Abstract
Objectives
Recommendations for vitamin D (VitD) intake and target serum levels of 25(OH)D in preterm infants are diverse. We hypothesized that preterm infants with low birth weight (BW) have low dietary intake of VitD and therefore should be supplemented with higher amounts of VitD.
Methods
Infants with BW < 2 kg were supplemented with 600 units of VitD a day during the first 2–6 weeks of life, whereas infants with BW>2 kg continued with the routine supplementation of 400 units of VitD daily. Serum levels of 25(OH)D, calcium, phosphorous, alkaline phosphatase (AP) and parathyroid hormone (PTH) were assessed 24 h after birth and before discharge. The total daily intake of vitD was calculated in each infant.
Results
Sixty-two infants were enrolled, 49 with BW < 2 kg. After birth, only 24% had sufficient levels of 25(OH)D, whereas before discharge 45 of 54 infants (83%) available for analysis reached sufficient levels of 25(OH)D. All 54 infants demonstrated significant elevation in serum levels of calcium, phosphorous, AP and significant reduction in PTH levels. The total daily intake of VitD was lower than recommended (800–1000 IU/d) in 16 of 45 infants with BW < 2 kg (36%) and in all nine infants with BW>2 kg. Nevertheless, only 2 of 25 infants with insufficient intake of VitD demonstrated insufficient levels of serum 25(OH)D. No case of vitamin D excess was recorded.
Conclusions
Increased supplementation of VitD (600 IU/d) for premature newborns with BW < 2 kg is effective in increasing both total daily intake of VitD and serum levels of 25(OH)D.
Acknowledgments
This study was made possible thanks to the staff in the Neonatal Intensive Care Unit at Kaplan Medical Center, Rehovot, Israel. The authors specially thank the patients and their parents.
Research funding: None declared.
Author contributions: A.Z. reviewed and analyzed the data and wrote the manuscript. C.T-O recruited the participants, collected blood samples, and reviewed the medical records of the patients. E.S.S. contributed to the study design and the statistical analysis, and edited the manuscript. L.H. performed the nutritional analysis of the diet of the participants. A.J-R reviewed the medical records and collected data of the newborns. O.F-R designed the study, recruited the participants, and edited the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Ethical statements: The study was approved by the ethics committee of Kaplan Medical Center and informed consent was obtained from the parents of the participating newborns.
References
1. Namgung, R, Tsang, RC. Factors affecting newborn bone mineral content: in utero effects on newborn bone mineralization. Proc Nutr Soc 2000;59:55–63. https://doi.org/10.1017/s0029665100000070.Search in Google Scholar PubMed
2. Cooper, C, Javaid, K, Westlake, S, Harvey, N, Dennison, E. Developmental origins of osteoporotic fracture: the role of maternal vitamin D insufficiency. J Nutr 2005;135:2728S–34S. https://doi.org/10.1093/jn/135.11.2728s.Search in Google Scholar PubMed
3. Arden, NK, Syddall, HE, Javaid, MK, Dennison, EM, Swaminathan, R, Fall, C, et al. Early life influences on serum 1,25(OH) vitamin D. Paediatr Perinat Epidemiol 2005;19:36–42. https://doi.org/10.1111/j.1365-3016.2004.00618.x.Search in Google Scholar PubMed
4. Ashraf, A, Mick, G, Atchison, J, Petrey, B, Abdullatif, H, McCormick, K. Prevalence of hypovitaminosis D in early infantile hypocalcemia. J Pediatr Endocrinol Metab 2006;19:1025–31. https://doi.org/10.1515/jpem.2006.19.8.1025.Search in Google Scholar PubMed
5. Lagishetty, V, Liu, NQ, Hewison, M. Vitamin D metabolism and innate immunity. Mol Cell Endocrinol 2011;347:97–105. https://doi.org/10.1016/j.mce.2011.04.015.Search in Google Scholar PubMed PubMed Central
6. Vachharajani, AJ, Mathur, AM, Rao, R. Metabolic bone disease of prematurity. NeoReviews 2009;10:e402–11.10.1542/neo.10-8-e402Search in Google Scholar
7. Pieltain, C, de Halleux, V, Senterre, T, Rigo, J. Prematurity and bone health. World Rev Nutr Diet 2013;106:181–8. https://doi.org/10.1159/000342680.Search in Google Scholar PubMed
8. Chen, W, Yang, C, Chen, H, Zhang, B. Risk factors analysis and prevention of metabolic bone disease of prematurity. Medicine (Baltimore) 2018;97:e12861. https://doi.org/10.1097/md.0000000000012861.Search in Google Scholar
9. Agostoni, C, Buonocore, G, Carnielli, VP, De Curtis, M, Darmaun, D, Decsi, T, et al. ESPGHAN committee on nutrition. Enteral nutrient supply for preterm infants: commentary from the European society of paediatric Gastroenterology, Hepatology and nutrition committee on nutrition. J Pediatr Gastroenterol Nutr 2010;50:85–91. https://doi.org/10.1097/mpg.0b013e3181adaee0.Search in Google Scholar
10. Misra, M, Pacaud, D, Petryk, A, Collett-Solberg, PF, Kappy, M. On behalf of the drug and therapeutic committee of the Lawson Wilkins Pediatric Endocrine Society: vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398–417. https://doi.org/10.1542/peds.2007-1894.Search in Google Scholar PubMed
11. Thandaryen, K, Pettifor, JM. Maternal vitamin D status: implications for the development of infantile nutritional rickets. Rheum Dis Clin North Am 2012;38:61–79.10.1016/j.rdc.2012.03.007Search in Google Scholar PubMed
12. Backström, MC, Kuusela, AL, Mäki, R. Metabolic bone disease of prematurity. Ann Med 1996;28:275–82. https://doi.org/10.3109/07853899608999080.Search in Google Scholar PubMed
13. Natarajan, CK, Sankar, MJ, Agarwal, R, Pratap, OT, Gupta, N, Jain, J, et al. Trial of daily vitamin D supplementation in preterm infants. Pediatrics 2014;133:e628–34. https://doi.org/10.1542/peds.2012-3395.Search in Google Scholar PubMed
14. Abrams, SA. Committee on nutrition. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics 2013;131:e1676–83. https://doi.org/10.1542/peds.2013-0420.Search in Google Scholar PubMed
15. Wagner, CL, Greer, FR. American Academy of pediatrics section on breastfeeding, American academy of pediatrics committee on nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142–52. https://doi.org/10.1542/peds.2008-1862.Search in Google Scholar PubMed
16. World Health Organization. Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries; 2011 Available from: https://www.who.int/maternal_child_adolescent/documents/infant_feeding_low_bw/en/.Search in Google Scholar
17. Ross, AC, Manson, JE, Abrams, SA, Aloia, JF, Brannon, PM, Clinton, SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96:53–8. https://doi.org/10.1210/jc.2010-2704.Search in Google Scholar PubMed PubMed Central
18. Ross, AC, Manson, JE, Abrams, SA, Aloia, JF, Brannon, PM, Clinton, SK, et al. The 2011 dietary reference intakes for calcium and vitamin D: what dietetics practitioners need to know. J Am Diet Assoc 2011;111:524–7. https://doi.org/10.1016/j.jada.2011.01.004.Search in Google Scholar PubMed
19. Tudehope, DI. Human milk and the nutritional needs of preterm infants. J Pediatr 2013;162:S17–25. https://doi.org/10.1016/j.jpeds.2012.11.056.Search in Google Scholar PubMed
20. Holik, MF, Binkley, NC, Bischoff-Ferrari, HA, Gordon, CM, Hanley, DA, Heaney, RP, et al. Endocrine society. Evaluation, treatment and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrin Metab 2011;96:1911–30. https://doi.org/10.1210/jc.2011-0385.Search in Google Scholar PubMed
21. Anderson-Berry, A, Thoene, M, Wagner, J, Lyden, E, Jones, G, Kaufmann, M, et al. Randomized trial of two doses of vitamin D3 in preterm infants <32 weeks: dose impact on achieving desired serum 25(OH)D3 in a NICU population. PLoS One 2017;12:e0185950. https://doi.org/10.1371/journal.pone.0185950.Search in Google Scholar PubMed PubMed Central
22. Pittard, WB, Geddes, KM, Hulsey, TC, Hollis, BW. How much vitamin D for neonates?. Am J Dis Child 1991;145:1147–9. https://doi.org/10.1001/archpedi.1991.02160100079027.Search in Google Scholar PubMed
23. Cho, SY, Park, H-K, Lee, HJ. Efficacy and safety of early supplementation with 800 IU of vitamin D in very preterm infants followed by underlying levels of vitamin D at birth. Ital J Pediatr 2017;43:45. https://doi.org/10.1186/s13052-017-0361-0.Search in Google Scholar PubMed PubMed Central
24. Bozkurt, O, Uras, N, Sari, FN, Atay, FY, Sahin, S, Alkan, AD, et al. Multi-dose vitamin D supplementation in stable very preterm infants: prospective randomized trial response to three different vitamin D supplementation doses. Early Hum Dev 2017;112:54–9. https://doi.org/10.1016/j.earlhumdev.2017.07.016.Search in Google Scholar PubMed
25. Matejek, T, Navratilova, M, Zaloudkova, L, Malakova, J, Maly, J, Skalova, S, et al. Vitamin D status of very low birth weight infants at birth and the effects of generally recommended supplementation on their vitamin D levels at discharge. J Matern Fetal Neonatal Med 2019;32:2860–7.10.1080/14767058.2019.1586873Search in Google Scholar PubMed
26. Alshahrani, F, Aljohani, N. Vitamin D: deficiency, sufficiency and toxicity. Nutrients 2013;5:3605–16. https://doi.org/10.3390/nu5093605.Search in Google Scholar PubMed PubMed Central
27. Vieth, R. Critique of the consideration for establishing the tolerable upper intake level for vitamin D: critical need for revision upwards. J Nutr 2006;136:1117–22. https://doi.org/10.1093/jn/136.4.1117.Search in Google Scholar PubMed
28. Tergestina, M, Jose, A, Sridhar, S, Job, V, Rebekah, G, Kuruvilla, KA, et al. Vitamin D status and adequacy of standard supplementation in preterm neonates from South India. J Pediatr Gastroenterol Nutr 2014;58:661–5. https://doi.org/10.1097/mpg.0000000000000296.Search in Google Scholar PubMed
29. Flidel-Rimon, O, Raz, M, Balla, U, Hofi, L, Juster-Reicher, A, Shinwell, ES. Early, rapidly progressive enteral nutrition promoted growth of very low birth weight (VLBW) infants. J Matern Fetal Neonatal Med 2017;30:1227–31. https://doi.org/10.1080/14767058.2016.1209651.Search in Google Scholar PubMed
30. Fort, P, Salas, AA, Nicola, T, Craig, CM, Carlo, WA, Ambalavanan, N. A comparison of 3 vitamin D dosing regimens in extremely preterm infants: a randomized controlled trial. J Pediatr 2016;174:132–8. https://doi.org/10.1016/j.jpeds.2016.03.028.Search in Google Scholar PubMed PubMed Central
31. Backstrom, MC, Maki, R, Kuusela, AL, Sievanen, H, Koivisto, AM, Ikonen, RS, et al. Randomized controlled trial of vitamin D supplementation on bone density and biochemical indices in preterm infants. Arch Dis Child Fetal Neonatal 1999;80:F161–6. https://doi.org/10.1136/fn.80.3.f161.Search in Google Scholar PubMed PubMed Central
32. Koo, WW, Krug-Wispe, S, Neylan, M, Succop, P, Oestreich, AE, Tsang, RC. Effect of three levels of vitamin D intake in preterm infants receiving high mineral-containing milk. J Pediatr Gastroenterol Nutr 1995;21:182–9. https://doi.org/10.1097/00005176-199508000-00010.Search in Google Scholar PubMed
33. McCarthy, RA, McKenna, MJ, Oyefeso, O, Uduma, O, Murray, BF, Brady, JJ, et al. Vitamin D nutritional status in preterm infants and response to supplementation. Br J Nutr 2013;110:156–63. https://doi.org/10.1017/s0007114512004722.Search in Google Scholar
34. Pinto, K, Collins, CT, Gibson, RA, Andersen, CC. Vitamin D in preterm infants: a prospective observational study. J Paediatr Child Health 2015;51:679–81. https://doi.org/10.1111/jpc.12847.Search in Google Scholar PubMed
35. Tergestina, M, Rebekah, G, Job, V, Simon, A, Thomas, N. A randomized double-blind controlled trial comparing two regimens of vitamin D supplementation in preterm neonates. Perinatol 2016;36:763–7. https://doi.org/10.1038/jp.2016.70.Search in Google Scholar PubMed
36. Mathur, NB, Saini, A, Mishra, TK. Assessment of adequacy of supplementation of vitamin D in very low birth weight preterm neonates: a randomized controlled trial. J Trop Pediatr 2016;62:429–35. https://doi.org/10.1093/tropej/fmv110.Search in Google Scholar PubMed
37. Newton, DA, Baatz, JE, Kindy, MS, Gattoni-Celli, S, Shary, JR, Hollis, BW, et al. Vitamin D binding protein polymorphisms significantly impact vitamin D status in children. Pediatr Res 2019;86:662–9. https://doi.org/10.1038/s41390-019-0322-y.Search in Google Scholar PubMed PubMed Central
38. Hossein-Nezhad, A, Holick, MF. Optimize dietary intake of vitamin D: an epigenetic perspective. Curr Opin Clin Nutr Metab Care 2012;15:567–79. https://doi.org/10.1097/mco.0b013e3283594978.Search in Google Scholar PubMed
39. Teale, GR, Cunningham, CE. Vitamin D deficiency is common among pregnant women in rural Victoria. Aust N Z J Obstet Gynaecol 2010;50:259–61. https://doi.org/10.1111/j.1479-828x.2010.01147.x.Search in Google Scholar PubMed
40. Halicioglu, O, Aksit, S, Koc, F, Akman, SA, Albudak, E, Yaprak, I, et al. Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey. Paediatr Perinat Epidemiol 2012;26:53–60. https://doi.org/10.1111/j.1365-3016.2011.01238.x.Search in Google Scholar PubMed
41. Agarwal, R, Virmani, D, Jaipal, ML, Gupta, S, Gupta, N, Sankar, MJ, et al. Investigators of LBW Micronutrient Study Group. Vitamin D status of low birth weight infants in Delhi: a comparative study. J Trop Pediatr 2012;58:446–50. https://doi.org/10.1093/tropej/fms013.Search in Google Scholar PubMed
42. Narchi, H, Kochiyil, J, Zayed, R, Abdulrazzak, W, Agarwal, M. Longitudinal study of vitamin D status in the 1st 6 months of life. Ann Trop Paediatr 2011;31:225–30. https://doi.org/10.1179/1465328111y.0000000017.Search in Google Scholar PubMed
43. Hollis, BW, Wagner, CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr 2004;80:1752S–8S. https://doi.org/10.1093/ajcn/80.6.1752s.Search in Google Scholar
44. Naik, P, Faridi, MMA, Barta, P, Madhu, SV. Oral supplementation of parturient mothers with vitamin D and its effect on 25OHD status of exclusively breastfed infants at 6 months of age: a double-blind randomized placebo controlled trail. Breastfeed Med 2017;12:621–8. https://doi.org/10.1089/bfm.2016.0164.Search in Google Scholar PubMed
© 2020 Walter de Gruyter GmbH, Berlin/Boston
