Response to Supplemental Vitamin D in Formula Fed, Late Preterm Infants During Initial Hospitalization
by Hanson, Corrine K., Ph.D., UNIVERSITY OF NEBRASKA MEDICAL CENTER, 2010, 148 pages; 3440793
Objective: To examine serum 25(OH)D levels in formula fed, late preterm infants hospitalized in the Newborn Intensive Care Nursery. The primary endpoint of the study was serum 25(OH)D levels.
Background: Evidence suggests that adequate vitamin D status in infancy plays a role in the prevention of disease, including type 1 diabetes, decreased risk of malignancies, multiple sclerosis, schizophrenia, infection, asthma, and improved bone health.
Patients and Methods: A randomized, double blinded clinical trial of 52 formula fed infants born ?32 weeks gestational age, randomized to a control group who received a placebo or a supplemented group who received 400 IU of vitamin D3/day. Serum 25(OH)D levels were measured from cord blood, every 7 days during the infant's hospitalization, and at discharge. Intact parathyroid hormone, C-reactive protein, and Complement 3 were measured at discharge.
Results: Ninety-four percent of all infants at birth had serum 25(OH)D levels of <30ng/mL. The mean (?SD) cord blood 25(OH)D level for all subjects was 17.6 (?7.0) ng/mL.
White infants had significantly higher 25(OH)D levels over the course of the study than non-white infants (p=0.0003).
The mean 25(OH)D level of both the supplemented and unsupplemented groups remained below 30 ng/mL at discharge (supplemented group: 23.1?7.0 ng/mL, unsupplemented group: 17.8?4.7 ng/mL, p=0.007). Serum 25(OH)D showed a positive correlation with serum calcium in the first week of life (r=0.44, p=0.003) and negative correlation with parathyroid hormone levels at discharge (r=-0.35, p=0.02). No correlation with CRP levels or C3 at discharge was found.
Conclusion: Maternal use of prenatal vitamins was not protective against vitamin D deficiency. Lower 25(OH)D levels in the newborn are associated with lower serum calcium in the first week of life and elevated parathyroid hormone levels at discharge.
Formula fed, late preterm infants in the NICU require additional vitamin D supplementation to achieve 25(OH)D levels of ?30 ng/mL during initial hospitalization.
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400 IU increased vitamin D levels from a low of 18 to only 23 ng/ml