Vit D in Pre-Term Infants
This article outlines the consequences of inadequate vitamin D, calcium, and phosphorous intake that is especially problematic for premature infants. They conclude that:
1. Pre-term infants are at high risk of rickets.
2. Bone mineral biochemical tests should be done at 4-5 weeks age if birth weight is less than 1500 grams.
3. Serum APA (alkaline phosphatase) of 800-1000 IU/L or evidence of fractures suggests rickets and should prompt x-rays and treatment.
4. Persistent serum phosphorus less than 4 mg/dl should be followed and consider giving more phosphorus.
5. Babies with birth weights below 2 KG should be given human milk mineral fortification if breast feeding and premature formula if formula fed.
6. The very low birth weight babies should have their APA 2-4 weeks after discharge from the hospital.
7. When weight reaches 1500 grams and infants can tolerate feeds, vitamin D should be supplemented at 400 IU a day, up to a maximum of 1000 IU a day.
In Europe, all premature infants are given 1000 IU a day and this is certainly a better approach. In the abstract of this article they recommend premature infants get 200-400 IU a day vitamin D. I see no reason to wait and follow until rickets and bone fractures develop to start giving the right amount of calcium, phosphorus, and vitamin D. Absolutely everyone in this country is sub-optimal in their vitamin D status and most are outright deficient. Mom’s should be taking 5000 IU Vitamin D during pregnancy (my recommendation and that of other vitamin D experts, though not the current mainstream recommendations) so they will have higher levels in their newborns and breast milk. All infants, premature or not, should take 1000 IU a day.