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Preemies have increased need for vitamin D and Calcium (Rickets)– May 2013

Calcium and vitamin d requirements of enterally fed preterm infants.

Pediatrics. 2013 May;131(5):e1676-83. doi: 10.1542/peds.2013-0420. Epub 2013 Apr 29.
Abrams SA; Committee on Nutrition; Collaborators (6)

Bone health is a critical concern in managing preterm infants. Key nutrients of importance are calcium, vitamin D, and phosphorus. Although human milk is critical for the health of preterm infants, it is low in these nutrients relative to the needs of the infants during growth. Strategies should be in place to fortify human milk for preterm infants with birth weight <1800 to 2000 g and to ensure adequate mineral intake during hospitalization and after hospital discharge. Biochemical monitoring of very low birth weight infants should be performed during their hospitalization. Vitamin D should be provided at 200 to 400 IU/day both during hospitalization and after discharge from the hospital. Infants with radiologic evidence of rickets should have efforts made to maximize calcium and phosphorus intake by using available commercial products and, if needed, direct supplementation with these minerals.

PMID: 23629620
TABLE 1 High-Risk Criteria for Rickets in Preterm Infants
Born at <27 weeks' gestation Birth weight <1000 g
Long-term parenteral nutrition (eg, >4 to 5 weeks)
Severe bronchopulmonary dysplasia with use of loop diuretics (eg, furosemide) and fluid restriction
Long-term steroid use
History of necrotizing enterocolitis
Failure to tolerate formulas or human milk fortifiers with high mineral content

Disagreement as to how much vitamin D is needed: 150 IU or 1000 IU

Image


PDF is attached at the bottom of this page

See also VitaminDWiki

Infant-Child category starts with

Having a good level of vitamin D cuts in half the amount of:

Need even more IUs of vitamin D to get a good level if;

  • Have little vitamin D: premie, twin, mother did not get much sun access
  • Get little vitamin D: dark skin, little access to sun
  • Vitamin D is consumed faster than normal due to sickness
  • Older (need at least 100 IU/kilogram, far more if obese)
  • Not get any vitamin D from formula (breast fed) or (fortified) milk
    Note – formula does not even provide 400 IU of vitamin D daily

Infants-Children need Vitamin D

  • Sun is great – well known for 1,000’s of years.
    US govt (1934) even said infants should be out in the sun
  • One country recommended 2,000 IU daily for decades – with no known problems
  • As with adults, infants and children can have loading doses and rarely need tests
  • Daily dose appears to be best, but monthly seems OK
  • Vitamin D is typically given to infants in the form of drops
       big difference in taste between brands
       can also use water-soluable form of vitamin D in milk, food, juice,
  • Infants have evolved to get a big boost of vitamin D immediately after birth
    Colostrum has 3X more vitamin D than breast milk - provided the mother has any vitamin D to spare
  • 100 IU per kg of infant July 2011, Poland etc.
    1000 IU per 25 lbs.jpg
    More than 100 IU/kg is probably better

Getting Vitamin D into infants

Many infants reject vitamin D drops, even when put on nipple
I speculate that the rejection is due to one or more of: additives, taste, and oils.
Infants have a hard time digesting oils, 1999  1997   and palm oils W.A. Price 1 2 3
Coconut oil, such as in D-Drops, is digested by infants. 1,   2   3
Bio-Tech Pharmacal Vitamin D has NO additves, taste, oil
One capsule of 50,000 Bio-Tech Pharmacal Vitamin D could be stirred into monthly formula
   this would result in ~1,600 IUs per day for infant, and higher dose with weight/age/formula consumption

See also web

  • Vitamin D Council summary of the publication
    For babies that weigh less than 1500 g (3.3 lbs), they should get biochemical testing for bone mineral status starting 4 to 5 weeks after birth. Babies that weigh over 1500 g do not necessarily need this testing.
    If the babies’ serum alkaline phosphatase activity is greater than 800 IU/L to 1000 IU/L or the baby is getting fractures, they should receive radiographic evaluation for rickets and treated with calcium and phosphorus as necessary.
    Preterm infants weighing less than 1800 to 2000 g (4.4 lbs) should receive human milk fortified with minerals or take formula specifically designed for preterm infants.
    For preterm and very low birth weight infants that weigh less than 1500 g, they should get 200 to 400 IU of vitamin D/day.
       For infants that weigh over 1500 g, they should get 400 IU/day. The maximum preterm and very low birth weight infants can get is 1000 IU/day.
    When infants reach a body weight of greater than 1500 g, vitamin D intake should be around 400 IU. The maximum they can get is 1000 IU/day.
    Infants with cholestasis, other malabsorptive disorders, or renal disease should be considered for special assessment, sometimes warranting 25(OH)D levels over 50 ng/ml.

Attached files

ID Name Comment Uploaded Size Downloads
2761 Preemie 4.jpg admin 10 Jul, 2013 20:01 29.09 Kb 1619
2677 Preemies, Calcium, Vitamin D.pdf PDF 2013 admin 30 Jun, 2013 18:30 704.42 Kb 612
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