Iglesias-Platas Isabel, Sobczyńska-Malefora Agata, Ponnusamy Vennila, Mahaveer Ajit, Voong Kieran, Nichols Amy, Dockery Karen, Holland Nicky, Mulla Shaveta, Shearer Martin J, Card David, Hall Lindsay J, Harrington Dominic J, Clarke Paul
Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK.
Nutristasis Unit, Synnovis, Guy's and St. Thomas' Hospital NHS Trust, London SE1 7EH, UK.
Nutrients. 2024 Dec 6;16(23):4220. doi: 10.3390/nu16234220.
Adequate folate intake is required in preterm infants for rapid growth and development, but there is little evidence to back recommendations. We aimed to assess folate status in preterm infants at discharge and in early infancy, according to exposure to folate sources, particularly in those exclusively/predominantly breastfed. A prospective, multicenter, observational cohort study was conducted in the UK, involving 45 preterm infants <33 weeks' gestational age (GA) exclusively/predominantly fed human milk when approaching NICU (Neonatal Intensive Care Unit) discharge. Serum folate levels were measured near NICU discharge (T1) and at 2-3 months corrected age (T2). Folate status was categorized per WHO (World Health Organization) guidelines: deficiency (<6.8 nmol/L), possible deficiency (6.8-13.4 nmol/L), normal (13.5-45.3 nmol/L), and elevated (>45.3 nmol/L). Nutritional information on feed and supplements was collected from hospital notes and maternal interviews. Thirty-two infants (71%) received parenteral nutrition. Twelve infants (32%) remained exclusively breastfed at T2. No infant from the whole cohort had a serum folate concentration <13.5 nmol/L at either time point. A proportion of infants had serum folate concentrations >45.3 nmol/L: 14/45 (31%) at T1, 19/37 (42%) at T2, and 7/37 (16%) at both time points. Elevated concentrations were seen particularly in infants who received folic acid supplements or nutrition containing folic acid, such as parenteral nutrition and breastmilk fortifiers. Folate deficiency was not observed in this cohort; folate concentrations were high and in line with those observed in healthy term infants. Further research is needed to assess the high folate concentrations in premature babies and whether they may have any adverse clinical impact.
早产婴儿的快速生长和发育需要充足的叶酸摄入，但几乎没有证据支持相关建议。我们旨在根据叶酸来源情况，评估早产婴儿出院时及婴儿早期的叶酸状况，尤其是那些纯母乳喂养/以母乳喂养为主的婴儿。在英国进行了一项前瞻性、多中心观察性队列研究，纳入45名胎龄<33周的早产婴儿，在接近新生儿重症监护病房（NICU）出院时纯母乳喂养/以母乳喂养为主。在NICU出院时（T1）和矫正年龄2 - 3个月时（T）测量血清叶酸水平。根据世界卫生组织（WHO）指南对叶酸状况进行分类：缺乏（<6.8 nmol/L）、可能缺乏（6.8 - 13.4 nmol/L）、正常（13.5 - 45.3 nmol/L）和升高（>45.3 nmol/L）。从医院记录和对母亲的访谈中收集有关喂养和补充剂的营养信息。32名婴儿（71%）接受了肠外营养。12名婴儿（32%）在T2时仍纯母乳喂养。整个队列中没有婴儿在任何一个时间点血清叶酸浓度<13.5 nmol/L。一部分婴儿血清叶酸浓度>45.3 nmol/L：T1时为14/45（31%），T2时为19/37（42%），两个时间点均为7/37（16%）。血清叶酸浓度升高尤其见于接受叶酸补充剂或含叶酸营养物（如肠外营养和母乳强化剂）的婴儿。该队列中未观察到叶酸缺乏；叶酸浓度较高，与健康足月儿观察到的浓度一致。需要进一步研究来评估早产婴儿中叶酸浓度较高的情况以及它们是否可能有任何不良临床影响。
