Multivitamin Supplementation in Preterm Infants

Physiological Rationale for Extended Supplementation

Preterm infants are born with critically low body stores of fat-soluble vitamins due to limited placental transfer in the third trimester, making them vulnerable to deficiencies 1
Very low birth weight infants (<1500g) have less adaptive capacity to vitamin variations compared to term infants, making them particularly vulnerable to deficiencies, according to the American Academy of Pediatrics 2

The American Society for Parenteral and Enteral Nutrition recommends daily administration of Vitamin A: 700-1500 IU/kg/day 1
The American Society for Parenteral and Enteral Nutrition recommends daily administration of Vitamin D: 200-1000 IU/day (or 40-150 IU/kg/day) 3
The American Society for Parenteral and Enteral Nutrition recommends daily administration of Vitamin E: 2.8-3.5 mg/kg/day (not exceeding 11 mg/day) 3
The American Society for Parenteral and Enteral Nutrition recommends daily administration of Vitamin C: 15-25 mg/kg/day 4, 3
The American Society for Parenteral and Enteral Nutrition recommends daily administration of Vitamin K: 10 μg/kg/day 3
The American Society for Parenteral and Enteral Nutrition recommends weight-based dosing of B vitamins as specified in guidelines 4, 3

The American Academy of Pediatrics recommends continuing multivitamin drops at pediatric-specific formulations once transitioned to enteral feeds 5
The American Academy of Pediatrics recommends Vitamin D supplementation (400 IU/day) for all breastfed infants regardless of gestational age at birth 5

The American Academy of Pediatrics recommends never using adult multivitamin formulations in preterm infants due to potential toxicity 1, 5
The American Academy of Pediatrics recommends using only neonatal-specific parenteral multivitamin preparations designed for preterm infants 5
The American Academy of Pediatrics recommends using pediatric multivitamin drops at recommended doses, which are safe and do not cause adverse effects like diarrhea 2

The American Society for Parenteral and Enteral Nutrition recommends adding vitamins to lipid emulsions whenever possible to increase stability and reduce losses, particularly for vitamin A 1, 5
The American Society for Parenteral and Enteral Nutrition recommends administering vitamins daily when on parenteral nutrition 3, 5
The American Society for Parenteral and Enteral Nutrition recommends routine monitoring of vitamin concentrations (except vitamin D) only if on long-term parenteral nutrition 3, 5

The American Academy of Pediatrics recommends considering oral supplementation of vitamin D during weaning from parenteral nutrition 3