Vitamins and Iron Supplementation

Vitamins and Iron Supplementation

(Version 1.0 01/21/02 - 05/07/03)

Multivitamins

Although the actual vitamin needs of the preterm infant remain ill-defined, to meet current recommendations for vitamin A, D, and K intakes, some preterm infants need to receive a vitamin supplement.

Infants receiving full feeds of 24kcal/oz preterm formula, EPF or SSC, are receiving adequate vitamin intakes.

Premature infants being fed on fortified breast milk (except mild fortified with HMF) or a transitional formula need a vitamin supplement. Add 1cc Poly-vi-sol with Iron po qd to unfortified breast milk. Provide 0.5cc Poly-vi-sol with Iron po qd to the preterm infant fed a 22 kcal/oz transitional formula, an elemental or soy formula, or breast milk fortified with SNC, Enfacare, or Neosure Powder.

References:

American Academy of Pediatrics. Pediatric Nutrition Handbook, 4^th ed. 1998.

Greer FR. Vitamin metabolism and requirements in the micropremie. Clin Perinatol 2000; 27: 95-118.

Iron

As fetuses accumulate iron predominantly in the third trimester, prematurely born infants have inadequate iron stores. All premature infants should receive an iron supplement by 2 months chronologic age. Iron supplements have been shown to be safe as early as 2 weeks chronologic age, and many premies will receive iron earlier than 2 months of age.

During their first weeks of life, micropremies usually receive multiple blood transfusions which provide supplemental iron. Furthermore, parenteral iron supplements were historically associated with an increased incidence of sepsis. Therefore, iron supplements are provided enterally (as Fer-in-Sol drops or polyvisol with iron) As iron can cause GI intolerance, Fer-in-Sol should not be given until the baby is tolerating full feeds of an adequate caloric density for growth.

Recommended iron intakes for premature infants are:

< 1000g birthweight 4 mg/kg/d elemental iron

> 1500g birthweight 2 mg/kg/d elemental iron

Infants receiving erythropoeitin (Epogen) need > 6 mg/kg/d elemental iron.

Fer-In-Sol drops contain 2.5 mg elemental iron in 0.1cc.

Poly-vi-sol with iron contains 10 mg elemental iron in 1cc.

Premature infants receiving full feeds of a 24 kcal/oz preterm formula (EPF or SSC) or a 22 kcal/oz transitional formula (Neosure or Enfacare) get an intake of ~2 mg/kg/d elemental iron from their feeds. Infants fed breast milk and fortified breast milk consume negligible amounts of iron.

VLBW infants receiving 24 kcal/oz preterm formula should be given 0.1 cc/kg/d of Fer-in-Sol to provide supplemental iron.

The breast milk-fed VLBW infant may be given Poly-vi-sol with Iron 1 cc po qd.

The preterm infant fed 22 kcal/oz transitional formula should receive Poly-vi-sol with Iron 0.5cc po qd.

Approved at the Clinical Division Meeting 1/21/02. Updated by Kira Mollenkopf 5/07/03.

References:

American Academy of Pediatrics. Pediatric Nutrition Handbook, 4^th ed. 1998. pgs. 61-2.

American Academy of Pediatrics. Nutritional needs of low-birth-weight infants. Pediatrics 1985; 75: 976-86.