INTRODUCTION: Very-low-birth-weight (VLBW; BW <1500g) infants receive specific nutriture, parenteral multivitamins and preterm infant formula, which provide up to 18 fold more riboflavin (vitamin B2:B2 than human milk. We have shown that VLBW infants who received this nutriture developed plasma B2 to 50-fold cord B2 during their first postnatal month. B2 photodegrades with light exposure (e.g. phototherapy) to produce lipid peroxides (LP), compounds associated with development of ROP and BPD. The American Society of Clinical Nutrition has recommended lower daily B2 administration; however, simple nutriture dilution would diminish doses of vitamins A and E (VIT-A, VIT-E), lipid soluble vitamins with antioxidant effects. The hypothesis of this study was that a newly developed nutritional regime could provide lower daily B2 while supporting VIT-A and VIT-E administration. METHODS: Infants (BW <1000g) received control (C) nutrition, 0.75-0.91 mg/k/day of B2, or the revised (RV) protocol, 0.19-0.35 mg/k/d of B2. RV lipid soluble vitamins were admixed with the daily lipid administration. Blood was collected weekly during the first postnatal month. Plasma B2, VIT-A and VIT-E were measured by HPLC. Data were analyzed with repeated measures ANOVA for postnatal weeks 1-4. RESULTS: BW, gestational age and baseline B2 showed no difference between C (n = 10) and RV(n = 8). B2 rose in both groups (Figure) but was lower in RV (130.1±13.6 ug/L, n=31, mean±SEM) compared to C(194.9±19.8 ug/L, n=38, p < 0.01). Both VIT-A and VIT-E were elevated in RV compared to C, p<0.05. CONCLUSIONS: We conclude that decreasing the daily B2 dose decreased B2 proportionately in VLBW infants during their first postnatal month. Lipid soluble vitamins admixed with the lipid emulsion resulted in higher plasma VIT-A and VIT-E.

figure 1