Plasma and red cell folate values and folate requirements in formula-fed premature infants

Abstract

Plasma and red cell folate concentrations (lactobacillus casei activity) and other pertinent blood values have been studied during the 1st year of life in 41 premature infants (mean gestational age 31.6, range 26-35 weeks). They were formula-fed, 48.5 nmol (21 micrograms) folate per 1, from 1 month of age. The infants were divided into two groups according to their birth weights (BW): group A, BW less than or equal to 1750 g and group B, BW greater than 1750 g, respectively. One-half of the infants in each group received an extra 113.5 nmol (50 micrograms) folic acid daily. The premature infants were compared with 35 breast-fed term infants considered to have an optimal folate status. The infants not receiving folic acid supplementation had low plasma and red cell folate concentrations during the first months of life, while those receiving supplementation had values comparable to the breast-fed infants. No significant differences in the gain in weight and increase in length were observed when the folic acid supplemented infants in group A were compared with the non-supplemented infants. However, in the case of group B a significant increase in length and a somewhat greater weight gain were observed for infants with folic acid supplementation in comparison with those not given extra folate. No significant differences were observed between the haemoglobin, RBC and VPRC values in the folic acid supplemented and non-supplemented infants. It is estimated that the optimal folate intake during the first months of life in formula-fed premature infants is about 150 nmol (65 micrograms) per day. This amount is higher than previously recommended. The infants from all groups had a folate intake similar to, or above, the minimal daily requirement needed for erythropoiesis.

Red Cell Folate and Plasma Homocysteine in Preterm Infants

“…An increased transfer of folate to the fetus during the last weeks of pregnancy [2] results in higher red cell folate in both preterm and full-term infants compared to adults [3][4][5] . In studies done in the 1970s and 1980s, this high folate concentration was sustained in breastfed term infants [3] but fell significantly in the first 2-3 months of life in preterm infants regardless of the mode of feeding [4] . This led to the recommendation of routine supplementation of preterm infants with folic acid to prevent deficiency [6] .…”

Is Folic Acid Supplementation Really Necessary in Preterm Infants ≤32 Weeks of Gestation?

“…In the 1980s, with the discovery of significantly lower levels of serum folate in the first 2 to 3 months of life in preterm infants, routine folic acid supplementation was recommended to prevent the development of folate deficiency (11)(12)(13)(14); however, with the availability of new parenteral nutrition products and PFs containing folic acid, additional folic acid supplementation has become a source of controversy. Micronutrient support of mothers' milk and the development of modern PFs for preterm infants have decreased the need for folic acid supplementation, although the practice of folic acid supplementation remains commonplace.…”

Assessment of different folic acid supplementation doses for low-birth-weight infants

“…The erythrocyte folate level (RBCFL) is higher in preterm and term babies compared with adults because fetal folate transfer is increased in pregnancy (especially in the third trimester) (2)(3)(4)(5). Folate decreases gradually in the first months of life, predominantly in low-birth-weight (LBW) babies.…”

“…In this rapid growth period of life, requirement of folic acid (FA) increases and the risk of development of folate deficiency is increased. Studies conducted in the 1970s-80s reported that folate levels in preterm babies decreased in the first 2-3 months of life (3,4). Therefore, routine FA supplementation was recommended for all preterm babies in the 1990s (6).…”