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Improving Vitamin D Status in Preterm Newborns: A Randomized Trial of 800 vs. 400 IU/Day
Nawinda Rueang-Amnat1, Kulnipa Kittisakmontri2, Varangthip Khuwuthyakorn1
1Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Insights
Higher vitamin D3 dosage (800 IU/day) effectively improved vitamin D levels in preterm infants, significantly reducing hypovitaminosis D without toxicity. This finding supports optimized supplementation for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Pediatric Endocrinology
Background:
- Preterm newborns face high risk of hypovitaminosis D, potentially hindering bone development.
- Limited data exists on vitamin D deficiency prevalence and standardized supplementation in Thailand.
- Hypovitaminosis D can impair bone mineralization in premature infants.
Purpose of the Study:
- To compare the efficacy of 400 IU/day versus 800 IU/day vitamin D3 supplementation.
- To assess the impact on serum 25-hydroxyvitamin D (25(OH)D) levels in preterm infants.
- To evaluate effects on metabolic bone parameters and hypovitaminosis D prevalence.
Main Methods:
- Randomized controlled trial involving preterm infants (≤32 weeks gestation or ≤1500g birth weight).
- Infants received either 400 IU/day or 800 IU/day of vitamin D3.
- Serum 25(OH)D, calcium, phosphorus, alkaline phosphatase, and albumin measured at baseline and 6 weeks.
Main Results:
- The 800 IU/day group showed significantly higher 25(OH)D levels at 6 weeks (47.3 vs. 32.0 ng/mL, p=0.013).
- Hypovitaminosis D prevalence decreased from 89% to 5% in the 800 IU/day group (vs. 74% to 32% in 400 IU/day group, p=0.036).
- No significant differences in metabolic bone parameters or toxicity were observed between groups.
Conclusions:
- Supplementation with 800 IU/day of vitamin D3 is more effective in improving vitamin D status in preterm infants.
- The higher dosage significantly reduces the prevalence of hypovitaminosis D without adverse effects.
- This dosage regimen is recommended for optimizing vitamin D levels in preterm newborns.
Abstract:
Background and Aims: Preterm newborns are particularly susceptible to hypovitaminosis D, potentially impairing bone mineralization. In Thailand, data on its prevalence and standardized supplementation protocols remain limited. This study aimed to compare the efficacy of two vitamin D3 dosages (400 IU/day vs. 800 IU/day) in improving serum vitamin D concentrations and metabolic bone parameters in preterm newborns. Methods: A randomized controlled trial was conducted in preterm newborns born at ≤32 weeks' gestation or with birth weight ≤1500 g. Preterm newborns were randomized to receive either 400 IU or 800 IU/day of vitamin D3. Serum 25-hydroxyvitamin D (25(OH)D) was measured using electrochemiluminescence immunoassay (ECLIA). Metabolic bone parameters-including calcium, phosphorus, alkaline phosphatase, and albumin-were assessed at baseline and again at six weeks of age. Results: Of the 38 enrolled infants, baseline 25(OH)D levels were comparable between groups (14.8 ± 4.8 ng/mL in the 800 IU/day group vs. 14.7 ± 6.9 ng/mL in the 400 IU/day group). At six weeks, the 800 IU group demonstrated significantly higher 25(OH)D levels (47.3 ± 21.0 ng/mL vs. 32.0 ± 14.2 ng/mL; p = 0.013), with a large effect size (Cohen's d = 0.85) and the difference-in-differences of +15.7 ng/mL. The prevalence of hypovitaminosis D declined from 89% to 5% in the 800 IU/day group and from 74% to 32% in the 400 IU/day group (p = 0.036). No significant differences in metabolic bone parameters or signs of toxicity were observed. Conclusions: Vitamin D3 supplementation at 800 IU/day significantly improved vitamin D status and reduced hypovitaminosis D in preterm newborns, without observed toxicity.
