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Higher doses of vitamin D recommended for preterm infants

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WASHINGTON — The risk for rickets among premature infants and children with markedly low vitamin D levels has caused various organizations to establish different dosing recommendations. At the 2013 Pediatric Academic Societies Annual Meeting, researchers reported that preterm infants should be administered 800 IU per day for ideal bone strength.

According to a press release, Chandra Kumar Natarajan, DM, a fellow in training at the All India Institute of Medical Sciences in New Delhi, and colleagues collected blood samples to determine the serum 25-hydroxyvitamin D levels of 96 breast-fed infants born between 28 and 34 weeks of gestation. The researchers assigned the infants to either 800 IU or 400 IU of oral vitamin D3.

“The study results show conclusively that in preterm infants with high rates of vitamin D insufficiency at baseline, supplementation with 800 IU of vitamin D3 per day compared to 400 IU per day reduces vitamin D insufficiency at term equivalent age and at 3 months,” Natarajan said. “There also is a trend toward a decrease in the prevalence of vitamin D insufficiency, even in the 400-IU group at 3 months. Therefore, 400 IU per day may be sufficient after 3 months.”

According to data, vitamin D insufficiency was common in the 800-IU group (79%) and the 400-IU group (83%) before administration of supplements.

After supplementation was administered, the researchers reported a reduced prevalence of vitamin D insufficiency at 40 weeks in the 800-IU group vs. the 400-IU group (38% vs. 67%). At 3 months, the insufficiency was significantly lower in the 800-IU group (12% vs. 35%).

Furthermore, one infant in the 800-IU group demonstrated vitamin D levels (100 ng/mL-150 ng/mL) higher than the recommended levels at 3 months (2.4%; 95% CI, 0.06-12.5), according to the abstract. However, no major adverse events were reported.

“The incidence of vitamin D excess in the 800-IU group may indicate the need for monitoring vitamin D levels in infants on vitamin D supplementation, but we need larger studies to answer this,” Natarajan said. “Similarly, larger studies with longer duration of follow-up may be needed to find out any meaningful difference in clinical outcomes such as bone mineralization.”

For more information:

Natarajan C. #2183.8. Presented at: Pediatric Academic Societies Annual Meeting; May 4-7, 2013; Washington.