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Plasma folate levels in preterm infants, with and without a 1 mg daily folate supplement
N J Fuller1, C J Bates, T J Cole
1Medical Research Council, Dunn Nutrition Unit, Cambridge, United Kingdom.
Insights
Preterm infants receiving 1 mg of folate daily showed initial plasma folate increases, followed by decreases due to body growth. Lower daily folate doses (0.05-0.2 mg) may be more appropriate for preterm infants.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Pediatrics
Background:
- Preterm infants often require nutritional support, including folate supplementation.
- Current practice involved 1 mg oral folate (pteroylglutamic acid) daily for preterm infants post-enteral feeding.
Purpose of the Study:
- To evaluate plasma folate levels in preterm infants receiving a standard 1 mg daily oral folate supplement.
- To determine optimal folate supplementation dosage for preterm infants.
Main Methods:
- Plasma folate levels were measured in 70 preterm infants before supplementation.
- Plasma folate levels were monitored in 83 preterm infants after initiating 1 mg daily oral folate.
- Infant body size changes were considered in relation to folate levels.
Main Results:
- Plasma folate levels in unsupplemented preterm infants fell from 45 to 12 micrograms/l by weeks 2-3.
- Supplementation with 1 mg folate increased levels to a median of 300 micrograms/l.
- Despite continued supplementation, individual plasma folate levels decreased, likely due to body size increase (dilution).
Conclusions:
- The standard 1 mg daily folate dose may lead to supra-physiological levels and dilution effects in growing preterm infants.
- A lower daily folate dosage range of 0.05-0.2 mg may be more suitable for well preterm infants.
- Further research is needed to establish precise folate requirements for preterm neonates.
Abstract:
One hundred and four preterm infants were studied during the first few months of life in the Special Care Baby Unit of Addenbrooke's Hospital, Cambridge, United Kingdom. Previously, it had been the daily practice within the Unit to give a 1 mg oral supplement of folate (in the form of pteroylglutamic acid), once the infants had commenced full enteral feeding. At least one blood sample was obtained from 70 infants before oral folate supplementation was started. In these, the plasma folate levels fell progressively from a median value of 45 micrograms/l to a median of 12 micrograms/l, by the 2nd-3rd week of life. Once started on the oral supplement, 83 of the infants provided at least one blood sample. The plasma folate level of these infants rose immediately to a median value of 300 micrograms/l and a maximum of 1000 micrograms/l. Within individuals, these plasma folate levels decreased progressively following the introduction of the supplement, despite continuing daily supplementation. In a typical baby this decrease appeared to be explained by an increase in body-size, i.e. dilution of the folate into a larger pool. The implications of this level of supplementation are discussed, and in the light of our observations we suggest that daily supplementation in the range, 0.05-0.2 mg folate may be preferable for well preterm infants.