Full volumes of enteral feedings were defined as infants attaining 150–160 mL/kg/day. Parenteral nutrition was gradually tapered as enteral nutrition was advanced and was discontinued when infants were receiving 120 mL/kg/d from feeds. If infants showed intolerance with new transition, fortified breast milk 22 Cal/oz was given for 1–2 days before advancing to 24 Cal/oz. Feeds were fortified to 24 Cal/oz using bovine milk-derived human milk fortifier (Enfamil Human Milk Fortifier Acidified Liquid, Mead Johnson) when infants’ enteral intake was more than 60 mL/kg/day. Donor human milk was not available at our center. Feeding was advanced at 10–20 mL/kg/day if tolerated at the discretion of the primary neonatologists. Enteral feeding was initiated with 10–20 mL/kg of maternal breast milk or regular premature formula (Enfamil ® Premature 20 Cal/oz, Mead Johnson) within 24–48 h when the clinical condition was stable. VLBW infants were started on parenteral nutrition from the first day of life. Vitamin D, calcium, and phosphorus intake The Institutional Review Board of Cook County Health System approved the study. Infants who died within 7 days of life, or those with congenital anomalies or known inborn metabolic disorders were excluded from this study. VLBW infants (inborn and outborn), born between Novemand Maand admitted to NICU, were enrolled after obtaining informed written consent from their mothers. Hospital of Cook County, Chicago, Illinois. Thus, we sought: (1) to determine the prevalence of VDD, and insufficiency at birth in VLBW infants admitted to the neonatal intensive care unit (NICU) of an urban Chicago public hospital, and (2) to assess whether the current practice of vitamin D supplementation is appropriate for VLBW infants in our population.Ī prospective cohort study was conducted at the NICU of John Stroger, Jr. To our knowledge, the adequacy of this dose for VLBW infants has not been studied recently. The amounts of vitamin D in parenteral nutrition that can be provided are dependent on manufacturer multivitamin formulation, which is 120 IU for infants weighing <1 kg, and 260 IU for infants weighing between 1 and 3 kg. The American Society for Parenteral Nutrition guidelines suggests supplementing 200 IU of vitamin D per day. Moreover, there is a scarcity of studies and guidelines addressing the vitamin D contents of parenteral nutrition for very low birth weight infants (VLBW, birth weight <1500 g). Previous randomized trials of premature infants receiving daily vitamin D intake of 200, 400, 800, or 2000 IU reported varying levels of vitamin D sufficiency (VDS). Current recommendation for oral supplementation varies from 200–400 IU/day as per the American Academy of Pediatrics (AAP) to 800–1000 IU/day by the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). The recommended daily vitamin D requirement for premature infants also varies. A 25(OH)D > 100 ng/mL is considered vitamin D excess (VDE). Īs per the Endocrine Society, VDD is defined as a serum 25-hydroxyvitamin D below 20 ng/mL, insufficiency as a 25(OH)D of 20–29 ng/mL, and sufficiency as a 25(OH)D of 30–100 ng/mL. As such, infants born to African American women tend to have lower vitamin D levels at birth and may be at a greater risk of its metabolic consequences. In the United States, African American women have the highest prevalence of VDD and are also at the greatest risk of premature delivery. ![]() ![]() Vitamin D levels at birth are also affected by race and season of birth. Consequently, preterm infants are born with lower vitamin D levels. Vitamin D is primarily transferred to the fetus in the third trimester of pregnancy. Furthermore, animal studies support the hypothesis that VDD might alter the risk of bronchopulmonary dysplasia (BPD). ![]() Vitamin D deficiency (VDD) may increase the risk of respiratory tract infections, asthma, seizures, and growth disturbances. The discovery of vitamin D receptors in other organs suggests that the role of vitamin D extends beyond bone homeostasis. Vitamin D, a fat-soluble vitamin, is critical for bone health and plays a crucial role in calcium and phosphorus metabolism.
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