1445 SERUM B 12 AND FOLATE LEVELS IN LBW INFANTS: REASSESSMENT OF RECOMMENDED INTRAVENOUS SUPPLEMENS

Abstract

Serum B 12 and folate were measured by RIA in maternal serum, cord blood and at 2 wk intervals in 18 LBW infants (gestational age 29.9 ± 1.9 weeks, birth weight 1.18 ± .26 kg). All infants received parenteral alimentation (PA) (18.8 ± 13.9 days, range 2-51 days) with supplemental B 12 (5 ugm/day) and folate (50 ugm/day) as recommended by the AAP Pediatric Nutrition Handbook (1979). After PA, infants received only B 12 and folate present in formula (1.5-2ugm/l and 50-100 ugm/l). Cord B 12 (805 ± 2.8 pg/m)and folate (14.6 ± 2.8 ng/ml) were higher (p<.01) than maternal B 12 (464 ± 534 pg/ml) and folate (4.4 ± 4.5 ng/ml). (Adult normals: B 12 >250 pg/ml, folate > 4 ng/ml). At two wks B 12 and folate were higher than cord levels (p<.01); 88% of B 12 levels > 2000 pg/ml and 75% of folate levels > 20 ng/ml. B 12 (100% > 2000pg/ml) remained > cord B 12 (p<0.01) throughout 6 wks PA. Folate (60% >20ng/ml) remained > cord folate (p<0.01) for 4 wks PA. B 12 and folate obtained 6 to 8 weeks after discontinuation of PA remained higher than cord B 12 and folate (p<0.01). Median B 12 1520 pg/ml and 100% folate levels were still > 20 ng/ml. Changes in B 12 and folate levels did not correlate with Hgb, rate of growth, length of PA or length of po feeds. LBW infants who receive at least two days of PA with B 12 and folate supplementation do not need oral supplements beyond what is present in formula. We conclude that the present recommended intravenous supplements of B 12 and folate are excessive and that lower levels of supplementation need to be assessed.

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