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Vitamin D status and response to supplementation in very preterm infants: A prospective cohort study

Suphawe Wasuanankun1, Prattana Rattanachamnongk2, Buranee Yangthara3

  • 1Department of Pediatrics, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand.

European Journal of Clinical Nutrition
|April 13, 2026
PubMed

Insights

Vitamin D deficiency is common in very preterm infants. Daily intake under 400 IU/kg typically normalizes vitamin D levels by 8 weeks, reducing risks associated with deficiency and excess.

Area of Science:

  • Neonatology
  • Pediatric Endocrinology
  • Nutritional Science

Background:

  • Very preterm infants face high risks of vitamin D deficiency (VDD), contributing to metabolic bone disease (MBD) and other complications.
  • Optimal vitamin D dosing for these infants remains unclear despite existing guidelines.
  • This study investigated VDD incidence and 25-hydroxyvitamin D [25(OH)D] responses to different vitamin D intakes in early life.

Purpose of the Study:

  • To determine the incidence of vitamin D deficiency (VDD) in very preterm infants.
  • To evaluate the impact of varying vitamin D intakes on serum 25-hydroxyvitamin D [25(OH)D] levels within the first 8 weeks of life.
  • To assess the safety and efficacy of different vitamin D supplementation regimens.

Main Methods:

  • A prospective cohort study of infants born before 32 weeks' gestation or with birth weight under 1500g.
  • Infants were grouped by total vitamin D intake (parenteral and enteral) during weeks 0-4: <400, 400-700, or >700 IU/kg/day.
  • Serum 25(OH)D levels were measured at birth, 4 weeks, and 8 weeks; VDD was defined as <20 ng/mL and vitamin D excess (VDE) as >100 ng/mL.

Main Results:

  • High VDD prevalence at birth (94.3%). At 4 weeks, VDD persisted in 17.8% (<400 IU/kg/day) and 6.5% (400-700 IU/kg/day), with minimal VDE.
  • By 8 weeks, 90.1% achieved normal 25(OH)D with <400 IU/kg/day, compared to 77.4% with 400-700 IU/kg/day.
  • Higher intakes (400-700 IU/kg/day) led to increased VDE (22.6%) by 8 weeks; MBD occurred in only one infant.

Conclusions:

  • VDD is nearly universal at birth in very preterm infants.
  • A daily intake of less than 400 IU/kg effectively normalized vitamin D status by 8 weeks, minimizing risks of both deficiency and excess.
  • Higher vitamin D doses did not offer additional benefits and increased the risk of vitamin D excess.
Abstract

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