Clinical Guideline
Vitamin (including Folic acid) supplementation in preterm infants
Definition
Vitamin supplementation is necessary in preterm infants to promote growth (including bone
mineralisation) and neurodevelopmental outcomes. We use Abidec in our neonatal unit.
This contains Vitamins A, B group, C and D.
Action
Criteria for starting vitamin supplements
Birth weight and gestation
All infants with birth weight  1.5 kg
and/or birth gestation < 34+0 weeks
Feeding
Donor breast milk or maternal breast milk
(expressed or breast fed) without fortifier
AND
All infants with birth weight 
centile for gestation (intrauterine
growth restriction - IUGR)
2nd
Term formula feeds
Extensively hydrolysed protein or amino-acid
based formula, high energy formula
When to start
 Infants should be tolerating enteral feed volumes at a minimum of 150mL/kg/day and
atleast 1 week of age
Dosage
 Abidec ® 0.6mL once daily (and) Folic acid 0.5mg once a week
How to prescribe
 Use the pre-printed section in the vitamins, supplements and sucrose page of the
drug chart
How to administer
 Given on its own if infant fed by oro/naso-gastric tube
 Mixed with a small volume of milk if fed orally by bottle/cup/syringe. Ensure complete
dose is given.
Contraindications
 Infant on total parenteral nutrition
 Infants fed on preterm formula and/or fortified breast milk
Additional supplementation
 Iron – as per departmental guideline
Criteria for stopping vitamin supplements
 Feeds changed to preterm formula
 Breast milk fortifier stopped. Please remember to prescribe vitamins as take home
medications when babies are discharged home with fortifier, as fortifier is only for
short-term use.
 6 – 12 months of age when infant is established on full weaning diet.
Vitamin supplementation in Preterm Infants
Clinical Guideline – version 2
Approved by: DCGSG & WiSCH CGDG
Principal author:
Dr S Babarao
Page 1 of 2
Review date: December 2016
References:
1. Greer, F. Neonatal Nutrition and Metabolism. Second Edition, ed. P. Thureen and W.
Hay. Published by Cambridge University Press. 2006
2. Agostoni, C et al. Enteral Nutrient Supply for Preterm Infants: Commentary from the
European Society for Paediatric Gastroenterology, Hepatology, and Nutrition
Committee on Nutrition. JPGN. Volume 50, Number 1, January 2010
Auditable Standards
1. All eligible infants with birth weight ≤ 1500 g should receive vitamin
supplements as per guideline – target 100%
2. All eligible infants born < 34+0 weeks gestation should receive vitamin
supplements as per guideline – target 100%
Version
Date of issue:
Date of review:
Review interval:
Monitoring Compliance:
Author:
Approved by:
Location of copies:
1
3 yearly
Audit every 3 years
Dr S Babarao
1. DCGSG
2. WiSCH CGDG
1. Intranet
2. Clinical Areas
Background
Vitamins are organic compounds required in trace amounts in the diet for the maintenance
of normal growth and development in newborn. The daily requirements in infancy are based
on the content of breast milk with the exceptions of vitamins D and K for which breast milk is
clearly deficient. The preterm baby is at risk of vitamin deficiency because the mechanism
of assimilating and conserving vitamins is still immature, coupled with low tissue stores,
rapid growth and high metabolic turnover. Minimum supplies of each vitamin should be
supplemented to ensure the preterm infant’s normal growth and development and also
reduce the risk of developing metabolic depletion. (ESPGHAN) According to the recently
published ESPGHAN guidance, following are the recommended intake of vitamins in
preterm infants.
Vitamin B1 (Thiamine): 140-300
Vitamin B2 (Riboflavin): 200-400
microgram/kg/day
microgram/kg/day
Vitamin B3 (Niacin): 380-5500
Vitamin B5 (Pantothenic acid): 0.33-2.1
microgram/kg/day
mg/kg/day
Vitamin B6 (Pyridoxine): 45-300
Vitamin B12 (Cobalamine): 0.1-0.77
microgram/kg/day
microgram/kg/day
Vitamin A: 1330-3330 IU/kg/day
Vitamin C: 11-46 mg/kg/day
Vitamin D: 800-1000 IU/day
Folic acid: 35-100 microgram/kg/day
Abidec® 0.6 mL dose contains Vitamin A 1333 IU, Vitamin D 400 IU, Vitamin B1 0.4mg,
Vitamin B2 0.8mg, Vitamin B6 0.8mg & Vitamin C 40mg. Abidec has refined arachis oil as
one of the ingredients.
Examples of term formula feeds: Cow & Gate®, SMA®, Aptamil®
Examples of preterm formula feeds: Nutriprem-1®, Nutriprem-2®
Examples of extensively hydrolysed protein formula: Pregestimil®, Neocate LCP®
Examples of high energy formula: Similac®, SMA high energy®
Vitamin supplementation in Preterm Infants
Clinical Guideline – version 2
Approved by: DCGSG & WiSCH CGDG
Principal author:
Dr S Babarao
Page 2 of 2
Review date: December 2016