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Survey of vitamin D supplementation practices in extremely preterm infants
Mar Romero-Lopez1,2, Mamta Naik3, Lindsay F Holzapfel4
1Department of Pediatrics, Division of Perinatal-Neonatal Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA. maria.del.mar.romerolopez@uth.tmc.edu.
Insights
Most U.S. neonatal intensive care units (NICUs) give extremely preterm (EP) infants 400 IU/day of vitamin D. Further trials are needed to determine optimal vitamin D supplementation for EP infants, comparing current practices with earlier, higher doses.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Endocrinology
Background:
- Extremely preterm (EP) infants often have vitamin D deficiency (serum 25-hydroxyvitamin D < 20 ng/mL).
- Optimal vitamin D supplementation strategies for EP infants are not well-established.
- Current practices vary, necessitating baseline data for clinical trial design.
Purpose of the Study:
- To assess current vitamin D supplementation practices in U.S. neonatal intensive care units (NICUs) caring for EP infants.
- To provide baseline data for future clinical trials on vitamin D supplementation in EP infants.
Main Methods:
- An online survey was conducted among U.S. NICUs caring for EP infants.
- Descriptive statistics were used to analyze vitamin D intake and supplementation practices.
- Responses were compared based on NICU affiliation and level of care.
Main Results:
- Responses from 253 NICUs indicated that 97% provide enteral vitamin D supplementation.
- The most common dosage was 400 IU/day (77%), often initiated after established feedings (71% started at ≥120 mL/kg/day).
- Nearly all NICUs (94%) prescribed vitamin D supplementation at discharge.
Conclusions:
- The majority of U.S. NICUs administer 400 IU/day of enteral vitamin D to EP infants.
- Clinical trials comparing the standard regimen with earlier, higher doses are necessary.
- Further research is needed to establish optimal vitamin D levels and supplementation strategies for EP infants to improve outcomes.
Background:
Most extremely preterm (EP) infants are vitamin D deficient (serum 25-hydroxyvitamin D levels below 20 ng/mL), and optimal supplementation practices for EP infants remain unknown. Our objective is to assess current vitamin D supplementation practices in U.S. neonatal intensive care units (NICU) for EP infants to provide baseline information for the design of future clinical trials.
Methods:
We conducted an online survey to study vitamin D intake and supplementation practices in U.S. NICUs caring for EP infants. Descriptive statistics compared responses by affiliation and level of care.
Results:
We analyzed responses from 253 NICUs, representing the majority of academic and level IV centers. Nearly all centers (97%) provided enteral vitamin D supplementation during the NICU stay, with 400 IU/day as the most common dosage (77%). Over half (56%) used feeding volume to initiate supplementation, with 71% of centers starting after achieving at least 120 ml/kg/day. Additionally, 94% of NICUs reported prescribing a vitamin D supplementation at discharge.
Conclusions:
Most NICUs in the U.S. supplement EP infants with 400 IU/day of enteral vitamin D. Clinical trials of vitamin D supplementation comparing the most common regimen to earlier and higher doses are needed to identify adequate regimens for EP infants.
Impact:
Despite the prevalence of vitamin D deficiency in extremely preterm (EP) infants at birth, optimal levels and supplementation strategies remain debated. Recent studies have suggested benefits of early high-dose vitamin D supplementation (800 IU/day) for reducing complications like bronchopulmonary dysplasia, infections, and disability. There is US center variation in timing and dose of vitamin D supplementation, being the most common regimen 400 IU/d started after established feedings (≥120 ml/kg/day). These findings inform and highlight the need for clinical trials of usual vs. early, higher-dose vitamin D supplementation to advance clinical outcomes and define desirable blood levels of EP infants.
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