Background
Recommended Intakes
Effect of Volume of Formula Intake
Effect of Formula Choice
Special Concerns
In the first weeks and months of life VLBW infants have increased needs per unit of body weight for energy, protein, vitamins, and minerals. It is not clear how long these increased needs persist for any one infant.
The need for vitamin mineral supplementation should be based on choice of breast milk or formula, the nutrient content of the feeding, and the volume consumed.
As the infant grows, it is common practice to assume that the preterm infant will need the same amount of nutrients as a term infants when a weight of 2.0-2.5 kg is achieved. Follow-up growth data and mineral status suggests that some preterm infants may continue to have higher needs for some nutrients. Prenatal and postnatal medical, developmental, and nutritional history may influence the individual infants actual needs.
The Food and Nutrition Board of the National Academy of Sciences has been revising dietary recommendations. The term Dietary Reference Intakes (DRIs) is now used to refer to a group of reference values that have been developed according to the current level of scientific knowledge about each nutrient. In the new recommendation system, the term DRI (dietary reference intakes) is used when sufficient evidence is available to determine specific levels of dietary adequacy for 50 percent of the population. An additional intake recommendation is added to that level so that the nutritional needs of almost all people of a given age and gender will be met. When there is insufficient evidence to establish an DRI, an adequate intake (AI) is determined. The AI is the observed intake level that appears to sustain adequate nutritional status in a population. For infants, this is based on the nutrient content of breastmilk. Further explanation of the new recommendations may be found at http://nap.edu/topics.php?topic=380.
Dietary Reference Intakes (DRIs): Recommended intake of select nutrients for Individuals
| Nutrient | 0-6 months |
7-12 months |
1-3 years |
| Protein g/d | 9.1 |
11 |
13 |
| Vitamin A ug/d | 400 |
500 |
300 |
| Vitamin D ug/d | 5 |
5 |
5 |
| Vitamin E mg/d | 4 |
5 |
6 |
| Folate ug/d | 65 |
80 |
150 |
| Calcium mg/d | 210 |
270 |
500 |
| Phosphorus mg/d | 100 |
275 |
460 |
| Magnesium mg/d | 30 |
75 |
80 |
| Iron mg/d | .27 |
11 |
7 |
| Zinc mg/d | 2 |
3 |
3 |
These recommendations are too new for health professionals who work with VLBW infants to have much experience with them. After discharge, VLBW infants may have needs that fall between the needs of the hospitalized preterm infant and a term infant. In addition, these recommendations are based on some assumptions, such as size, that may not be applicable to the individual VLBW infant. Recommendations for total daily intake may need to be adjusted for size differences.
Effect of Volume of Formula Intake
Nutrient content of formulas varies. Please see section on infant formulas for descriptions. Recommendations for supplementation will change if an infant is consuming a formula that has higher levels of energy and nutrients per ounce. This is an important issue if excessive supplementation is to be avoided.
Although it is inappropriate for most infants who weigh more than 2.5 kg, occasionally an infant will be discharged to the community on a formula for premature infants such as Simliac Special Care or Enfamil Premature formula. Additional supplements for these infants are inappropriate with the possible exception of iron. More commonly, infants are discharged on a preterm follow-up formula such as NeoSure or Enfamil 22. These infants also are unlikely to need additional supplementation.
The table below provides comparative information about potential vitamin and mineral intake from selected volumes of formula intake. It is based on the assumption that the VLBW infant will have an intake of formula that provides 120 kcal/kg/day. This Table can be compared to the DRI table above in order to estimate the need for supplementation. This comparison will also illustrate the potential for intakes exceeding recommendations with use of highly fortified formulas in larger infants.
DRI |
Similac Special Care (24 kcal/oz) |
Enfamil Premature Formula (24 kcal/oz) |
NeoSure (22 kcal/oz) |
||||||
Infant's Weight (kg) |
2.5 |
4 |
2.5 |
4 |
2.5 |
4 |
2.5 |
4 |
|
Formula Intake (oz) |
12 |
20 |
12 |
20 |
14 |
22 |
12 |
24 |
|
Vitamin A (IU) |
1500 |
3040 |
5067 |
3040 |
5067 |
1442 |
2266 |
800 |
1600 |
Vitamin D (IU) |
300 |
435 |
726 |
784 |
1307 |
251 |
394 |
20 |
41 |
| Vitamin E aTE | About 4 |
9.7 |
19.5 |
15.5 |
31 |
11 |
18 |
1.6 |
3.3 |
Vitamin C (mg) |
30 |
12 |
150 |
18 |
81 |
47 |
74 |
24 |
49 |
Folate (mg) |
25 |
90 |
180 |
85 |
170 |
78 |
123 |
20 |
41 |
Calcium (mg/kg/d) |
67 |
219 |
219 |
200 |
200 |
131 |
131 |
45 |
45 |
Phosphorus (mg/kg/d) |
50 |
121 |
121 |
100 |
100 |
77 |
77 |
23 |
23 |
Iron (mg/kg/d) |
1.0 |
2.2 |
2.2 |
2.2 |
2.2 |
2.2 |
2.2 |
.06 |
.06 |
3 (Institute of Medicine Staff, 1998)
4 Mean values from Fomon, 1993.
5 not available
Individual infants may also have increased nutrient needs for other vitamins and minerals secondary to medical conditions and/or drug nutrient interactions. Calcium, phosphorus, and vitamin D are of special concern for infants with risk of osteopenia. Some VLBW infants may be at higher risk for anemia.
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