Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial

Abstract

Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n = 55; approximately 800–1000 IU from combined sources) or monitored therapy (n = 54; with an option of dose modification). 25-hydroxyvitamin D [25(OH)D] concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52 ± 2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20−80 ng/mL) at 52 weeks of PCA (p = 0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.

Preterm Infants on Early Solid Foods and Vitamin D Status in the First Year of Life—A Secondary Outcome Analysis of a Randomized Controlled Trial

“…Data from the present study indicate that an increase in vitamin D supplementation and detailed recommendations for regular monitoring during the first year of life are necessary. Recent studies already show promising improvement using adjusted vitamin D supplementation [ 31 , 32 ]. Artman et al went up to 800 IE/day in infants with low serum 25-OH-vitamin D levels [ 31 ].…”

A third of premature neonates displayed inadequate 25‐hydroxyvitamin D levels before being discharged from a French neonatal intensive care unit

“…Interestingly, a previous study reported that 19% of preterm infants still had 25(OH)D levels of >125nmol/L at 34-37 weeks of corrected age after dose adjustments. 5 Despite this, we chose monthly monitoring with standardised adjustments. The multinomial analysis did not find any significant associations, probably due to the cohort's size and heterogeneity.…”

“…Interestingly, a previous study reported that 19% of preterm infants still had 25(OH)D levels of >125nmol/L at 34–37 weeks of corrected age after dose adjustments 5 . Despite this, we chose monthly monitoring with standardised adjustments.…”

Local protocol helped to deliver vitamin D levels more accurately in preterm infants

“…Many studies on preterm infants have compared responses to different levels of vitamin D supplementation with these guidelines in mind. The results have suggested supplementation levels of 800 to 1000 IU per day, but, above all, they have stressed the need to monitor 25‐hydroxy vitamin D level (25(OH)D) monthly in preterm infants 3‐5 . Vitamin D deficiency is frequent in the general population, even in children who are routinely supplemented with vitamin D up to 18 years of age 6 .…”

“…The results have suggested supplementation levels of 800 to 1000 IU per day, but, above all, they have stressed the need to monitor 25-hydroxy vitamin D level (25(OH)D) monthly in preterm infants. [3][4][5] Vitamin D deficiency is frequent in the general population, even in children who are routinely supplemented with vitamin D up to 18 years of age. 6 Preterm infants face a particular risk, mainly because they are dependent on maternal vitamin D status in utero, especially during the third trimester of pregnancy.…”