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Randomised controlled trial of vitamin D supplementation on bone density and biochemical indices in preterm infants
M C Backström1, R Mäki, A L Kuusela
1Department of Paediatrics, Tampere University Hospital, Tampere, Finland. maria.backstrom@pp.qnet.fi
Insights
A lower vitamin D dose (200 IU/kg/day, max 400 IU/day) effectively maintains vitamin D status and bone mineral density in preterm infants. This finding challenges the need for higher doses, suggesting potential risks of excess vitamin D supplementation.
Area of Science:
- Neonatal nutrition and endocrinology.
- Pediatric bone health and mineral metabolism.
Background:
- Preterm infants are at risk for vitamin D deficiency and associated bone complications.
- Optimal vitamin D dosing for preterm infants remains a subject of research to balance efficacy and safety.
Purpose of the Study:
- To compare the efficacy of a lower vitamin D dose (200 IU/kg/day, max 400 IU/day) versus a higher dose (960 IU/day) in preterm infants.
- To assess vitamin D status and bone mineral density in preterm infants receiving different vitamin D supplementation levels.
Main Methods:
- Randomized controlled trial involving 39 infants born before 33 weeks gestational age.
- Infants received either 200 IU/kg/day (max 400 IU/day) or 960 IU/day of vitamin D until 3 months corrected age.
- Assessment included vitamin D metabolites, bone mineral content/density (DXA), and biochemical markers of bone metabolism.
Main Results:
- No significant difference in 25-hydroxyvitamin D concentrations between the groups, although levels tended to be higher with the 960 IU/day dose.
- Bone mineral content and bone mineral density at 3 and 6 months corrected age were comparable between infants receiving low and high vitamin D doses.
- Potential risk factors did not alter the observed outcomes regarding bone health.
Conclusions:
- A vitamin D dose of 200 IU/kg/day (max 400 IU/day) is sufficient to maintain normal vitamin D status and achieve adequate bone mineral accretion in preterm infants.
- The previously recommended higher dose of 960 IU/day may not offer additional bone benefits and could potentially lead to excess vitamin D administration.
- Given vitamin D's hormonal role beyond bone, cautious dosing in preterm infants is advised to prevent potential adverse effects from excessive supplementation.
Aims:
To test the hypothesis that a vitamin D dose of 200 IU/kg, maximum 400 IU/day, given to preterm infants will maintain normal vitamin D status and will result in as high a bone mineral density as that attained with the recommended dose of 960 IU/day.
Methods:
Thirty nine infants of fewer than 33 weeks of gestational age were randomly allocated to receive vitamin D 200 IU/kg of body weight/day up to a maximum of 400 IU/day or 960 IU/day until 3 months old. Vitamin D metabolites, bone mineral content and density were determined by dual energy x-ray absorptiometry, and plasma ionised calcium, plasma alkaline phosphatase, and intact parahormone measurements were used to evaluate outcomes.
Results:
The 25 hydroxy vitamin D concentrations tended to be higher in infants receiving 960 IU/day, but the differences did not reach significance at any age. There was no difference between the infants receiving low or high vitamin D dose in bone mineral content nor in bone mineral density at 3 and 6 months corrected age, even after taking potential risk factors into account.
Conclusions:
A vitamin D dose of 200 IU/kg of body weight/day up to a maximum of 400 IU/day maintains normal vitamin D status and as good a bone mineral accretion as the previously recommended higher dose of 960 IU/day. Vitamin D is a potent hormone which affects organs other than bone and should not be given in excess to preterm infants.