For how many months are multivitamin (multiple vitamins) drops recommended for preterm newborn babies?

Duration of Multivitamin Supplementation in Preterm Infants

Preterm infants with very low birth weight (<1500g) should receive multivitamin supplementation until they reach at least 2000 grams body weight or achieve a caloric intake of 300 kcal/day, which typically occurs at 2-4 months post-discharge. 1

Evidence-Based Duration Guidelines

For Very Low Birth Weight Infants (<1500g)

• The most specific recommendation states that multivitamin supplementation should continue until preterm infants reach 2000 grams body weight OR 300 kcal/day caloric intake, whichever comes first 1
• This weight-based endpoint is more clinically relevant than a fixed time duration, as preterm infants have highly variable growth trajectories 1

Physiological Rationale for Extended Supplementation

• Preterm infants are born with critically low body stores of fat-soluble vitamins due to limited placental transfer in the third trimester 2
• Very low birth weight infants (<1500g) have less adaptive capacity to vitamin variations compared to term infants, making them particularly vulnerable to deficiencies 3
• Active placental transfer of water-soluble vitamins is interrupted prematurely, and since these vitamins are not stored, levels fall rapidly after birth 4

Specific Vitamin Requirements During Supplementation Period

Parenteral Nutrition Phase

When preterm infants require parenteral nutrition, they need daily administration of:

• Vitamin A: 700-1500 IU/kg/day 2
• Vitamin D: 200-1000 IU/day (or 40-150 IU/kg/day) 2
• Vitamin E: 2.8-3.5 mg/kg/day (not exceeding 11 mg/day) 2
• Vitamin C: 15-25 mg/kg/day 2
• Vitamin K: 10 μg/kg/day 2
• B vitamins: Weight-based dosing as specified in guidelines 2

Enteral/Oral Supplementation Phase

• Once transitioned to enteral feeds, continue multivitamin drops at pediatric-specific formulations 5
• Vitamin D supplementation (400 IU/day) should continue for all breastfed infants regardless of gestational age at birth 5, 6

Critical Safety Considerations

Product Selection

• Never use adult multivitamin formulations in preterm infants - they contain propylene glycol and polysorbate additives that are potentially toxic 2, 5
• Use only neonatal-specific parenteral multivitamin preparations designed for preterm infants 5
• Pediatric multivitamin drops at recommended doses are safe and do not cause adverse effects like diarrhea 3

Administration Best Practices

• Add vitamins to lipid emulsions whenever possible to increase stability and reduce losses, particularly for vitamin A 2, 5
• Administer vitamins daily when on parenteral nutrition 2, 5
• Routine monitoring of vitamin concentrations (except vitamin D) is not recommended unless on long-term parenteral nutrition 2, 5

Common Clinical Pitfalls to Avoid

• Do not discontinue supplementation based solely on chronological age - use weight and caloric intake as endpoints instead 1
• Do not assume formula-fed preterm infants receive adequate vitamins - most standard formulas are designed for term infants and may not meet preterm needs until adequate volumes are consumed 6, 1
• Do not overlook vitamin D supplementation after discharge - continue 400 IU/day for breastfed infants even after multivitamin drops are discontinued 5, 6
• Avoid extremely concentrated high-dose vitamin D drops that could lead to accidental toxicity 6

Post-Discharge Considerations

• Ninety percent of premature babies have nutritional deficiency at discharge, making continued supplementation critical 7
• Growth, neurodevelopmental outcome, and quality of life depend on adequate nutritional supply with essential nutrients including vitamins 7
• Oral supplementation of vitamin D should be considered during weaning from parenteral nutrition 2