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Folic acid supplementation in low birth weight infants
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Folic acid supplementation in low birth weight infants showed minor hemoglobin increases, but no significant impact on weight gain or red cell folate levels. Routine supplementation is not recommended, though folate intake may sometimes be suboptimal.
Area of Science:
- Nutritional science
- Pediatric nutrition
- Hematology
Background:
- Low birth weight infants are at risk for nutritional deficiencies.
- Folic acid is essential for red blood cell formation.
- Optimal folate intake for low birth weight infants is not fully established.
Purpose of the Study:
- To investigate the effects of folic acid supplementation on hematological parameters and growth in low birth weight infants.
- To assess red cell folate levels in supplemented versus unsupplemented infants.
- To determine the clinical significance of folic acid supplementation in this population.
Main Methods:
- A randomized controlled trial involving 246 low birth weight infants.
- Supplementation with folic acid from 3 weeks to 12 months of age.
- Monitoring of hemoglobin, hematocrit, and red cell folate levels, along with weight gain.
Main Results:
- Folic acid group showed statistically significant, but clinically small, increases in mean hemoglobin levels at 6 and 9 months.
- No significant differences in hematocrit or weight gain between groups.
- Median red cell folate levels remained within the normal adult range; low levels in the untreated group were usually temporary and not associated with anemia.
Conclusions:
- While folic acid supplementation led to minor hemoglobin increases, it did not significantly impact hematocrit or growth in low birth weight infants.
- Routine folic acid supplementation for all low birth weight infants is not currently recommended.
- Ensuring milk preparations contain adequate folate (around 3.5 microgram/100 ml) is important, as some infants may have suboptimal folate intake.
Abstract:
Low birth weight infants (246) entered a trial to folic acid supplementation from 3 weeks to 12 months of age. The folic acid group had significantly higher mean hemoglobin levels at 6 and 9 months of age but the differences were only about 0.5 gm/dl, there was no significant difference in hematocrit, and in both groups of infants the mean hemoglobin levels were higher than those of normal birth weight infants. The differences in hemoglobin, although statistically significant, are of uncertain clinical significance. Median red cell folate levels remained within the normal adult range in both groups of infants. A minority of infants in the untreated group had low red cell folate levels but this was usually temporary, corrected by dietary folate, and not associated with low hemoglobin. Weight gain was not affected by folic acid supplementation. The infants in this trial were fed with a milk preparation containing 3.5 microgram/100 ml of folic acid which is a similar concentration to that of human milk and we recommend that the folate content of milks fed to low birth weight infants should not fall below this level. We do not have sufficient grounds to recommend routine folic acid supplements for all low birth weight infants throughout the first year of life but there is a possibility that their folate intake may sometimes be suboptimal.