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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

Premature infants: Not getting their vitamin D?

Very premature infants are called early preterm infants (EPTIs) and are defined as infants born eight or more weeks early. A subset of EPTIs are born 12 weeks or earlier and often weigh less than a pound.

What are the vitamin D levels of such children, how to those levels change from birth to discharge, and how much vitamin D do they actually get during their hospitalization?

These questions have never fully be answered until recently when Doctor Nagendra Monangi, working under senior author Associate Professor Henry Akinbi, both of the Children’s Hospital Medical Center at the University of Cincinnati, conducted the first longitudinal study of vitamin D levels in very premature infants.

Monangi N, Slaughter JL, Dawodu A, Smith C, Akinbi HT. Vitamin D status of early preterm infants and the effects of vitamin D intake during hospital stay. Arch Dis Child Fetal Neonatal Ed. 2013 Jul 13.

Here is what they found:

  • Overall, 64% of EPTIs had serum 25(OH)D concentrations <20 ng/ml at birth.
  • Approximately 70% of infants born more than 12 weeks premature had 25(OH)D concentrations <20 ng/ml.
  • Sixty-three percent of mothers had 25(OH)D concentrations <20 ng/ml.
  • Mean vitamin D intake at 4 weeks postnatal age was only 290 IU/day.
  • At discharge, 40% of the infants still had intakes less than 400 IU/day.
  • Forty percent of infants born more than 12 weeks early still had 25 (OH)D levels <20 ng/ml at discharge.

The authors concluded:

“In this study, neither the vitamin D intake, nor the recommended serum 25(OH)D concentrations of ≥20 ng/ml were attained in many EPTIs. The serum 25(OH)D concentrations of infants were directly correlated with maternal vitamin D status at birth. Therefore, vitamin D status should be optimized in pregnant women as part of strategy to replete the offspring. In addition, EPTIs require heightened attention to vitamin D supplementation in the NICU to improve vitamin D intake and vitamin D status.”

The researchers also noted that while the U.S. Food and Nutrition Board recommends 400 IU/day for all children, no matter their weight, the European Society for Pediatrics Gastroenterology, Hepatology and Nutrition recommend 800–1000 IU/day for preterm infants, an amount that was certainly not being met.

  About: John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, emergency physician, and psychiatrist.
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3 Responses to Premature infants: Not getting their vitamin D?

  1. Rita and Misty says:

    Preterm births can have very serious and long term complications for infants:

    Mortality and Acute Complications in Preterm Infants
    http://www.ncbi.nlm.nih.gov/books/NBK11385/

    In summary, preterm births are associated with the following conditions:

    1. Immature lungs, leading to diseases such as bronchopulmonary dysplasia. There is currently a study in Denmark looking at this condition with respect to NO, vitamin A and vitamin D. http://clinicaltrials.gov/show/NCT01722760

    2. Neurological damage such as cerebral palsy, mental retardation, and autism (risk of autism increases with each week a baby is born early)

    Dr. Cannell’s papers on autism:
    http://www.ncbi.nlm.nih.gov/pubmed/23725905
    http://www.ncbi.nlm.nih.gov/pubmed/17920208
    http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2010.01883.x/full

    3. Increased risk of schizophrenia

    Here is an interesting study on Neonatal vitamin D status and risk of schizophrenia: a population-based case-control study:
    http://archpsyc.jamanetwork.com/article.aspx?articleid=210878

    4. Immature gastrointestinal sytsem leading to feeding intolerance, with the immature GI tract having difficulty digesting food necessary for ongoing growth and development.
    Preterm infants may also suffer from necrotizing enterocolitis (NEC), which is an acute injury of the small or large intestines that causes inflammation and injury to the bowel lining.

    5. Immature heart development , which may range from major morphological defects to dysfunctional autoregulation of blood vessels (hypotension).

    By the way: a May 2012 World Health Organization (WHO) report stated that preterm births are on the rise.

    The reported listed main causes of preterm births in low-income countries as being:
    •Infections
    •Malaria
    •HIV
    •High adolescent pregnancy rates

    In high-income countries, the main causes of preterm births were:
    •Increasing number of older women giving birth
    •Increased use of fertility drugs and resulting multiple pregnancies
    •Medically unnecessary inductions and Cesarean deliveries before full-term

    I found it disheartening that the WHO report did not list low vitamin D levels of expectant moms as a cause for preterm births, as I think it has already been proven that low maternal vitamin D level is a risk factor for premature delivery.

    Here is one article on the subject by Dr. William B. Grant:
    Adequate Vitamin D during Pregnancy Reduces the Risk of Premature Birth by Reducing Placental Colonization by Bacterial Vaginosis Species
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065193/

    To me, the Occam’s razor to preterm deliveries, and all the associated problems, would be Vitamin D3 supplementation: 7,000 iu D3 daily administered to expectant moms (5,000 iu D3 for the mom and 2,000 i.u. D3 daily for her precious cargo).

    Safe, Simple, Effective, Economical…

    :)

  2. Rebecca Oshiro says:

    Europe is usually more progressive in these matters, reflected in their updated recommendations for this population.

  3. Rita and Misty says:

    A friend recently stated that perhaps Europe is more progressive in all of these matters because of its universal healthcare system, leading to a need to keep costs down.

    I have my doubts regarding universal healthcare. I think universal health care can only provide rationed care at best. It increases taxes, and those who desire additional services will ultimately have to purchase costly supplemental private plans. I might be wrong. These are just my thoughts.