Background
Recommended Intakes
Effect of Volume of Formula Intake
Effect of Formula Choice
Special Concerns
Background
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 infant's actual needs.
Recommended Intakes
The Food and Nutrition Board of the National Academy of Sciences publishes Dietary Reference Intakes (DRIs), a group of reference values that have been developed according to the current level of scientific knowledge about each nutrient.
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 |
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
Effect of Formula Choice
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. Additional supplements for these infants are inappropriate with the possible exception of iron. More commonly, infants are discharged on a preterm post-discharge formula such as NeoSure or Enfamil 22. These infants also are unlikely to need additional supplementation.
Special Concerns
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.