The American Academy of Pediatrics (AAP) released new guidelines on vitamin D requirements for preterm infants and very low birth weight infants. The guidelines were developed by Professor Steven A Abrams, MD, and the AAP Committee on Nutrition.
In 2011, the Institute of Medicine (IOM) released requirements for all ages for the general population. However, preterm infants are considered a special population, so the IOM did not make any specific guidelines for these babies. Thus, the AAP felt there was a need to make guidelines for preterm infants.
Preterm infants are babies born less than 37 gestational weeks old. They can have poor bone health, likely because substantial bone mineralization occurs between 32 and 36 weeks of gestation. Although concrete data is lacking, it is estimated that anywhere between 10-20% of hospitalized preterm infants that weigh less than 1000 g (2.2 lbs) have rickets.
Therefore, vitamin D and calcium nutrition are very important to the development of preterm infants and very low birth weight infants, to ensure proper bone health and general development.
In their new guidelines, here is what the AAP recommends:
- For babies that weigh less than 1500 g (3.3 lbs), they should get biochemical testing for bone mineral status starting 4 to 5 weeks after birth. Babies that weigh over 1500 g do not necessarily need this testing.
- If the babies’ serum alkaline phosphatase activity is greater than 800 IU/L to 1000 IU/L or the baby is getting fractures, they should receive radiographic evaluation for rickets and treated with calcium and phosphorus as necessary.
- Preterm infants weighing less than 1800 to 2000 g (4.4 lbs) should receive human milk fortified with minerals or take formula specifically designed for preterm infants.
- For preterm and very low birth weight infants that weigh less than 1500 g, they should get 200 to 400 IU of vitamin D/day. For infants that weigh over 1500 g, they should get 400 IU/day. The maximum preterm and very low birth weight infants can get is 1000 IU/day.
- When infants reach a body weight of greater than 1500 g, vitamin D intake should be around 400 IU. The maximum they can get is 1000 IU/day.
- Infants with cholestasis, other malabsorptive disorders, or renal disease should be considered for special assessment, sometimes warranting 25(OH)D levels over 50 ng/ml.
The Committee concluded,
“Small-for-gestational-age infants at or near term, such as is common in many global settings, may usually be provided minerals in the same way as larger infants of the same gestational age. Such infants should be monitored carefully for growth, and an adequate intake of vitamin D should be ensured.”