Exclusive Breastfeeding Is Not Ensuring an Adequate Vitamin B Status in Premature Infants with Very Low Birth Weight.

Exclusively breastfed VLBW infants had lower cobalamin, PLP, and riboflavin concentrations compared to formula-fed infants.

• One-third of the infants were exclusively breastfed to 6 months corrected age (CA).
• Exclusively breastfed infants had lower cobalamin, pyridoxal 5'-phosphate (PLP), and riboflavin concentrations than formula-fed infants.
• 80% of exclusively breastfed infants had plasma total homocysteine (tHcy) concentrations ≥ 6.5 µmol/L, indicative of cobalamin deficiency during the first 6 months CA.

Serious deficiency of one or more B vitamins was evident in 3–9% of infants at each time point during the first 12 months of corrected age.

• Serious deficiency was observed at each of the four time points: term, 2 months, 6 months, and 12 months CA.
• Serious deficiency was more often found in breastfed infants, but not exclusively so.
• Sample sizes at each time point were: term (n = 35), 2 months CA (n = 47), 6 months CA (n = 48), and 12 months CA (n = 58).

Multivitamin supplementation was given to only a minority of infants and was associated with higher PLP and riboflavin levels.

• Only a minority of the recruited VLBW premature infants received multivitamin supplementation.
• Multivitamin supplementation was associated with higher pyridoxal 5'-phosphate (PLP) concentrations.
• Multivitamin supplementation was associated with higher riboflavin concentrations.

The study measured vitamin B12 (cobalamin), folate, vitamin B6 (PLP), vitamin B2 (riboflavin), total homocysteine (tHcy), and methylmalonic acid (MMA) in VLBW premature infants at four time points.

• Infants had very low birth weight, defined as less than 1500 g.
• Measurements were taken at term and at 2, 6, and 12 months corrected age.
• Both direct vitamin levels and metabolic markers (tHcy and MMA) were used to assess B vitamin status.
• Exclusive breastfeeding for the first 6 months of corrected age is the recommended feeding practice for VLBW premature infants.

The authors concluded that nutritional micronutrient recommendations must be improved and regular evaluation of vitamin status should be implemented in follow-up care for premature VLBW infants.

• Exclusive breastfeeding with inadequate multivitamin supplementation and no specific recommendation for introduction of solid food does not provide adequate B vitamin status.
• The authors call for improved nutritional micronutrient recommendations for this population.
• Regular evaluation of vitamin status was recommended to be implemented in the follow-up of premature VLBW infants.