, De Luis-Román DA, Fernández-Gómez JM, Ruiz-Mambrilla M, Pérez-Castrillón JL. Vitamin D Receptor (VDR) Gene Polymorphisms Modify the Response to Vitamin D Supplementation: A Systematic Review and Meta-Analysis. Nutrients. 2022;14(2):360. https://doi.org/10.3390/nu14020360.
Bacchetta J, Edouard T, Laverny G, Bernardor J, Bertholet-Thomas A, Castanet M, et al. Vitamin D and calcium in-takes in general pediatric populations: A French expert consensus paper. Arch Pediatr. 2022;29(4):312-325. https://doi.org/10.1016/j.arcped.2022.02.008.
Artman A, Huang A, Bowker R, Cerwinske L, Cooper S, Johnson T, et al. Evaluation of vitamin D protocol in the neonatal intensive care unit at Rush University Medical Center. JPEN J Parenter Enteral Nutr. 2022;46(3):618-625. https://doi.org/10.1002/jpen.2138.
Golan-Tripto I, Bistritzer J, Loewenthal N, Staretz-Chacham O, Dizitzer Y, Goldbart A. The effect of vitamin D administration on vitamin D status and respiratory morbidity in late premature infants. Pediatr Pulmonol. 2020;55(11):3080-3087. https://doi.org/10.1002/ppul.25006.
Irwinda R, Hiksas R, Lokeswara AW, Wibowo N. Vitamin D supplementation higher than 2000 IU/day compared to lower dose on maternal-fetal outcome: Systematic review and meta-analysis. Womens Health (Lond). 2022;18:17455057221111066. https://doi.org/10.1177/17455057221111066.
Rizzoli R. Vitamin D supplementation: upper limit for safety revisited? Aging Clin Exp Res 2021;33(1):19-24. https://doi.org/10.1007/s40520-020-01678-x.
Kołodziejczyk-Nowotarska A, Bokiniec R, Seliga-Siwecka J. Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial. Nutrients. 2021;13(10):3442. https://doi.org/10.3390/nu13103442.
Matejek T, Zapletalova B, Stepan M, Malakova J, Palicka V. Dynamics of the vitamin D C3-epimer levels in preterm infants. Clin Chem Lab Med. 2023;61(6):1084-94. https://doi.org/10.1515/cclm-2022-1128.
Romero-Lopez M, Tyson JE, Naik M, Pedroza C, Holzapfel LF, Avritscher E, et al. Randomized controlled trial of enteral vitamin D supplementation (ViDES) in infants <28 weeks gestational age or <1000 g birth weight: study protocol. Trials. 024;25(1):423. https://doi.org/10.1186/s13063-024-08274-8.
Jung JH, Kim EA, Lee SY, Moon JE, Lee EJ, Park SH. Vitamin D Status and Factors Associated with Vitamin D Deficiency during the First Year of Life in Preterm Infants. Nutrients. 021;13(6):2019. https://doi.org/10.3390/nu13062019.
Aristizabal N, Holder MP, Durham L, Ashraf AP, Taylor S, Salas AA. Safety and Efficacy of Early Vitamin D Supplementation in Critically Ill Extremely Preterm Infants: An Ancillary Study of a Randomized Trial. J Acad Nutr Diet. 2023;123(1):87- 94. https://doi.org/10.1016/j.jand.2022. 06.012.
Lo ACQ, Lo CCW. The effect of vitamin D supplementation on glycemic control/glucose metabolism and maternal-neonatal outcomes in women with established gestational diabetes mellitus: An updated meta-analysis. Clin Nutr. 2022;41(10):2420-2423. https://doi.org/10.1016/j.clnu.2022.08.014.
Cho MC, Cho IA, Seo HK, Kang MJ, Jo JY, Shin JK, et al. Serum vitamin D-binding protein (VDBP) concentration and rs7041 genotype may be associated with pre-term labor. J Matern Fetal Neonatal Med 2022;35(25):9422-9429. https://doi.org/10.1080/14767058.2022.2040475.
Tang WQ, Ma N, Meng LY, Luo YW, Wang YJ, Zhang D. Vitamin D supplementation improved physical growth and neurologic development of Preterm Infants receiving Nesting Care in the neonatal Intensive Care Unit. BMC Pediatr 2023;23(1):248. https://doi.org/10.1186/s12887-023-04075-1.
Jamali Z, Ghorbani F, Shafie’ei M, Tolooefar F, Maleki E. Risk factors associated with vitamin D deficiency in preterm neonates: a single-center step-wise regression analysis. BMC Pediatr 2023;23(1):324. https://doi.org/10.1186/s12887-023-04088-w.
Lian RH, Qi PA, Yuan T, Yan PJ, Qiu WW, Wei Y, et al. Systematic review and meta-analysis of vitamin D deficiency in different pregnancy on preterm birth: Deficiency in middle pregnancy might be at risk. Medicine (Baltimore). 2021;100(24):e26303. https://doi.org/10.1097/MD.0000000000026303.
Sarıdemir H, Surmeli Onay O, Aydemir O, Tekin AN. Questioning the adequacy of standardized vitamin D supplementation protocol in very low birth weight infants: a prospective cohort study. J Pediatr Endocrinol Metab 2021;34(12):1515-1523. https://doi.org/10.1515/jpem-2021-0390.
Treiber M, Mujezinović F, Pečovnik Balon B, Gorenjak M, Maver U, Dovnik A. Association between umbilical cord vitamin D levels and adverse neonatal outcomes. J Int Med Res 2020;48(10):300060520955001. https://doi.org/10.1177/0300060520955001.
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Kaempf JW, Gautham K. Do small baby units improve extremely premature infant outcomes? J Perinatol. 2022;42(2):281- 285. https://doi.org/10.1038/s41372-021-01076-9.
De Beritto TV, Chu A. The Evolving Need for Neonatal Care: From the Pre- mature Infant to the Rare Disease. Pediatr Ann. 2023;52(8):e282. https://doi.org/10.3928/19382359-20230613-03.
Flake AW. A supportive physiologic environment for the extreme premature infant: Improving life outside the womb. J Pediatr Surg. 2022;57(2):167-171. https://doi.rg/10.1016/j.jpedsurg.2021.10.025.
Mansur JL, Oliveri B, Giacoia E, Fusaro D, Costanzo PR. Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children. Nutrients. 2022;14(9):1900. https://doi.org/10.3390/nu14091900.
Zhang H, Wang S, Tuo L, Zhai Q, Cui J, Chen D, Xu D. Relationship between Maternal Vitamin D Levels and Adverse Outcomes. Nutrients. 2022;14(20):4230. https://doi.org/10.3390/nu14204230.
Abrams SA. Vitamin D and bone minerals in neonates. Early Hum Dev. 2021;162:105461. https://doi.org/10.1016/j.earlhumdev.2021.105461.
Chinnappan A, Sharma A, Agarwal R, Thukral A, Deorari A, Sankar MJ. Fortification of Breast Milk with Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates: A Randomized Noninferiority Trial. JAMA Pediatr. 2021;175(8):790-796. https://doi.org/10.1001/jamapediatrics.2021.0678.
Chacham S, Pasi R, Chegondi M, Ahmad N, Mohanty SB. Metabolic Bone Disease in Premature Neonates: An Unmet Challenge. J Clin Res Pediatr Endocrinol. 2020;12(4):332-339. https://doi.org/10.4274/jcrpe.galenos.2019.2019.0091.
Stoica AB, Mărginean C. The Impact of Vitamin D Deficiency on Infants’ Health. Nutrients. 2023;15(20):4379. https://doi.org/10.3390/nu15204379.
Jafari N, Taslimi Taleghani N, Kazemi SA, Abouoasef S, Motamed N, Jalilvand A. Association between Vitamin D Insufficiency and Respiratory Problems in Premature Neonates. Arch Iran Med. 2022;25(1):32-36. https://doi.org/10.34172/aim.2022.06.
Taiorazova G, Alimbaeva A, Tanatarov S. The role of vitamin D and trace elements in premature newborns with congenital pneumonia. Bratisl Lek Listy. 2023;124(8):572-577. https://doi.org/10.4149/BLL_2023_089.
Vivanti AJ, Monier I, Salakos E, Elie C, Tsatsaris V, Senat MV, et al. Vitamin D and pregnancy outcomes: Overall results of the FEPED study. J Gynecol Obstet Hum Reprod. 2020;49(8):101883. https://doi.org/10.1016/j.jogoh.2020.101883.
Cheng H, Chi P, Zhuang Y, Alifu X, Zhou H, Qiu Y, et al. Association of 25-Hydroxyvitamin D with Preterm Birth and Premature Rupture of Membranes: A Mendelian Randomization Study. Nutrients. 2023;15(16):3593. https://doi.org/10.3390/nu15163593.
Barbosa O, Sim-Sim M, Silvestre MP, Pedro C, Cruz D. Effects of vitamin D levels during pregnancy on prematurity: a systematic review protocol. BMJ Open. 2024;14(2):e076702. https://doi.org/10.1136/bmjopen-2023-076702.
van den Heuvel EG, Lips P, Schoonmade LJ, Lanham-New SA, van Schoor NM. Comparison of the Effect of Daily Vitamin D2 and Vitamin D3 Supplementation on Serum 25-Hydroxyvitamin D Concentration (Total 25(OH)D, 25(OH)D2, and 25(OH) D3) and Importance of Body Mass Index: A Systematic Review and Meta-Analysis. Adv Nutr. 2024;15(1):100133. https://doi.org/10.1016/j.advnut.2023.09.016.
Płudowski P, Kos-Kudła B, Walczak M, Fal A, Zozulińska-Ziółkiewicz D, Sieroszewski P, et al. Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Up-date in Poland. Nutrients. 2023;15(3):695. https://doi.org/10.3390/nu15030695.
Liu CC, Huang JP. Potential benefits of vitamin D supplementation on pregnancy. J Formos Med Assoc. 2023;122(7):557-563. https://doi.org/10.1016/j.jfma.2023.02.004.
Kumar M, Shaikh S, Sinha B, Upadhyay RP, Choudhary TS, Chandola TR, et al. Enteral Vitamin D Supplementation in Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics. 2022;150(Suppl 1):e2022057092K. https://doi.org/10.1542/peds.2022-057092K.
Fisher M, Marro L, Arbuckle TE, Potter BK, Little J, Weiler H, et al. Association between toxic metals, vitamin D and preterm birth in the Maternal-Infant research on environmental chemicals study. Paediatr Perinat Epidemiol. 2023;37(5):447- 457. https://doi.org/10.1111/ppe.12962.
Guo H, Xie J, Yu X, Tian Y, Guan M, Wei J. Effects of vitamin D supplementation on serum 25(OH)D(3) levels and neurobehavioral development in premature infants after birth. Sci Rep. 2024;14(1):23972. https://doi.org/10.1038/s41598-024-75191-w.
Chen GD, Pang TT, Li PS, Zhou ZX, Lin DX, Fan DZ, et al. Early pregnancy vitamin D and the risk of adverse maternal and infant outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):465. https://doi.org/10.1186/s12884-020-03158-6.
Motlagh AJ, Davoodvandi A, Saeieh SE. Association between vitamin D level in mother’s serum and the level of vitamin D in the serum of pre-term infants. BMC Pediatr. 2023;23(1):97. https://doi.org/10.1186/s12887-023-03854-0.
Bollen SE, Bass JJ, Fujita S, Wilkinson D, Hewison M, Atherton PJ. The Vitamin D/Vitamin D receptor (VDR) axis in muscle atrophy and sarcopenia. Cell Signal. 2022;96:110355. https://doi.org/10.1016/j.cellsig.2022.110355.
Aggeletopoulou I, Thomopoulos K, Mouzaki A, Triantos C. Vitamin D-VDR Novel Anti-Inflammatory Molecules-New Insights into Their Effects on Liver Diseases. Int J Mol Sci. 2022;23(15):8465. https://doi.org/10.3390/ijms23158465.
Voutsadakis IA. Vitamin D receptor (VDR) and metabolizing enzymes CYP27B1 and CYP24A1 in breast cancer. Mol Biol Rep. 2020;47(12):9821-9830. https://doi.org/10.1007/s11033-020-05780-1.
Usategui-Martín R, De Luis-Román DA, Fernández-Gómez JM, Ruiz-Mambrilla M, Pérez-Castrillón JL. Vitamin D Receptor (VDR) Gene Polymorphisms Modify the Response to Vitamin D Supplementation: A Systematic Review and Meta-Analysis. Nutrients. 2022;14(2):360. https://doi.org/10.3390/nu14020360.
Bacchetta J, Edouard T, Laverny G, Bernardor J, Bertholet-Thomas A, Castanet M, et al. Vitamin D and calcium in-takes in general pediatric populations: A French expert consensus paper. Arch Pediatr. 2022;29(4):312-325. https://doi.org/10.1016/j.arcped.2022.02.008.
Artman A, Huang A, Bowker R, Cerwinske L, Cooper S, Johnson T, et al. Evaluation of vitamin D protocol in the neonatal intensive care unit at Rush University Medical Center. JPEN J Parenter Enteral Nutr. 2022;46(3):618-625. https://doi.org/10.1002/jpen.2138.
Golan-Tripto I, Bistritzer J, Loewenthal N, Staretz-Chacham O, Dizitzer Y, Goldbart A. The effect of vitamin D administration on vitamin D status and respiratory morbidity in late premature infants. Pediatr Pulmonol. 2020;55(11):3080-3087. https://doi.org/10.1002/ppul.25006.
Irwinda R, Hiksas R, Lokeswara AW, Wibowo N. Vitamin D supplementation higher than 2000 IU/day compared to lower dose on maternal-fetal outcome: Systematic review and meta-analysis. Womens Health (Lond). 2022;18:17455057221111066. https://doi.org/10.1177/17455057221111066.
Rizzoli R. Vitamin D supplementation: upper limit for safety revisited? Aging Clin Exp Res 2021;33(1):19-24. https://doi.org/10.1007/s40520-020-01678-x.
Kołodziejczyk-Nowotarska A, Bokiniec R, Seliga-Siwecka J. Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial. Nutrients. 2021;13(10):3442. https://doi.org/10.3390/nu13103442.
Matejek T, Zapletalova B, Stepan M, Malakova J, Palicka V. Dynamics of the vitamin D C3-epimer levels in preterm infants. Clin Chem Lab Med. 2023;61(6):1084-94. https://doi.org/10.1515/cclm-2022-1128.
Romero-Lopez M, Tyson JE, Naik M, Pedroza C, Holzapfel LF, Avritscher E, et al. Randomized controlled trial of enteral vitamin D supplementation (ViDES) in infants <28 weeks gestational age or <1000 g birth weight: study protocol. Trials. 024;25(1):423. https://doi.org/10.1186/s13063-024-08274-8.
Jung JH, Kim EA, Lee SY, Moon JE, Lee EJ, Park SH. Vitamin D Status and Factors Associated with Vitamin D Deficiency during the First Year of Life in Preterm Infants. Nutrients. 021;13(6):2019. https://doi.org/10.3390/nu13062019.
Aristizabal N, Holder MP, Durham L, Ashraf AP, Taylor S, Salas AA. Safety and Efficacy of Early Vitamin D Supplementation in Critically Ill Extremely Preterm Infants: An Ancillary Study of a Randomized Trial. J Acad Nutr Diet. 2023;123(1):87- 94. https://doi.org/10.1016/j.jand.2022. 06.012.
Lo ACQ, Lo CCW. The effect of vitamin D supplementation on glycemic control/glucose metabolism and maternal-neonatal outcomes in women with established gestational diabetes mellitus: An updated meta-analysis. Clin Nutr. 2022;41(10):2420-2423. https://doi.org/10.1016/j.clnu.2022.08.014.
Cho MC, Cho IA, Seo HK, Kang MJ, Jo JY, Shin JK, et al. Serum vitamin D-binding protein (VDBP) concentration and rs7041 genotype may be associated with pre-term labor. J Matern Fetal Neonatal Med 2022;35(25):9422-9429. https://doi.org/10.1080/14767058.2022.2040475.
Tang WQ, Ma N, Meng LY, Luo YW, Wang YJ, Zhang D. Vitamin D supplementation improved physical growth and neurologic development of Preterm Infants receiving Nesting Care in the neonatal Intensive Care Unit. BMC Pediatr 2023;23(1):248. https://doi.org/10.1186/s12887-023-04075-1.
Jamali Z, Ghorbani F, Shafie’ei M, Tolooefar F, Maleki E. Risk factors associated with vitamin D deficiency in preterm neonates: a single-center step-wise regression analysis. BMC Pediatr 2023;23(1):324. https://doi.org/10.1186/s12887-023-04088-w.
Lian RH, Qi PA, Yuan T, Yan PJ, Qiu WW, Wei Y, et al. Systematic review and meta-analysis of vitamin D deficiency in different pregnancy on preterm birth: Deficiency in middle pregnancy might be at risk. Medicine (Baltimore). 2021;100(24):e26303. https://doi.org/10.1097/MD.0000000000026303.
Sarıdemir H, Surmeli Onay O, Aydemir O, Tekin AN. Questioning the adequacy of standardized vitamin D supplementation protocol in very low birth weight infants: a prospective cohort study. J Pediatr Endocrinol Metab 2021;34(12):1515-1523. https://doi.org/10.1515/jpem-2021-0390.
Treiber M, Mujezinović F, Pečovnik Balon B, Gorenjak M, Maver U, Dovnik A. Association between umbilical cord vitamin D levels and adverse neonatal outcomes. J Int Med Res 2020;48(10):300060520955001. https://doi.org/10.1177/0300060520955001.
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Publicado
2026-03-04
Cómo citar
Guo, X., Sun, Y., Chen, Y., Xu , F., & Li, Y. (2026). Effects of Vitamin D deficiency and supplementation on 25(OH)D3 levels and neuropsychobehavioral development in premature infants.: Efectos de la deficiencia de vitamina D y la suplementación sobre los niveles de 25(OH)D3 y el desarrollo neuropsicológicoconductual en bebés prematuros. Investigación Clínica, 67(1), 5-18. https://doi.org/10.54817/IC.v67n1a01
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