# The use of choline supplementation in premature newborns: a systematic review

## TL;DR

This systematic review examines the appropriate routes and doses of choline supplementation for preterm infants to meet their metabolic needs.

## Contribution

The study provides a systematic review of choline supplementation in preterm infants, highlighting gaps in parenteral dosing and suggesting an effective enteral dose.

## Key findings

- Parenteral choline dosage remains uncertain, with serum levels inversely related to administered quantity in preterm infants.
- An enteral dose of 40–50 mg/kg/day appears sufficient to maintain plasma choline levels similar to those in umbilical cord blood.
- The need for early choline supplementation is still debated, with no consensus on optimal parenteral dosing.

## Abstract

To identify the routes and doses of choline supplementation required to meet the metabolic demands of preterm infants.

The information was searched in three databases: US National Library of Medicine National Institute of Health (PubMed), Scientific Electronic Library Online (SciELO) and Web of Science. The search for articles was updated in August 2024, with no restrictions on publication year or language. This review was registered in the International Prospective Register of Systematic Reviews — PROSPERO (ID: 549568).

The final selection of studies yielded eight original articles, which were subsequently evaluated for their methodological quality. The recommended dosage of parenteral choline remains uncertain. However, studies have demonstrated a reduction in serum choline level inversely proportional to the quantity administered via parenteral nutrition, particularly in preterm infants with slow progression to enteral nutrition. The dose of 40–50 mg/kg/day of enteral choline appears to be sufficient to maintain plasmatic levels at a concentration comparable to that observed in the umbilical cord of preterm infants.

The need for daily choline supplementation from the first day of life is still controversial. The results of the selected studies do not allow for the determination of the optimal choline dosage for parenteral nutrition in these infants. Nevertheless, there is some scientific evidence suggesting that providing 40–50 mg/kg/day enterally is sufficient to meet the metabolic needs of preterm infants.