Some preemies needed more than 400 IU of vitamin D – July 2013

Vitamin D nutritional status in preterm infants and response to supplementation.

Br J Nutr. 2013 Jul 14;110(1):156-63. doi: 10.1017/S0007114512004722. Epub 2012 Nov 27.
McCarthy RA, McKenna MJ, Oyefeso O, Uduma O, Murray BF, Brady JJ, Kilbane MT, Murphy JF, Twomey A, O' Donnell CP, Murphy NP, Molloy EJ.
Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Republic of Ireland. rmccarthy at nmh.ie

Little is known about vitamin D status in preterm infants and their response to supplementation. To investigate this, we assessed serum 25-hydroxyvitamin D (25OHD) levels using RIA in a consecutive sample of stable preterm very low birth weight (VLBW) infants (born ≤ 32 weeks gestation or birth weight ≤ 1·5 kg), and we explored associated factors. Serum 25OHD level was first assessed once infants were tolerating feeds (n 274). If this first 25OHD level was below 50 nmol/l (20 ng/ml), which is the level associated with covering requirements in terms of skeletal health in the majority, then we recommended prolonged augmented vitamin D intake ( ≥ 10 μg (400 IU) daily) from a combination of fortified feeds and vitamin supplements and follow-up re-assessment at approximately 6 weeks corrected age (n 148). The first assessment, conducted at a median for chronological age of 18 (interquartile range (IQR) 11-28) d, found that 78 % had serum 25OHD levels below 50 nmol/l. Multivariable analysis demonstrated that the determinants of serum 25OHD levels were duration of vitamin D supplementation and gestational age at birth (r 2 0·215; P< 0·001). At follow-up, after a median of 104 (IQR 78-127) d, 87 % achieved levels ≥ 50 nmol/l and 8 % had levels >125 nmol/l, a level associated with potential risk of harm. We conclude that low 25OHD levels are an issue for preterm VLBW infants, warranting early nutritional intervention.

In infants with serum 25OHD levels < 50 nmol/l, a vitamin D intake of ≥ 10 μg (400 IU) daily achieves target levels in the majority; however, further work is needed to determine the exact dose to safely meet target levels without overcorrection.

PMID: 23182428

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Summary: 400 IU vitamin D failed to raise 13% of preemies to 20ng/ml

Would need much more than 400 IU vitamin D for preemies born in countries which consider 30ng/ml to be the minimum amount.
Many vitamin D studies have found that 40ng/ml is the optimal amount. Might need 1600 IU to get preemie to that level.

See also Vitamin D Life

• Infants in France and Finland need 1000 IU of vitamin D, but apparently infants in US need only 400 - 2013 and these are not even preemies
• Preemies have low vitamin D levels yet only get 400 IU – July 2013
• Many preemies need at least 800 IU of vitamin D – RCT May 2013
• Preemies have increased need for vitamin D and Calcium (Rickets)– May 2013
• Recurrent pre term birth and low vitamin D – Dec 2012
• Low birth weight associated with vitamin D levels less than 11 ng – Nov 2012
• Reminder – 400 IU is enough only when infant already had a good level of vitamin D – Nov 2012
• Osteopenia in preterm infants – May 2012
• All items in category Infant/Child and Vitamin D 606 items