What is the recommended dose of vitamin B12 (cobalamin) for a neonate in the Intensive Care Unit (ICU)?

Vitamin B12 Dosing for Neonates in the ICU

The recommended dose of vitamin B12 (cobalamin) for neonates in the ICU is 0.3 μg/kg/day. 1

Dosing Recommendations by Age

• Preterm and term infants up to 12 months: 0.3 μg/kg/day 1
• Children and adolescents (1-18 years): 1 μg/day 1

Administration in Parenteral Nutrition

Vitamin B12 is typically administered as part of parenteral nutrition for neonates in the ICU. The guidelines from ESPGHAN/ESPEN/ESPR/CSPEN provide clear recommendations for vitamin B12 supplementation in this population:

• Vitamin B12 should be included in the parenteral nutrition formulation at 0.3 μg/kg/day for all neonates 1
• This dosing is appropriate for both preterm and term infants up to 12 months of age 1
• The recommendation is based on expert consensus from major pediatric nutrition societies 1

Special Considerations for Neonates

• Vitamin B12 is an organometallic complex that participates in metabolic reactions involving the synthesis of DNA nucleotides 1
• Neonates, especially premature infants, have immature enzymatic systems that may affect vitamin metabolism 1
• Higher doses (0.6 μg/kg/day) have been reported to lead to elevated serum levels, suggesting the current recommendation is sufficient 1

Monitoring and Adjustment

• For neonates receiving parenteral nutrition, routine monitoring of vitamin B12 status is not typically required unless there are specific risk factors 2
• Risk factors warranting closer monitoring include:
  • Maternal vitamin B12 deficiency (especially in vegetarian/vegan mothers) 3
  • Gastrointestinal disorders affecting absorption 1
  • Prolonged parenteral nutrition without adequate supplementation 1

Clinical Implications of Deficiency

• Vitamin B12 deficiency in neonates can lead to:
  • Hematologic abnormalities (megaloblastic anemia) 3, 4
  • Neurological manifestations that may become irreversible if not treated 3
  • Developmental delays 4

Important Cautions

• Folic acid supplementation can mask vitamin B12 deficiency and should not be given without ensuring adequate vitamin B12 status 3
• Vitamin B12 requirements are increased during pregnancy and lactation, which can affect neonatal stores 3
• Infants of vegetarian mothers who are exclusively breastfed may be at higher risk of deficiency, even if mothers are asymptomatic 3

By following these evidence-based dosing recommendations, clinicians can ensure adequate vitamin B12 supplementation for neonates in the ICU setting, preventing deficiency while avoiding excessive dosing.