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

Background

Exclusive breastfeeding for the first 6 months of corrected age (CA) is recommended for premature infants with very low birth weight (<1500 g) (VLBW). B vitamins are essential for normal development and growth, including DNA methylation, and we investigated whether exclusive breastfeeding for the first 6 months provides an adequate cobalamin, folate, vitamin B6, and vitamin B2 status compared to additional or exclusive formula feeding from term to 12 months CA.

Methods

In recruited infants born prematurely with VLBW, levels of vitamin B12 (cobalamin), folate, vitamin B6 (pyridoxal 5'-phosphate, PLP), vitamin B2 (riboflavin), and the metabolic markers, total homocysteine (tHcy) and methylmalonic acid (MMA), were determined at term (n = 35) and at 2 (n = 47), 6 (n = 48), and 12 months (n = 58) CA.

Results

Only a minority of the infants were given multivitamin supplementation, and this was associated with higher PLP and riboflavin levels. One-third of the infants were exclusively breastfed to 6 months CA, and these had lower cobalamin, PLP, and riboflavin concentrations compared to formula-fed infants; additionally, 80% had plasma 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 the infants at each time point during the first 12 months CA, more often in breastfed infants, but not exclusively.

Conclusions

Exclusive breastfeeding with inadequate multivitamin supplementation and no specific recommendation for introduction of solid food does not provide an adequate B vitamin status in infants born prematurely with VLBW. Nutritional micronutrient recommendations must be improved, and regular evaluation of vitamin status should be implemented in the follow-up for premature VLBW infants.