Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial

Area of Science:

• Neonatal Medicine
• Pediatric Nutrition
• Endocrinology

Background:

• Vitamin D is vital for infant development, impacting immunity, allergies, and neurodevelopment.
• Preterm infants are at higher risk for vitamin D deficiency due to various factors.
• Both inadequate and excessive vitamin D supplementation can pose health risks.

Purpose of the Study:

• To evaluate the efficacy of monitored vitamin D supplementation versus standard therapy in preterm infants.
• To assess the impact of different supplementation strategies on 25-hydroxyvitamin D [25(OH)D] concentrations.
• To identify risks of vitamin D toxicity and deficiency in preterm infants under different protocols.

Main Methods:

• 109 preterm infants (24-32 weeks gestation) were randomized into standard (500 IU) or monitored therapy groups.
• 25-hydroxyvitamin D [25(OH)D] levels were measured at multiple time points from birth up to 52 weeks post-conceptional age (PCA).
• Monitored therapy allowed for dose adjustments to maintain optimal vitamin D levels.

Main Results:

• 23% of infants on standard therapy had potentially toxic 25(OH)D levels (>90 ng/mL) at 40 weeks PCA, requiring discontinuation.
• A significantly higher percentage of infants in the monitored group achieved safe vitamin D levels (20-80 ng/mL) at 52 weeks PCA (p=0.017).
• Two infants in the control group showed biochemical markers of vitamin D toxicity; five infants had elevated levels and abnormal ultrasounds.

Conclusions:

• Monitored vitamin D supplementation is more effective in maintaining safe 25(OH)D levels in preterm infants.
• Standard vitamin D supplementation protocols may lead to toxicity, necessitating careful monitoring and dose adjustment.
• Optimal vitamin D supplementation (800-1000 IU) requires monitoring to prevent both deficiency and overdose in preterm infants.