Water soluble vitamin status of low birthweight infants receiving total parenteral nutrition

Levy, Ryna (1990) Water soluble vitamin status of low birthweight infants receiving total parenteral nutrition. Masters thesis, Memorial University of Newfoundland.

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Abstract

Vitamin recommendations for low birthweight (LBW) infants on total parenteral nutrition (TPN) are met with 3 mL of a multivitamin supplement, MVI-Pediatric (McGraw Laboratories). However, there is limited data available on the adequacy of this preparation and on the exact needs of infants receiving TPN. The purpose of this study was to assess the thiamin, riboflavin, folate and vitamin B₁₂ status of parenterally fed LBW infants receiving MVI-Pediatric. Thirty infants were randomly assigned to receive either 3 mL of MVI Pediatric (PAR3 group; birthweight = 1133 ± 293 g; gestational age = 29.4 ± 2.1 weeks) or 2 mL (PAR2 group; 1137 ± 231 g; 28.5 ± 1.8 weeks). One hundred percent (%) received TPN for the first week, 50% by the second, and less than 33% by the third. Eighteen control infants received enteral feeds only (ENT group; 1281 ± 271 g; 29.6 ± 1.7 weeks). -- Weekly blood, 24 hour urine collections and dietary intake data were obtained. The adequacy of thiamin and riboflavin was assessed by erythrocyte transketolase activity (ETA) and erythrocyte glutathione reductase activity coefficient (EGRAC) respectively. Urinary thiamin and riboflavin levels were measured by fluorometric techniques. Plasma folate, red blood cell (RBC) folate, urinary folate and plasma vitamin B₁₂ concentrations were determined by a radioassay. As well, the thiamin, folate and B₁₂ levels in the TPN admixture and MVI-Pediatric were analyzed. -- The ETA and EGRA were within the normal range for all groups at each time period. No significant differences were found in ETA among the 3 groups. The EGRAC did differ significantly between the PAR2 (0.98 ± 0.07) and PAR3 groups (1.11 ± 0.10) at week 2 but no difference was observed between the ENT group and the parenteral groups at any time. Urinary thiamin and riboflavin levels were significantly lower prior to the initiation of parenteral or enteral feeds than at subsequent sampling times. However, there was no difference found between groups during the study period. -- No difference was observed in RBC folate levels at any time. Plasma folate did significantly differ between the PAR3 group (24 ± 7 ng/mL) and both the PAR2 (13 ± 5 ng/mL) and ENT groups (16 ± 3 ng/mL) prior to the initiation of feeds and at week 1 and between the PAR3 (30 ± 16 ng/mL) and PAR2 (16 ± 4 ng/mL) infants at week 2. A difference was found in plasma vitamin B₁₂ between the ENT groups (551 ± 287 pg/mL) and both the parenteral groups (PAR2 = 841 ± 405 pg/mL; PAR3 = 924 ± 424 pg/mL) at week 1 and between the ENT (530 ± 238 pg/mL) and PAR3 (999 ± 425 pg/mL) groups at week 2. -- From the results of the present study it appears that 2 mL of MVI-Pediatric is sufficient to meet the thiamin, riboflavin, folate and vitamin B₁₂ needs of the parenterally fed LBW infant.

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