Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus

Abstract

Preterm infants have a lower level of nutrient body stores and immature body systems, resulting in a higher risk of malnutrition. Imbalanced complementary feeding could lead to further risk of nutritional deficits and excesses. However, evidence on their nutritional requirements following hospital discharge is limited. When planning complementary feeding, appropriate micronutrient intake should be considered for their critical role in supporting various body functions. This narrative review summarizes the need for iron, zinc, vitamin D, calcium, phosphate and long-chain polyunsaturated fatty acids (LCPUFAs) supplementation in preterm infants during complementary feeding. Regarding iron and vitamin D, the scientific community is reaching an agreement on supplementation in some categories of prematures. On the contrary, there is still not enough evidence to detail possible recommendations for LCPUFAs, zinc, calcium and phosphorus supplementation. However, these micronutrients are paramount for preterms’ health: LCPUFAs can promote retinal and brain development while calcium and phosphorus supplementation is essential to prevent preterms’ metabolic bone disease (MBD). Waiting for a consensus on these micronutrients, it is clear how the knowledge of the heterogeneity of the prematures population can help adjust the nutritional planning regarding the growth rate, comorbidities and comprehensive clinical history of the preterm infant.

Suplementasi Vitamin D pada Bayi Prematur

“…14 VITAMIN D PADA KEHAMILAN Defisiensi vitamin D pada ibu hamil akan menyebabkan defisiensi vitamin D pada bayi lahir. 15 World Health Organization (WHO) tidak menganjurkan suplementasi vitamin D pada ibu hamil. Namun, ibu hamil dengan defisiensi vitamin D dapat diberi suplementasi vitamin D 200 IU per hari.…”

“…Pemberian vitamin D ini akan mencegah anak menderita rakhitis yang merupakan akibat hipovitaminosis D ekstrim. 15,20 Suplementasi vitamin D juga dikaitkan dengan peningkatan z-score untuk panjang, berat, dan lingkar lengan bayi. 21 Sediaan standar di Amerika Serikat yaitu suplementasi vitamin berbentuk tetes mengandung 400 IU per dosis dan susu formula standar mengandung 400 IU/L vitamin D. Dosis tersebut diatur supaya bayi yang menerima ASI setidaknya mendapat 400 IU/hari vitamin D. Namun, bayi prematur memiliki keterbatasan dalam asupan nutrisi karena ketidakmatangan usus dan Pada bayi dengan nutrisi parenteral total, mulai pemberian suplemen vitamin D bila serum 25 (OH)D <50 nmol/L 18 Dosis maksimal vitamin D usia 0-6 bulan, yaitu 1.000 IU/hari 1,18 Jika serum 25 (OH)D > 375 nmol/L, hati-hati hiperkalsemia dan hiperfosfatemia 18 CONTINUING PROFESSIONAL DEVELOPMENT pembatasan cairan, sehingga meningkatkan risiko kekurangan vitamin D. 3 Berbagai jenis vitamin D yang tersedia dan cara pemberian yang berbeda-beda membuat bayi prematur dengan berat badan ≤1.000 g tidak bisa mendapatkan asupan vitamin D sebanyak 400 IU/hari, kecuali diberi tambahan suplemen vitamin D. Di Amerika Serikat, suplementasi vitamin D tambahan dapat berupa multivitamin 0,5 mL/hari untuk bayi dengan berat badan <1.250 g dan 1 mL/ hari untuk berat badan >1.250 g atau lebih; 1 mL sediaan multivitamin mengandung 400 IU vitamin D. 3 PENYEBAB DEFISIENSI VITAMIN D 9 Asupan vitamin yang kurang adekuat atau penyakit tertentu pada bayi dapat menyebabkan defisiensi vitamin D. Penyebab defisiensi vitamin dapat berupa pemberian ASI yang tidak difortifikasi, bayi dengan nutrisi parenteral tanpa disertai pemberian vitamin, insufisiensi renal, malabsorpsi (misalnya necrotizing enterocolitis, intestinal failure, kolestasis).…”

Improving Nutrition through Biofortification - A Systematic Review

“…Minerals such as Fe, Zn, iodine (I 2 ), calcium (Ca) and phosphorus (P) are required for growth in children, adolescents and adults (Savarino et al, 2021). Iron is important for the synthesis of haemoglobin and the functioning of the red blood cells in oxygen transport and energy production (Ilardi et al, 2021). Additionally, it aids in brain development, cellular metabolism and enzymatic functions (Cornelissen et al, 2019;Godswill et al, 2020;McCann et al, 2020).…”

“…Adolescents have increased Fe requirements due to its relevance in muscle development and formation of new red blood cells especially in adolescent girls who experience menstruation (Savarino et al, 2021). Also, pregnant and lactating female adults have increased Fe requirements due to the need to deposit Fe for infants (Godswill et al, 2020;Ilardi et al, 2021). The recommended Fe intake for children, adolescents and adults are 7-11 mg/day, 13 mg/day and 18 mg/day, respectively (Godswill et al, 2020;Savarino et al, 2021).…”

Impact of Docosahexaenoic acid supplementation on proinflammatory cytokines release and the development of Necrotizing enterocolitis in preterm Neonates: A randomized controlled study

“…Consequently, effective strategies in the prevention of NEC, including nutritional approaches, are critically needed. A growing body of evidence suggests the imperative role of immune modulatory nutrients in primary prevention of NEC including probiotics, prebiotics, long-chain polyunsaturated fatty acids (LCPUFA) and amino acids (glutamine, cysteine, L-arginine, and N-acetylcysteine) ( Ilardi et al, 2021 , Zhou et al, 2015 ).…”