# Exclusive Breastfeeding Is Not Ensuring an Adequate Vitamin B Status in Premature Infants with Very Low Birth Weight

## TL;DR

Exclusive breastfeeding may not provide enough B vitamins for premature infants with very low birth weight, leading to potential deficiencies.

## Contribution

The study shows that exclusive breastfeeding without multivitamin supplementation can result in B vitamin deficiencies in premature infants.

## Key findings

- Breastfed infants had lower cobalamin, PLP, and riboflavin levels compared to formula-fed infants.
- 80% of breastfed infants had elevated tHcy, indicating cobalamin deficiency.
- 3–9% of infants showed serious B vitamin deficiencies at each time point up to 12 months.

## Abstract

Background: Exclusive breastfeeding for the first 6 months of corrected age (CA) is recommended for premature infants with very low birth weight (<1500 g) (VLBW). B vitamins are essential for normal development and growth, including DNA methylation, and we investigated whether exclusive breastfeeding for the first 6 months provides an adequate cobalamin, folate, vitamin B6, and vitamin B2 status compared to additional or exclusive formula feeding from term to 12 months CA. Methods: In recruited infants born prematurely with VLBW, levels of vitamin B12 (cobalamin), folate, vitamin B6 (pyridoxal 5′-phosphate, PLP), vitamin B2 (riboflavin), and the metabolic markers, total homocysteine (tHcy) and methylmalonic acid (MMA), were determined at term (n = 35) and at 2 (n = 47), 6 (n = 48), and 12 months (n = 58) CA. Results: Only a minority of the infants were given multivitamin supplementation, and this was associated with higher PLP and riboflavin levels. One-third of the infants were exclusively breastfed to 6 months CA, and these had lower cobalamin, PLP, and riboflavin concentrations compared to formula-fed infants; additionally, 80% had plasma tHcy concentrations ≥ 6.5 µmol/L, indicative of cobalamin deficiency during the first 6 months CA. Serious deficiency of one or more B vitamins was evident in 3–9% of the infants at each time point during the first 12 months CA, more often in breastfed infants, but not exclusively. Conclusions: Exclusive breastfeeding with inadequate multivitamin supplementation and no specific recommendation for introduction of solid food does not provide an adequate B vitamin status in infants born prematurely with VLBW. Nutritional micronutrient recommendations must be improved, and regular evaluation of vitamin status should be implemented in the follow-up for premature VLBW infants.