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Molybdenum requirements in low-birth-weight infants receiving parenteral and enteral nutrition
J K Friel1, A C MacDonald, C N Mercer
1Department of Biochemistry, Memorial University of Newfoundland, Janeway Child Health Centre, St John's, Canada.
Insights
Molybdenum (Mo) deficiency is a risk for low-birth-weight (LBW) infants. Recommended intakes are 1 mcg/kg/day intravenously and 4-6 mcg/kg/day orally to ensure adequate Mo balance.
Area of Science:
- Biochemistry
- Pediatric Nutrition
- Trace Element Metabolism
Background:
- Molybdenum (Mo) is essential for three key enzymatic systems.
- No documented cases of Mo deficiency exist in infants.
- Low-birth-weight (LBW) infants may be susceptible to Mo deficiency due to limited stores, rapid growth, and reliance on unsupplemented parenteral nutrition.
Purpose of the Study:
- To investigate the molybdenum requirements in low-birth-weight infants.
- To determine adequate molybdenum intake levels for LBW infants receiving various forms of nutrition.
Main Methods:
- Collected all feeds, urine, and feces from 16 LBW infants at different nutritional stages: baseline, total parenteral nutrition (TPN), supplemental parenteral nutrition (SPN), and full oral feeds (FOFs).
- Measured molybdenum (Mo) intake, output, and balance across these nutritional phases.
- Analyzed Mo balance in relation to infant weight and nutritional support methods.
Main Results:
- Molybdenum balance improved over time but remained negative in some infants despite intakes exceeding recommendations.
- Molybdenum intake varied significantly across nutritional phases, from 0.03 mcg/d at baseline to 6.1 mcg/d during FOFs.
- Molybdenum output also varied, with a notable increase during FOFs (4.1 mcg/d).
Conclusions:
- An intravenous molybdenum intake of 1 mcg/kg/day (10 nmol/kg/day) is suggested.
- An oral molybdenum intake of 4-6 mcg/kg/day (40-60 nmol/kg/day) is proposed as adequate for LBW infants.
- These intake levels aim to ensure positive molybdenum balance and prevent deficiency in vulnerable LBW infants.
Background:
Molybdenum (Mo) is an essential trace element required by three enzymatic systems, yet there are no reports of Mo deficiency in infants. Low-birth-weight infants (LBW) might be at risk for Mo deficiency because they are born before adequate stores for Mo can be acquired, they have rapid growth requiring increased intakes, and they frequently receive supplemental parenteral nutrition (SPN) and total parenteral nutrition (TPN) unsupplemented with molybdenum.
Methods:
To investigate Mo requirements of LBW infants (n = 16; birth weight, 1336+/-351 g; gestational age, 29.8+/-2.5 weeks; M+/-SD), the authors collected all feeds, urine, and feces prior to TPN (baseline, n = 16, collections = 16), during TPN (n = 9, collections = 19), during SPN (n = 13, collections = 17), and after one week of full oral feeds (FOFs) of formula or human milk (FOF, n = 16, collections = 16).
Results:
Infant weights at collection times were: 1.3+/-0.3 g, 1.27+/-0.4 g, 1.4+/-0.3 g, and 1.7+/-0.5 g, respectively. Mo intake was 0.03+/-0.1 microg/d, 0.34+/-0.1 microg/d, 1.25+/-1.7 microg/d, and 6.1+/-2.5 microg/d. Mo output was 0.64+/-0.6, 0.34+/-0.5, 0.68+/-0.8, and 4.1+/-2.5 microg/d. Mo balance at these times was -0.60+/-0.5, -0.001+/-0.5, 0.57+/-1.9, and 2.0+/-2.9 microg/d. Mo balance increased with time, yet some infants were always in negative balance, even though Mo intakes exceeded recommendations.
Conclusions:
The authors speculate that an intravenous intake of 1 microg/kg/d (10 nmol/kg/d) and an oral intake of 4-6 microg/kg/d (40-60 nmol/kg/d) would be adequate for the LBW infant.